Cryptogenic stroke: Is silent atrial fibrillation the culprit?

TY - JOUR

T1 - Cryptogenic stroke

T2 - Is silent atrial fibrillation the culprit?

AU - Glotzer, Taya V.

AU - Ziegler, Paul D.

N1 - Publisher Copyright: © 2015 Heart Rhythm Society. All rights reserved.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - BACKGROUND: Stroke without an identifi able cause is frightening to patients and their families and is frustrating for the caring physician. Approximately 30% of patients with cardiac implanted electronic devices have some evidence of atrial fi brillation (AF), and much of it is silent: asymptomatic, and previously unrecognized. OBJECTIVE: The purpose of this review is to examine "silent AF" as a potential cause of cryptogenic stroke. METHODS/RESULTS: We begin by reviewing most of the published literature on screening for AF with different monitoring technologies in the setting of cryptogenic stroke. We present the results of 2 recent large randomized trials, CRYSTAL AF and EMBRACE, which compare standard of care monitoring in cryptogenic stroke patients to invasive and noninvasive monitoring strategies, respectively. Finally, we review the relationship of silent AF to stroke in the cardiac implanted electronic device population. Patient selection, duration of monitoring, sensitivity and speci fi city of monitoring technology, patient compliance, and several other factors affect the yield of AF detection during monitoring. CONCLUSION: Data suggest that silent AF is identifi ed in approximately 30% of cryptogenic stroke patients and has important therapeutic implications. Oral anticoagulation likely should be prescribed when silent AF is detected.

AB - BACKGROUND: Stroke without an identifi able cause is frightening to patients and their families and is frustrating for the caring physician. Approximately 30% of patients with cardiac implanted electronic devices have some evidence of atrial fi brillation (AF), and much of it is silent: asymptomatic, and previously unrecognized. OBJECTIVE: The purpose of this review is to examine "silent AF" as a potential cause of cryptogenic stroke. METHODS/RESULTS: We begin by reviewing most of the published literature on screening for AF with different monitoring technologies in the setting of cryptogenic stroke. We present the results of 2 recent large randomized trials, CRYSTAL AF and EMBRACE, which compare standard of care monitoring in cryptogenic stroke patients to invasive and noninvasive monitoring strategies, respectively. Finally, we review the relationship of silent AF to stroke in the cardiac implanted electronic device population. Patient selection, duration of monitoring, sensitivity and speci fi city of monitoring technology, patient compliance, and several other factors affect the yield of AF detection during monitoring. CONCLUSION: Data suggest that silent AF is identifi ed in approximately 30% of cryptogenic stroke patients and has important therapeutic implications. Oral anticoagulation likely should be prescribed when silent AF is detected.

KW - Atrial fibrillation

KW - Continuous monitoring

KW - Implantable device

KW - Stroke

UR - https://www.scopus.com/pages/publications/84920696626

U2 - 10.1016/j.hrthm.2014.09.058

DO - 10.1016/j.hrthm.2014.09.058

M3 - Article

C2 - 25285649

SN - 1547-5271

VL - 12

SP - 234

EP - 241

JO - Heart Rhythm

JF - Heart Rhythm

IS - 1

ER -