Risk Stratification Tools to Guide a Personalized Approach for Cardiac Monitoring in Embolic Stroke of Undetermined Source

Abstract

Current recommendations support a personalized sequential approach for cardiac rhythm monitoring to detect atrial fibrillation after embolic stroke of undetermined source. Several risk stratification scores have been proposed to predict the likelihood of atrial fibrillation after embolic stroke of undetermined source. This systematic review aimed to provide a comprehensive overview of the field by identifying risk scores proposed for this purpose, assessing their characteristics and the cohorts in which they were developed and validated, and scrutinizing their predictive performance. We identified 11 risk scores, of which 4 were externally validated. The most frequent variables included were echocardiographic markers and demographics. The areas under the curve ranged between 0.70 and 0.94. The 3 scores with the highest area under the curve were the Decryptoring (0.94 [95% CI, 0.88–1.00]), newly diagnosed atrial fibrillation (0.87 [95% CI, 0.79–0.94]), and AF‐ESUS (Atrial Fibrillation in Embolic Stroke of Undetermined Source) (0.85 [95% CI, 0.80–0.87]), of which only the latter was externally validated. Risk stratification scores can guide a personalized approach for cardiac rhythm monitoring after embolic stroke of undetermined source.

Clinical practice of continuous rhythm monitoring after embolic stroke of undetermined source

“…Recognizing the need for better patient selection prior to ICM implantation the European Society of Cardiology has suggested the use of risk scores to select patients with cryptogenic stroke at high-risk of AF prior to ICM-implantation [ 20 , 21 ]. One example is the HAVOC score introduced by Elkind and colleagues in 2021 [ 13 ].…”