Prolonged Cardiac Monitoring to Detect Atrial Fibrillation after Cryptogenic Stroke or Transient Ischemic Attack: A Meta‐Analysis of Randomized Controlled Trials

Dahal, Khagendra; Chapagain, Bikas; Maharjan, Raju; Farah, Hussam W.; Nazeer, Ayesha; Lootens, Robert J.; Rosenfeld, Alan

doi:10.1111/anec.12319

Cited by 24 publications

(14 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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]. In addition, a meta-analysis of RCTs showed improved detection of AF after cryptogenic stroke/TIA with prolonged cardiac monitoring [29]. Therefore, even in the presence of PFO, AF should be considered as a potential cause of some presumptive cryptogenic strokes.…”

Section: Discussionmentioning

confidence: 92%

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

et al. 2019

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 92%

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

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In addition, patients with atrial fibrillation and previous stroke or TIA are at high risk (averaging 10% per year) of developing recurrent stroke107 Thus, a certain period of cardiac monitoring after stroke or TIA to look for atrial fibrillation seems reasonable. Compared with a shorter duration of monitoring, prolonged monitoring for seven days or more was shown to detect more atrial fibrillation in RCTs evaluating patients with stroke or TIA,50108109110111 but no difference in recurrent stroke was shown. However, these studies were not adequately powered to detect differences in clinical outcomes.…”

Section: Applications Of Newer Detection Methodsmentioning

confidence: 92%

“…Although prolonged cardiac monitoring has been shown to detect more atrial fibrillation in patients with ischemic stroke,50108109110111 the recommendations for its use are less certain in the guidelines as its clinical benefit and cost effectiveness remain uncertain. The AHA/ASA guideline stated that the clinical benefit of prolonged cardiac monitoring to detect atrial fibrillation after acute ischemic stroke is uncertain (class IIb) 118.…”

Section: Guidelinesmentioning

confidence: 99%

Newer technologies for detection of atrial fibrillation

Zungsontiporn

Link

2018

BMJ

View full text Add to dashboard Cite

Atrial fibrillation is a common arrhythmia that is associated with increased risk of stroke, which can be reduced with appropriate anticoagulation treatment. However, it remains underdiagnosed in contemporary clinical practice using conventional detection methods, resulting in missed opportunities to implement appropriate treatment. Newer technologies developed in recent years can potentially enhance the detection of atrial fibrillation and overcome certain limitations of the conventional methods. However, uncertainties remain about their use and the significance of atrial fibrillation detected by some of these newer technologies. This review examines the evidence supporting the use of some of these technologies and evaluates their applications in certain clinical scenarios.

show abstract

“…Several monitoring strategies have been investigated to detect asymptomatic AF after an ischemic stroke, including electrocardiography (ECG), in-hospital monitoring, Holter ECG of variable duration, external event or loop recorders, mobile cardiac outpatient telemetry, and implantable cardiac monitors. These studies, and their recent meta-analyses, [7][8][9][10][11][12] contributed significantly to our current understanding of the incidence of AF after ischemic stroke.…”

Section: Stroke Recurrence In Patients With Prior Cs and Esusmentioning

confidence: 98%

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

Sanna

Ziegler

Crea

2018

Clinical Cardiology

View full text Add to dashboard Cite

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 (...

show abstract

Prolonged Cardiac Monitoring to Detect Atrial Fibrillation after Cryptogenic Stroke or Transient Ischemic Attack: A Meta‐Analysis of Randomized Controlled Trials

Abstract: Prolonged cardiac monitoring improves detection of atrial fibrillation and anti-coagulation use after cryptogenic stroke or TIA and therefore should be considered instead of shorter duration of cardiac monitoring.

Cited by 24 publications

References 26 publications

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

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

Newer technologies for detection of atrial fibrillation

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

Contact Info

Product

Resources

About