Detection of Atrial Fibrillation in Cryptogenic Stroke
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Purpose of Review
To summarize the literature on the detection of atrial fibrillation (AF) in patients with “cryptogenic” stroke, a cohort including about 25% of all ischemic stroke patients and patients with embolic stroke of undetermined source (ESUS).
A first episode of AF is detected in up to one third of cryptogenic stroke and in up to one fourth of ESUS patients during long-term monitoring. AF prevalence correlates to patient selection, duration, and quality of ECG monitoring. Higher rates of AF were reported in stroke patients with left atrial pathology, specific ECG alterations, or increased natriuretic peptides. While AF detection impacts on medical stroke prevention in the vast majority of patients, patient selection for prolonged monitoring is largely left at the physician’s discretion.
AF detection after cryptogenic stroke or ESUS is a frequent, potentially causal condition. Whether subsequent oral anticoagulation may improve outcome remains open.
KeywordsIschemic stroke Atrial fibrillation ECG monitoring Stroke unit Cryptogenic stroke Embolic stroke of undetermined source
Compliance with Ethical Standards
Conflict of Interest
Karl Georg Haeusler has received grants and personal fees from Bayer and Sanofi, personal fees from Boehringer Ingelheim, Daiichi-Sankyo, Pfizer, BMS, Medtronic, EIP Pharma, Edwards Lifesciences, and non-financial support from Getemed.
Serdar Tütüncü has received lecture fees from DTN-Kompakt (meeting/conference).
Renate B. Schnabel has received a grant from the European Research Council, and personal fees from BMS/Pfizer and the German Cardiac Society.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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