Insertable cardiac monitors for detection of atrial fibrillation after cryptogenic stroke: a meta-analysis

Lü, Yue; Diao, Shanshan; Huang, Shuangjiao; Zhao, Jie-Ji; Ye, Meng-Fan; Yao, Fei; Kong, Yan; Xu, Zai‐Quan

doi:10.1007/s10072-021-05104-6

Cited by 11 publications

(11 citation statements)

References 39 publications

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“…Insertable cardiac monitors (ICMs) are the tools with highest sensitivity and specificity for identifying AF in patients with cryptogenic stroke, significantly more effective than any of the intermittent monitoring strategies. Depending on the definition of episode duration, monitoring duration, and the amount and type of screening performed before device implantation, the incidence of AF detected by ICMs ranges from 16% to 34% 9 …”

Section: Occult Atrial Fibrillation—look Longer and Use More Sophisti...mentioning

confidence: 99%

“…Depending on the definition of episode duration, monitoring duration, and the amount and type of screening performed before device implantation, the incidence of AF detected by ICMs ranges from 16% to 34%. 9 This benefit must be balanced against larger costs due to the ICMs use, so more personalized strategies are needed. Identifying new biomarkers to help selecting patients with the highest possibility of detecting AF by prolonged monitoring may be a useful tool.…”

Section: O Ccult Atrial Fib Rill Ati On-look Long Er and Us E More So...mentioning

confidence: 99%

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Cryptogenic stroke and TIA: Suggested diagnostic approach while waiting for evaluation and treatment guidelines

Ratajczak-Tretel

Lambert

Atar

et al. 2022

Acta Neuro Scandinavica

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The etiology of approximately one third of ischemic strokes remains undetermined, resulting in their classification as cryptogenic. 1 One sixth meet the definition of embolic stroke of undetermined source (ESUS). 2 The category cryptogenic is heterogeneous and includes cases with unknown etiology, where two or more competing causes are possible, or where the investigation is incomplete. ESUS occurs in the absence of lacunar infarcts, significant stenosis in pre-and cerebral arteries, or cardiac conditions with high risk of embolism, such as atrial fibrillation. Treatment is challenging: it is unknown whether standard secondary prevention provides sufficient protection against recurrence in all cases, while an empiric strategy of routinely administered anticoagulation appears to be both harmful

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Section: Occult Atrial Fibrillation—look Longer and Use More Sophisti...mentioning

confidence: 99%

Section: O Ccult Atrial Fib Rill Ati On-look Long Er and Us E More So...mentioning

confidence: 99%

Cryptogenic stroke and TIA: Suggested diagnostic approach while waiting for evaluation and treatment guidelines

Ratajczak-Tretel

Lambert

Atar

et al. 2022

Acta Neuro Scandinavica

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“…Eine Übersicht über das Design und die Ergebnisse relevanter Kohortenstudien und randomisierter Studien unter Einschluss von Schlaganfallpatienten findet sich in einem Positionspapier der Arbeitsgemeinschaft „Herz und Hirn“ der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V. (DGK) und DSG, das in Zusammenarbeit mit der Stroke-Unit-Kommission der DSG und dem AFNET e. V. erstellt wurde 5 . Zudem sei in diesem Kontext auf die Publikation der IDEAS-Studie und Metaanalysen zur Datenlage verwiesen 6 , 7 , 10 . Auf die im letzten Jahr im Fachblatt Lancet Neurology veröffentlichten Ergebnisse der randomisierten MonDAFIS-Studie wird im nachfolgenden Absatz im Detail eingegangen 11 , 12 .…”

Section: Datenlageunclassified

“…Bei etwa 4-13 % aller Schlaganfallpatienten findet sich im Rahmen des akutstationären Aufenthalts hingegen erstmals ein nicht diagnostiziertes VHF [3]. Der Nachweis eines initial nur intermittierend auftretenden und häufig klinisch asymptomatischen VHFs stellt jedoch eine diagnostische Herausforderung dar und korreliert mit der Qualität der EKG-Auswertung, der Dauer des EKG-Monitorings und der Patientenauswahl [4][5][6][7].…”

