Score for the Targeting of Atrial Fibrillation: A New Approach to Diagnosing Paroxysmal Atrial Fibrillation

Abstract

Background and Purpose: Detecting paroxysmal atrial fibrillation (PAF) after ischaemic stroke is challenging. There are several methods to increase the detection rate of PAF, but it is first necessary to identify subgroups of patients at risk. In a previous study, we established a clinicoradiologic score that predicts atrial fibrillation (AF) in stroke patients. The purpose of the present study is to validate this score specifically for PAF patients. Methods: 500 consecutive ischaemic stroke patients were examined in our stroke unit. A blind evaluation of the STAF (score for the targeting of atrial fibrillation) was performed for each patient with or without AF. Firstly, we established the reproducibility of the STAF performance by comparing areas under the receiver operating characteristic curves in the preliminary and present studies. Secondly, to validate the predictive value of the STAF in occult AF, areas under the receiver operating characteristic curves were compared for each type of AF. Thirdly, the best threshold value was calculated. Results: AF was detected in 145 cases including 45% of paroxysmal forms. There is no significant score performance difference (p = 0.192) between the preliminary and prospective cohort areas under the receiver operating characteristic curves. This confirms the reproducibility of STAF performance. The area under the receiver operating characteristic curve for the PAF group was 0.907 versus 0.911 for the permanent AF group (p = 0.906). The diagnostic value of the STAF is as good in permanent as paroxysmal AF. In PAF, a STAF ≧5 has a sensitivity of 91% and a specificity of 77%. Conclusions: Due to its reproducibility and predictive value, the STAF can be used by neurologists as part of a novel diagnostic strategy for occult AF.

Slow Sinus Heart Rate as a Potential Predictive Factor of Paroxysmal Atrial Fibrillation in Stroke Patients

“…In clinical practice, we should first identify patients with a high possibility of latent PAF and then conduct intensive investigations on them. Other strategies to detect high-risk patients have been proposed such as the automated screening algorithm for PAF [17], score for the targeting of AF [18,19] or detection of premature atrial beats [20]. These different schemes might be combined in the future.…”

Stroke unit treatment: long-term effects

“…Whereas the use of anticoagulant medication in the acute phase has not y et b een investigated, prestroke optimal anticoagulation is associated with better in-hospital outcome and outcome after 2 years in comparison to aspirin medication, suboptimal anticoagulation or no therapy [21]. In cases of further indication of paroxysmal atrial fibrillation, e.g., a high STAF-Index (Score for Targeting of Atrial Fibrillation) [23], the detection rate can be considerably increased by permanent recording over weeks and months after stroke, as has been shown by the Cristal AF and Embrace studies [19,24].…”

Prolonged Cardiac Monitoring for Detection of Paroxysmal Atrial Fibrillation After Cerebral Ischemia

“…Several risk factors have been reported (Table 3), and some risk-stratification scores have been proposed. 22,[41][42][43][44][45][46][47] Older age is the factor most consistently associated with higher risk of AF, and this risk increases with the accumulation of vascular risk factors and in patients with documented vascular disease. Thus, most patients with stroke already have some of the main risk factors for AF.…”

“…Yet, findings on brain imaging (embolic pattern), 41,42 ECG/Holter (frequent premature atrial complexes), 22,29,43 and echocardiography (left atrial dilatation on transthoracic and perhaps reduced left atrial appendage ejection fraction on transesophageal echocardiogram) can help stratify the risk further. 22,[45][46][47] It is reasonable to restrict prolonged ambulatory cardiac rhythm monitoring to patients with stroke deemed cyptogenic after a comprehensive evaluation and an embolic pattern on brain imaging (multiterritorial or single cortical-subcortical infarctions). Monitoring should be initiated early after the cerebrovascular event to maximize the detection yield.…”