Paroxysmal Atrial Fibrillation in Cryptogenic Stroke: A Case–Control Study

Rabinstein, Alejandro A.; Fugate, Jennifer E.; Mandrekar, Jay; Burns, Joseph D.; Seet, Raymond C.S.; Dupont, Stefan A.; Kauffman, Timothy J.; Asirvatham, Samuel J.; Friedman, Paul A.

doi:10.1016/j.jstrokecerebrovasdis.2013.05.013

Cited by 51 publications

(48 citation statements)

References 26 publications

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“…Another theory is that AF is not a direct consequence of mechanical dysfunction; fibrosis and inflammation cause atrial dysfunction and the myopathic process, resulting in AF. According to this hypothesis, there isn't a temporal relationship between thromboembolic events and arrhythmia (12). This hypothesis is supported by the TRENDS study findings (17).…”

Section: Discussionmentioning

confidence: 68%

“…The present findings are similar to those of some earlier studies. Alhadramy et al (11) reported that the frequency of PAF was 10% and that in 72% of the cases PAF duration was <30 s. Rabinstein et al (12) observed a PAF frequency of 19.5% and that 80% of the cases had PAF duration <30 s. Khan et al (13) reported a PAF frequency of 15% and that 65% of the cases had PAF duration <30 s.…”

Section: Discussionmentioning

confidence: 99%

“…Newer guidelines did not focus on the treatment approaches for the episodes <30 s in duration. Rabinstein et al (12) reported that attacks of asymptomatic PAF frequently occur during the post-stroke period in elderly patients, but that there is no consensus concerning whether or not anticoagulant treatment should be used. Khan et al (13) reported that cardiologists prefer to use anticoagulation for PAF >30 s PAF twice more; however, there was no difference in the preferences of non-cardiologists, according to the duration of PAF.…”

Section: Discussionmentioning

confidence: 99%

“…Holter monitorization (HM) and other monitorization methods are used to detect PAF in stroke patients (7). The PAF detection rate is reported to be 2%-25% (8,9,10,11,12,13). The primary cause for this variability is differences between methods and the definition of PAF.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Holter Monitorisation Results in Early Period of Acute Ischemic Stroke

Günaydın¹,

Baştan²,

Acar³

et al. 2017

Arch Neuropsychiatr

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Introduction: Paroxysmal atrial fibrillation (PAF) has a similar risk with persistent AF for ischemic stroke. Holter monitorization (HM) and other long-term monitorization methods increased the detection of PAF and short-lasting runs of tachyarrhythmias. Their classification as PAF and roles in the etiology of ischemic stroke is controversial. In this study, we aimed to investigate the frequency of any duration of PAF and clinical characteristics of the patients with acute ischemic stroke who have undergone 24-hrs HM.Methods: Patients with acute ischemic stroke and transient ischemic attack (TIA) hospitalized in the Neurology ward and undergone 24-hrs of HM during their hospital stay were included in the study. HM reports, clinical, and laboratory characteristics were analyzed, retrospectively. Patients were grouped into three based on HM: 1st group, without PAF; 2nd group, PAF >30 seconds (s) and 3rd group, PAF<30s.Results: PAF of any duration was detected in 18.8% (n=49) of 261 patients. The duration of PAF was <30s in 16.1% (n=42) and >30s in 2.7% (n=7) of the patients. The mean age, left atrium diameter and CHA2DS2-VASc scores of the second group were significantly higher than the first group (p<0.001, p<0.001 and p=0.007; respectively). The mean age, left atrium diameter, modified Rankin Scores (mRS), and CHA2DS2-VASc scores of the third group were significantly higher than the first group (p<0.001; for all). There was no difference between the second and the third groups in means of mean age, left atrial diameter, MRS, and CHA2DS2-VASc scores (p<0.017, for all). Conclusion:In this study, 24-hrs HM in the early period of acute ischemic stroke results yielded a high frequency of PAF<30s and predictive features were in parallel with the literature.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Holter Monitorisation Results in Early Period of Acute Ischemic Stroke

Günaydın¹,

Baştan²,

Acar³

et al. 2017

Arch Neuropsychiatr

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show abstract

“…Recent investigations have recommended that the use of short time intervals such as five seconds may be sufficient for the detection of AF due to increased risk of stroke [17][18][19]…”

Section: Introductionmentioning

confidence: 99%

Atrial Fibrillation Analysis for Real Time Patient Monitoring

Aliami

Stranieri

Marzbanrad

et al. 2017

Computing in Cardiology Conference (CinC)

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Effect of Long-term Continuous Cardiac Monitoring vs Usual Care on Detection of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease

Bernstein

Kamel

Granger

et al. 2021

JAMA

122

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IMPORTANCEPatients with ischemic stroke attributed to large-or small-vessel disease are not considered at high risk for atrial fibrillation (AF), and the AF incidence rate in this population is unknown.OBJECTIVES To determine whether long-term cardiac monitoring is more effective than usual care for AF detection in patients with stroke attributed to large-or small-vessel disease through 12 months of follow-up. DESIGN, SETTING, AND PARTICIPANTSThe STROKE-AF trial was a randomized (1:1), multicenter (33 sites in the US) clinical trial that enrolled 496 patients between April 2016 and July 2019, with primary end point follow-up through August 2020. Eligible patients were aged 60 years or older or aged 50 to 59 years with at least 1 additional stroke risk factor and had an index stroke attributed to large-or small-vessel disease within 10 days prior to insertable cardiac monitor (ICM) insertion.INTERVENTIONS Patients randomized to the intervention group (n = 242) received ICM insertion within 10 days of the index stroke; patients in the control group (n = 250) received site-specific usual care consisting of external cardiac monitoring, such as 12-lead electrocardiograms, Holter monitoring, telemetry, or event recorders. MAIN OUTCOMES AND MEASURESIncident AF lasting more than 30 seconds through 12 months. RESULTS Among 492 patients who were randomized (mean [SD] age, 67.1 [9.4] years; 185 [37.6%] women), 417 (84.8%) completed 12 months of follow-up. The median (interquartile range) CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age Ն75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category) score was 5 (4-6). AF detection at 12 months was significantly higher in the ICM group vs the control group (27 patients [12.1%] vs 4 patients [1.8%]; hazard ratio, 7.4 [95% CI, 2.6-21.3]; P < .001). Among the 221 patients in the ICM group who received an ICM, 4 (1.8%) had ICM procedure-related adverse events (1 site infection, 2 incision site hemorrhages, and 1 implant site pain).CONCLUSIONS AND RELEVANCE Among patients with stroke attributed to large-or small-vessel disease, monitoring with an ICM compared with usual care detected significantly more AF over 12 months. However, further research is needed to understand whether identifying AF in these patients is of clinical importance.

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Paroxysmal Atrial Fibrillation in Cryptogenic Stroke: A Case–Control Study

Cited by 51 publications

References 26 publications

Holter Monitorisation Results in Early Period of Acute Ischemic Stroke

Holter Monitorisation Results in Early Period of Acute Ischemic Stroke

Atrial Fibrillation Analysis for Real Time Patient Monitoring

Effect of Long-term Continuous Cardiac Monitoring vs Usual Care on Detection of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease

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