Section: Introductionunclassified

Detektion von Vorhofflimmern nach akutem ischämischem Schlaganfall

Häusler¹,

Kirchhof²,

Endres³

2022

Nervenheilkunde

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ZUSAMMENFASSUNGFür die diagnostische Abklärung nach einem akuten ischämischen Schlaganfall wird gemäß Leitlinien eine kontinuierliche und qualitativ hochwertige EKG-Ableitung zum erstmaligen Nachweis eines Vorhofflimmerns (VHF) empfohlen. Bei etwa 15–20 % aller ischämischen Schlaganfälle findet sich VHF, das regelhaft eine Indikation für eine Sekundärprävention mittels oraler Antikoagulation begründet. Welche Schlaganfallpatienten einem verlängerten EKG-Monitoring unterzogen werden sollten, basiert vornehmlich auf Expertenkonsens unter Berücksichtigung klinischer, laborchemischer, echo- und elektrokardiografischer Parameter. Zudem sind die optimale Dauer und (Kosten-)Effizienz eines verlängerten EKG-Monitorings für die Sekundärprävention des Schlaganfalls noch unklar. Neben einer kurzen Darstellung der Datenlage stellen die Autoren (stellvertretend für das Scientific Board der Studie) die Ergebnisse der „Impact of standardized MONitoring for Detection of Atrial Fibrillation in Ischemic Stroke (MonDAFIS)“ Studie dar und geben Empfehlungen für die tägliche Praxis.

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“…From a neurologist’s perspective, recognizing the characteristics of aPL-stroke may be advantageous for reducing cryptogenic stroke. Great effort has been focused on finding occult atrial fibrillation (AF) in the diagnosis of cryptogenic stroke, and AF is reportedly detected in 25% of patients with cryptogenic stroke 5 . However, the underlying etiologies of cryptogenic stroke can be diverse, and aPL-stroke may also be an underestimated cause.…”

Section: Introductionmentioning

confidence: 99%

Neuroimaging features of antiphospholipid antibody-related stroke compared with atrial fibrillation-related stroke

Yang

Kang

Kim

et al. 2022

Sci Rep

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Recognizing the lesion pattern of antiphospholipid antibody-related stroke (aPL-stroke) may contribute to establishing the cause in patients with cryptogenic stroke. We aimed to describe the neuroimaging features of aPL-stroke compared with atrial fibrillation-related stroke (AF-stroke), a major hidden cause of cryptogenic stroke. Using a prospective stroke registry, we identified consecutive aPL- and AF-stroke patients without other potential causes of stroke. Neuroimaging features based on diffusion-weighted imaging and angiographic findings at admission were compared. A total of 56 and 333 patients were included in the aPL- and AF-stroke groups, respectively. aPL-stroke patients more often presented with single small lesions (aPL-stroke, 30.4% vs. AF-stroke, 7.5%, p < 0.001), while the predominant pattern in AF-stroke patients was large territorial lesions (26.8% vs. 56.5%, p < 0.001). aPL-stroke patients had smaller infarct volume (1.58 mL [0.45; 9.41] vs. 11.32 mL [2.82; 33.08], p < 0.001) and less experience of relevant artery occlusion (17.9% vs. 54.7%, p < 0.001). The proportion of multi-territory lesions, an embolic pattern, was similar between the two groups (28.6% vs. 22.8%, p = 0.44). In comparison only including patients with multi-territory lesions as well, aPL-stroke patients showed small lesion dominance and smaller infarct volume. Multivariate analyses showed independent associations between mild neuroimaging features (small lesion prevalence, smaller infarct volume, and absence of relevant artery occlusion) and aPL-stroke. Patterns of small lesion prevalence, small infarct volume, and absence of relevant artery occlusion were suggestive of aPL-stroke rather than AF-stroke. Cryptogenic stroke patients with such neuroimaging features may benefit from aPL testing for a precise diagnosis.

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Insertable cardiac monitors for detection of atrial fibrillation after cryptogenic stroke: a meta-analysis

Cited by 11 publications

References 39 publications

Cryptogenic stroke and TIA: Suggested diagnostic approach while waiting for evaluation and treatment guidelines

Cryptogenic stroke and TIA: Suggested diagnostic approach while waiting for evaluation and treatment guidelines

Detektion von Vorhofflimmern nach akutem ischämischem Schlaganfall

Neuroimaging features of antiphospholipid antibody-related stroke compared with atrial fibrillation-related stroke

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