Document Detail

Detection of atrial fibrillation after cryptogenic stroke.
MedLine Citation:
PMID:  22562457     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Patients with ischemic stroke and atrial fibrillation (AF) are treated with long-term oral anticoagulation (OAC) because it is considerably more effective than antiplatelet (AP) therapy for the prevention of subsequent strokes and systemic emboli. Therefore, detecting AF changes therapy and makes secondary prevention more effective. Technology for detection of rare episodes of paroxysmal AF (PAF) has improved recently. AF that is only detectable by prolonged monitoring (occult AF, or oAF) may underlie some strokes of unknown cause (cryptogenic stroke). However, the ideal method and duration of cardiac monitoring to detect oAF after stroke is unknown. Furthermore, new technologies allow the detection of brief, rare episodes of AF that would not have been detectable at the time classic studies establishing the benefit of OAC were conducted. Therefore, it is unknown what the minimum threshold of oAF burden or duration is that mandates OAC instead of AP therapy. Here we review the available technologies, and discuss the therapeutic implications and uncertainties when oAF is found after ischemic stroke. There is evidence that 3 weeks of outpatient cardiac telemetry has a high yield of detection of AF after cryptogenic stroke; however, ongoing studies may show that even longer monitoring periods have higher yield.
Richard A Bernstein
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current treatment options in cardiovascular medicine     Volume:  14     ISSN:  1534-3189     ISO Abbreviation:  Curr Treat Options Cardiovasc Med     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-24     Completed Date:  2012-10-02     Revised Date:  2013-07-25    
Medline Journal Info:
Nlm Unique ID:  9815942     Medline TA:  Curr Treat Options Cardiovasc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  298-304     Citation Subset:  -    
Department of Neurology, Feinberg School of Medicine of Northwestern University, 710 North Lake Shore Drive, Abbott Hall 11th Floor, Chicago, IL, 60611, USA,
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