Atrial Fibrillation Detection and Load: Knowledge Gaps Related to Stroke Prevention

Abstract

Atrial fibrillation is a major cause of ischemic stroke. Technological advances now support prolonged cardiac rhythm monitoring using either surface electrodes or insertable cardiac monitors. Four major randomized controlled trials show that prolonged cardiac monitoring detects subclinical paroxysmal atrial fibrillation in 9% to 16% of patients with ischemic stroke, including in patients with potential alternative causes such as large artery disease or small vessel occlusion; however, the optimal monitoring strategy, including the target patient population and the monitoring device (whether to use an event monitor, insertable cardiac monitor, or stepped approach) has not been well defined. Furthermore, the clinical significance of very short duration paroxysmal atrial fibrillation remains controversial. The relevance of the duration of monitoring, burden of device-detected atrial fibrillation, and its proximity to the acute ischemic stroke will require more research to define the most effective methods for stroke prevention in this patient population.

Cardioembolic Stroke: Past Advancements, Current Challenges, and Future Directions

“…In contrast, in patients with a relatively low risk of stroke (e.g., low CHA2DS2-VASc score), screening may be conducted with a sequential step-up strategy. This strategy has demonstrated an increase in the detection rate of new AF in patients with ischemic cerebral infarction: 7.7% on admission, 5.1% during hospitalization, 10.7% at the first outpatient visit, 16.9% at the second with ECG or ILR [ 24 ].…”