Device-detected atrial fibrillation and risk for stroke: an analysis of &gt;10 000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices)

Boriani, Giuseppe; Glotzer, Taya V.; Santini, Massimo; West, Teena; Melis, Mirko De; Sepši, Milan; Gasparini, Maurizio; Lewalter, Thorsten; Camm, John; Singer, Daniel E.

doi:10.1093/eurheartj/eht491

Cited by 392 publications

(300 citation statements)

References 22 publications

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“…Ryzyko udaru u pacjentów z AHRE wydaje się mniejsze niż u pacjentów z rozpoznaniem AF i nie wszystkie epizody AHRE oznaczają AF [142]. Udary mózgu często występują również u pacjentów, u których nie stwierdza się AHRE w ciągu 30 dni poprzedzających wystąpienie udaru [143][144][145][146][147]. W rezultacie nie jest jasne, czy AHRE wiążą się z tymi samymi wymogami terapeutycznymi, co jawne AF [148], a korzyści z OAC u pacjentów z AHRE są oceniane w trwających próbach klinicznych, np.…”

Section: Pacjenci Ze Stymulatorami I Innymi Wszczepionymi Urządzeniamiunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,402

4,206

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Section: Pacjenci Ze Stymulatorami I Innymi Wszczepionymi Urządzeniamiunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,402

4,206

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“…Studies on community screening, 16 in patients with implanted devices, [17][18][19][20][21][22] and after ischemic stroke 14,23 have found that AF is mostly asymptomatic and would therefore remain undetected with monitoring strategies based on symptom-triggered recordings. Monitoring strategies based on algorithm-activated recordings have the potential to detect both symptomatic and asymptomatic AF.…”

Section: Device-related Factorsmentioning

confidence: 99%

“…The threshold for a significant increase of TE risk varied from 5 minutes to 24 hours. [17][18][19][44][45][46][47] It seems reasonable to speculate that the implications of AF burden may be different in patients with different baseline risks, in particular in patients with or without prior stroke. An interesting observation supporting the hypothesis of a multivariable model and the absence of a fixed threshold predictive of increased risk is suggested from a proof-of-concept study in which the risk of stroke or TE events was found to be not only a function of the time spent in AF, but also of the baseline characteristics of the patients.…”

Section: Af Burden and Risk Of Strokementioning

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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“…30 There is some evidence that the amount of arrhythmia in AF patients correlates with thromboembolic risk, but a large study is required to validate this finding. 34 The arrhythmic burden can be quantified with a continuous monitoring system, even though ILR data have shown a good correlation with continuous Holter monitoring. 35,36 Finally, the registration of the beginning of an AF episode with event recorders may help to establish the pathogenic mechanism of the arrhythmia.…”

Section: Holter Monitors and Loop Recorders In Patient Follow-upmentioning

confidence: 99%

Holter Monitoring and Loop Recorders: From Research to Clinical Practice

Galli¹,

Ambrosini²,

Lombardi³

2016

Arrhythmia &Amp; Electrophysiology Review

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Since the 1960s, Holter monitoring has been a cornerstone for diagnosing suspected arrhythmias in patients of all ages. 1 The most common monitoring systems allow the continuous registration of three or more leads for 24-48 hours; newer Holter monitors allow continuous electrocardiogram (ECG) registration for 2 weeks.1 Extending the time of ECG registration will increase the diagnostic yield of Holter monitoring, especially for those rhythm disturbances that are infrequent but recurrent.1,2 This need for a prolonged ECG monitoring has been addressed by event recorders, which can monitor patients for up to 3 years, storing the ECG obtained a few minutes before and after the onset of an arrhythmia in its memory and transmitting data to the cardiac unit. 1,2 When interpreting the results of the ECG, the cardiologist has to determine whether symptoms reported by the patient could be linked to significant disturbances in heart rhythm.2 In other circumstances the detection of atrial or ventricular arrhythmias may alert the cardiologist, even if they occur asymptomatically, thus prompting a specific therapeutic decision such as starting antiarrhythmic or anticoagulant drugs or implanting a pacemaker or a cardioverter defibrillator. Cardiac Monitoring SystemsCardiac rhythm monitoring has an established diagnostic and prognostic role in different circumstances: syncope, palpitations and monitoring of patients with known or suspected episodes of atrial fibrillation (AF), e.g. those with stroke of uncertain aetiology (cryptogenic stroke).1-3 ECG monitoring may also play a role in identifying ventricular tachycardia (VT) in patients with recognised risk of sudden cardiac death. 4 As many devices with different characteristics are available, the choice of the most suitable monitoring system largely depends on the likelihood of detecting a significant correlation between symptoms and ECG findings. Holter MonitorsTraditional ambulatory Holter monitors are simple devices that usually have three leads and continuously register the ECG. They can be short-(24-48 hours) or long-duration (1-2 weeks) devices.1 Two-week Holter monitoring is preferred when diagnosing or excluding AF in cryptogenic stroke, but loop recorders and outpatient telemetry have even higher detection rates. Loop Recorders and Post-event RecordersNewer generation monitors are the so-called event recorders.According to their specific functions they can be divided into two categories: loop recorders, which include external loop recorders (ELRs) and implantable loop recorders (ILRs); and post-event recorders (non-looping recorders). 1 AbstractHolter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. Despite the fact their use is widely prescribed by general practitioners, little is known about their evolving role in the management of patients with cryptogenic stroke, paroxysmal atrial fibrillation, unexplained recurrent syncope and risk stratification in implantable cardioverter defibrillator or pacemaker candidates. New Holt...

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Device-detected atrial fibrillation and risk for stroke: an analysis of >10 000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices)

Cited by 392 publications

References 22 publications

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

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

Holter Monitoring and Loop Recorders: From Research to Clinical Practice

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