Heart Rhythm Monitoring Strategies for Cryptogenic Stroke: 2015 Diagnostics and Monitoring Stroke Focus Group Report

Albers, Gregory W.; Bernstein, Richard A.; Brachmann, Johannes; Camm, John; Easton, J. Donald; Fromm, Peter; Goto, Shinya; Granger, Christopher B.; Hohnloser, Stefan H.; Jaffer, Amir K.; Krieger, Derk; Passman, Rod; Pines, Jesse M.; Reed, Shelby D.; Rothwell, Peter M.; Kowey, Peter R.

doi:10.1161/jaha.115.002944

Cited by 48 publications

(29 citation statements)

References 57 publications

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“…In conclusion, the results of the present meta-analysis support extended-duration ICM monitoring as a reasonable option for patients with IS or TIA, and initial negative screening for AF detection [62], that may substantially enhance detection of predominantly subclinical AF episodes.…”

Section: Discussionsupporting

confidence: 56%

Duration of Implantable Cardiac Monitoring and Detection of Atrial Fibrillation in Ischemic Stroke Patients: A Systematic Review and Meta-Analysis

et al. 2019

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Background and PurposeCurrent guidelines do not provide firm directions on atrial fibrillation (AF) screening after ischemic stroke (IS). We sought to investigate the association of implantable cardiac monitoring (ICM) duration with the yield of AF detection in IS patients. MethodsWe included studies reporting AF detection rates by ICM in IS patients with negative initial AF screening. We excluded studies reporting prolonged cardiac monitoring with devices other than ICM, not providing AF detection rates or monitoring duration, and reporting overlapping data for the same population. The random-effects model was used for all pooled estimates and meta-regression analyses. ResultsWe included 28 studies (4,531 patients, mean age 65 years). In meta-regression analyses, the proportion of AF detection by ICM was independently associated with monitoring duration (coefficient=0.015; 95% confidence interval [CI], 0.005 to 0.024) and mean patient age (coefficient=0.009; 95% CI, 0.003 to 0.015). No associations were detected with other patient characteristics, including IS subtype (cryptogenic vs. embolic stroke of undetermined source) or time from IS onset to CM implantation. In subgroup analyses, significant differences (P<0.001) in the AF detection rates were found for ICM duration (<6 months: 5% [95% CI, 3% to 6%]; ≥6 and ≤12 months: 21% [95% CI, 16% to 25%]; >12 and ≤24 months: 26% [95% CI, 22% to 31%]; >24 months: 34% [95% CI, 29% to 39%]). ConclusionsExtended duration of ICM monitoring and increased patient age are factors that substantially increase AF detection in IS patients with initial negative AF screening.

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Section: Discussionsupporting

confidence: 56%

Duration of Implantable Cardiac Monitoring and Detection of Atrial Fibrillation in Ischemic Stroke Patients: A Systematic Review and Meta-Analysis

et al. 2019

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“…Although occult AF is uncommon among patients < 60 years of age with cryptogenic stroke [26], the American Heart Association/American Stroke Association guidelines for stroke prevention recommends at least 30 days of cardiac monitoring in patients with no apparent cause of stroke/TIA to detect occult AF based on observational studies [25,27]. A previous RCT (CRYSTAL AF) has supported the prolonged cardiac monitoring and the results showed that AF was more frequently detected in patients with recent cryptogenic stroke (12.4% detection rate in the monitored group vs. 2% in the unmonitored group; HR 7.3; 95% CI 2.6-20.8; p < 0.001) [28].…”

Section: Discussionmentioning

confidence: 99%

Patent foramen ovale closure versus medical therapy after cryptogenic stroke: An updated meta-analysis of all randomized clinical trials

et al. 2019

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“…More recently, underlying AF in cryptogenic stroke has received increasing attention . As many episodes of paroxysmal AF (if transient and/or infrequent) are asymptomatic and may be undetected on standard cardiac monitoring, such as 24‐ or 48‐h Holter monitoring, an implanted cardiac monitor has been applied to patients with cryptogenic stroke . However, in some patients, the hypercoagulable state associated with occult cancer underlies the cause of cryptogenic stroke.…”

Section: Discussionmentioning

confidence: 99%

Plasma D‐dimer levels and ischaemic lesions in multiple vascular regions can predict occult cancer in patients with cryptogenic stroke

Gon

Sakaguchi

Takasugi

et al. 2016

Euro J of Neurology

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Heart Rhythm Monitoring Strategies for Cryptogenic Stroke: 2015 Diagnostics and Monitoring Stroke Focus Group Report

Cited by 48 publications

References 57 publications

Duration of Implantable Cardiac Monitoring and Detection of Atrial Fibrillation in Ischemic Stroke Patients: A Systematic Review and Meta-Analysis

Duration of Implantable Cardiac Monitoring and Detection of Atrial Fibrillation in Ischemic Stroke Patients: A Systematic Review and Meta-Analysis

Patent foramen ovale closure versus medical therapy after cryptogenic stroke: An updated meta-analysis of all randomized clinical trials

Plasma D‐dimer levels and ischaemic lesions in multiple vascular regions can predict occult cancer in patients with cryptogenic stroke

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