Risk of Stroke in Patients With Short-Run Atrial Tachyarrhythmia

Yamada, Shuichi; Lin, Chin Yu; Chang, Shih Lin; Chao, Tze Fan; Lin, Yenn Jiang; Lo, Li Wei; Chung, Fa Po; Hu, Yu Feng; Tuan, Ta Chuan; Liao, Jo Nan; Chung, Fa‐Po; Chang, Yao Ting; Chang, Tsan‐Kuo; Wu, Chen-Tu; Higa, Satoshi; Chen, Shih Ann

doi:10.1161/strokeaha.117.018475

Cited by 20 publications

(11 citation statements)

References 23 publications

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“…There is growing literature on the association between AT and ischemic stroke, and the need of CHA2DS2VASC score for risk stratification for this finding [7][8][9][10]. The pathophysiology of cardio-embolic stroke is not fully understood but studies have linked hypercoagulability with an increased risk of stroke.…”

Section: Discussionmentioning

confidence: 99%

Ischemic Stroke in a Patient With Atrial Tachycardia, Methylenetetrahydrofolate Reductase Mutation and New-Onset Atrial Fibrillation: Is Early Initiation of Anticoagulation Therapy Indicated?

Eyituoyo

Arinze

Aben

et al. 2020

Cureus

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Atrial fibrillation is the most common dysrhythmia, affecting about 6 million people in the United States. Atrial fibrillation has been shown to be an independent risk factor for stroke. Atrial tachycardia are common findings on Holter monitoring in the general population and may be associated with the development of atrial remodeling and atrial fibrillation inducibility. Studies have shown that atrial tachycardia is associated with the development of atrial fibrillation and subsequent stroke. The American Heart Association current guidelines recommend the use of oral anticoagulants in patients with atrial fibrillation and an elevated CHA2DS2-VASc ≥2 in men or ≥3 in women. However, anticoagulant therapy is not currently recommended in patients with atrial tachycardia despite increasing evidence of its association with the development of stroke. We report the case of a 68-year-old woman with a past medical history significant for repetitive atrial tachycardia and methylenetetrahydrofolate reductase mutation who presented to an outside emergency department following a fall, weakness and associated aphasia while in atrial fibrillation. Thrombolysis and control of the patient's rhythm resulted in an initial improvement in the patient symptoms and reversal to normal sinus rhythm. She was subsequently referred to a tertiary stroke center for further management.

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Section: Discussionmentioning

confidence: 99%

Ischemic Stroke in a Patient With Atrial Tachycardia, Methylenetetrahydrofolate Reductase Mutation and New-Onset Atrial Fibrillation: Is Early Initiation of Anticoagulation Therapy Indicated?

Eyituoyo

Arinze

Aben

et al. 2020

Cureus

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“…persistent and permanent AF. 35–38 AHRES have been consistently associated with an increased risk of clinical stroke 10,39–50 and of silent brain lesions. 51 Moreover, patients with AHRE are 5.7 times (95% CI 4.0–8.0, p < 0.001) more likely to develop clinical AF at follow-up.…”

Section: What Should We Do After the Detection Of A First Episode Of Af?mentioning

confidence: 99%

Long-term monitoring to detect atrial fibrillation with the indwelling implantable cardiac monitors

Sanna

2018

International Journal of Stroke

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An increasing number of detection tools are available and several detection strategies have been described to pursue the diagnosis of atrial fibrillation to prevent ischemic stroke. Monitoring tools include standard electrocardiography, snapshot single-lead recordings with professional or personal devices (e.g. smartphone-based), Holter monitor, external devices with long-term recording capabilities, and cardiac implantable electronic devices, including pacemakers, implantable cardioverter defibrillators and insertable cardiac monitors. Insertable cardiac monitors have shown high sensitivity and specificity for the detection of atrial fibrillation, allow up to three years of continuous monitoring, do not require cooperation of the patient, are well tolerated, have a short device-related time delay between detection of atrial fibrillation and notification to the physician, provide information on atrial fibrillation burden and are minimally invasive. On the other hand, insertable cardiac monitors require a considerable use of resources to process the recordings and have a significant initial cost. Studies conducted with insertable cardiac monitors on patients with prior stroke and on patients with risk factors for stroke but no prior cerebrovascular events or atrial fibrillation have consistently shown a measurable incidence of atrial fibrillation at follow-up. However, the effectiveness of oral anticoagulations in reducing the incidence of ischemic stroke in patients with atrial fibrillation lasting less than 24 h, though reasonable, is currently unproven. The future of atrial fibrillation detection tools and atrial fibrillation detection strategies will be influenced by ongoing studies exploring whether oral anticoagulations reduce the incidence of stroke in patients with atrial fibrillation burden lower than 24 h.

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“…In this way, the strengths of both types of databases can be integrated [ 33 ]. For example, despite being applied to a clinical condition other than stroke, record linkage between a clinical registry of patients undergoing 24-hour Holter monitoring and the NHIRD has produced fruitful research results [ 46 , 47 ]. In addition, record linkage will enable us to determine the differences in the baseline characteristics and outcomes between stroke patients admitted to hospitals that do and do not participate in the stroke registry [ 48 ], and thus provide an opportunity to examine the generalizability of the results of studies that use registry data.…”

Section: Future Perspectivesmentioning

confidence: 99%

Registry-based stroke research in Taiwan: past and future

Hsieh

Sung³

2018

Epidemiol Health

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Stroke registries are observational databases focusing on the clinical information and outcomes of stroke patients. They play an important role in the cycle of quality improvement. Registry data are collected from real-world experiences of stroke care and are suitable for measuring quality of care. By exposing inadequacies in performance measures of stroke care, research from stroke registries has changed how we manage stroke patients in Taiwan. With the success of various quality improvement campaigns, mortality from stroke and recurrence of stroke have decreased in the past decade. After the implementation of a nationwide stroke registry, researchers have been creatively expanding how they use and collect registry data for research. Through the use of the nationwide stroke registry as a common data model, researchers from many hospitals have built their own stroke registries with extended data elements to meet the needs of research. In collaboration with information technology professionals, stroke registry systems have changed from web-based, manual submission systems to automated fill-in systems in some hospitals. Furthermore, record linkage between stroke registries and administrative claims databases or other existing databases has widened the utility of registry data in research. Using stroke registry data as the reference standard, researchers have validated several algorithms for ascertaining the diagnosis of stroke and its risk factors from claims data, and have also developed a claims-based index to estimate stroke severity. By making better use of registry data, we believe that we will provide better care to patients with stroke.

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Risk of Stroke in Patients With Short-Run Atrial Tachyarrhythmia

Cited by 20 publications

References 23 publications

Ischemic Stroke in a Patient With Atrial Tachycardia, Methylenetetrahydrofolate Reductase Mutation and New-Onset Atrial Fibrillation: Is Early Initiation of Anticoagulation Therapy Indicated?

Ischemic Stroke in a Patient With Atrial Tachycardia, Methylenetetrahydrofolate Reductase Mutation and New-Onset Atrial Fibrillation: Is Early Initiation of Anticoagulation Therapy Indicated?

Long-term monitoring to detect atrial fibrillation with the indwelling implantable cardiac monitors

Registry-based stroke research in Taiwan: past and future

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