Detection of paroxysmal atrial fibrillation with transtelephonic EKG in TIA or stroke patients

Gaillard, Nicolas; Deltour, Sandrine; Vilotijevic, B.; Hornych, A; Crozier, Sophie; Léger, A.; Frank, Richard G.; Samson, Yves

doi:10.1212/wnl.0b013e3181e0427e

Cited by 110 publications

(81 citation statements)

References 12 publications

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“…31 Recent technological advances have made it possible to perform long-term cardiac rhythm monitoring up to months or even years after a stroke. 32 When compared with 24-hour Holter monitoring, higher yield of AF detection with in-hospital [33][34][35][36][37] and outpatient telemonitoring, [38][39][40][41] and more recently implantable loop recorder, [42][43][44][45][46] has been reported. However, the yield varied greatly depending on the study population (age and stroke subtypes), interval of monitoring from stroke onset, duration of monitoring, and the definition of AF, as well as the choice of monitoring devices (Figure 2).…”

Section: Monitoring and Imaging Techniques For Paroxysmal Afmentioning

confidence: 99%

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Bang

Ovbiagele

Kim

2014

Stroke

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Section: Monitoring and Imaging Techniques For Paroxysmal Afmentioning

confidence: 99%

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Bang

Ovbiagele

Kim

2014

Stroke

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“…[36][37][38][39][40][41][42] Several key factors such as patient age, the duration of the minimum AF episode, and follow-up duration are provided to help put these results into context. increased risk of all-cause mortality and stroke.…”

Section: Study Design-related Factorsmentioning

confidence: 99%

Detection and management of atrial fibrillation after cryptogenic stroke or embolic stroke of undetermined source

Sanna

Ziegler

Crea

2018

Clinical Cardiology

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Cryptogenic stroke (CS) and embolic stroke of unknown source (ESUS) represent a major challenge to healthcare systems worldwide. Atrial fibrillation (AF) is commonly found after CS or ESUS. Independent of the mechanism of the index CS or ESUS, detection of AF in these patients offers the opportunity to reduce the risk of stroke recurrence by prescribing an anticoagulant instead of aspirin. The detection of AF may be pursued with different monitoring strategies. Comparison of monitoring strategies should take into account that AF detection rates reported in published studies, and then pooled in meta-analyses, are not only a function of the monitoring strategy itself, but also depend on patient-related, device-related, and study design-related factors. Once AF is found, the decision to anticoagulate a patient should be made on the basis of AF burden and the baseline risk of the patient. Empirical anticoagulation in patients with ESUS and no evidence of AF is an intriguing but still-unproven strategy and therefore should not be adopted outside of randomized clinical trials.Each year, >790 000 people experience a new or recurrent stroke in the United States. 1 The cause of ischemic stroke remains undetermined after hospitalization in 10% to 40% of cases; this is often referred to as "cryptogenic" stroke (CS). 2 Differences in the definition and diagnostic workup contribute to this variable incidence in published series. To mitigate this limitation, the term "embolic stroke of undetermined source" (ESUS) has recently been proposed to identify those cases where the etiology of nonlacunar ischemic stroke remains elusive after a standardized diagnostic pathway. 3 The prevalence of ESUS was 16% to 32% in a recently published series. 4 Hence, even after a standardized comprehensive evaluation, the cause of ischemic stroke remains elusive in a significant proportion of patients, thus representing a major challenge for treatment selection. | STROKE RECURRENCE IN PATIENTS WITH PRIOR CS AND ESUSIn a recent study, patients with CS had an ischemic stroke recurrence rate of 9.1% (range, 6.2%-12.0%), 24.0% (range, 19.1%-28.9%), and 31.9% (range, 25.2%-38.6%) at 1, 5, and 10 years, respectively. 5 Recurrent stroke in these patients was classified again as cryptogenic in 63% of cases. 5 Stroke recurrence rate in ESUS was also reported to be high and similar to CS. 6 Possible causes of stroke recurrence, irrespective of the mechanism of the index stroke, are paroxysmal atrial fibrillation (AF), arterial sources of thromboembolism (TE), patent foramen ovale (PFO), cardiac structural abnormalities, and other less common etiologies. Detection of AF after a CS or ESUS does not imply causality but still offers an opportunity for reducing the risk of stroke recurrence by prescribing oral anticoagulation (OAC). However, AF is often asymptomatic, paroxysmal, and difficult to detect with conventional tools. Several monitoring strategies have been investigated to detect asymptomatic AF after an ischemic stroke, including electrocardiography (...

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“…For example, long-term continuous electrocardiographic monitoring or 30-day event recorders show a 9-23% detection rate of occult AF among those without known AF or with previously diagnosed cryptogenic stroke [28][29][30].…”

Section: Evaluation Of Patients At Risk For Cardioembolic Strokementioning

confidence: 99%

Prevention of Cardioembolic Stroke

Freeman

Aguilar

2011

Neurotherapeutics

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Cardiac causes of ischemic stroke lead to severe neurological deficits from large intracranial artery occlusion compared to small vessel ischemic stroke. The most common cause of cardioembolic stroke is atrial fibrillation (AF), which has an increasing incidence with age. AF stroke trials demonstrate that anti-coagulation is superior to anti-platelet therapy in terms of ischemic stroke prevention. Recently, warfarin was compared with dabigatran, an oral, direct thrombin inhibitor, and was found to be at least equally effective in reducing ischemic stroke with less intracranial bleeding risk. Future research is investigating other direct thrombin inhibitors as potential alternatives to warfarin, which has a narrow therapeutic index, requires frequent blood monitoring, has multiple drug interactions, and a higher rate of intracranial bleeding. Other causes of cardioembolic stroke include myocardial infarction, left ventricular thrombus, reduced ejection fraction, valvular abnormalities, and endocarditis. Patent foramen ovale is a common finding on echocardiograms in patients with and without stroke (up to 20% of the population), and it is a controversial source of cryptogenic stroke. The best way to prevent cardioembolic stroke remains early detection and treatment of AF, and treating the underlying stroke mechanism. Cardiac magnetic resonance imaging is an emerging technology and reveals some sources of cardiac embolism missed by echocardiography, and might provide an additional diagnostic tool in investigating cardioembolic stroke.

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Detection of paroxysmal atrial fibrillation with transtelephonic EKG in TIA or stroke patients

Abstract: Transtelephonic EKG monitoring increases detection rate of paroxysmal atrial fibrillation in stroke and TIA patients whose 24-hour Holter result was negative, especially if they had frequent premature atrial ectopic beats, recent anterior circulation infarct on MRI, or both.

Cited by 110 publications

References 12 publications

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Detection and management of atrial fibrillation after cryptogenic stroke or embolic stroke of undetermined source

Prevention of Cardioembolic Stroke

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