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cardiac monitoring in cryptogenic stroke

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https://www.readbyqxmd.com/read/27861421/current-and-emerging-uses-of-insertable-cardiac-monitors-evaluation-of-syncope-and-monitoring-for-atrial-fibrillation
#1
Todd T Tomson, Rod Passman
Insertable cardiac monitors (ICMs) have provided clinicians with a superb tool for assessing infrequent or potentially asymptomatic arrhythmias. ICMs have shownd their usefulness in the evaluation of unexplained syncope, providing high diagnostic yields in a cost effective manner. While unexplained syncope continues to be the most common reason for their use, ICMs are increasingly being used for the monitoring of atrial fibrillation (AF). Recent trials have demonstrated that a substantial proportion of patients with cryptogenic stroke have AF detected only by the prolonged monitoring provided by ICMs...
November 17, 2016: Cardiology in Review
https://www.readbyqxmd.com/read/27817241/role-of-hospitalists-in-the-diagnosis-of-atrial-fibrillation-for-the-management-of-cryptogenic-stroke-patients
#2
Alpesh Amin
Cryptogenic strokes are responsible for significant morbidity and mortality. Identifying the underlying cause of cryptogenic stroke is imperative for appropriate short and long-term management of these patients. In particular, detecting atrial fibrillation in cryptogenic stroke patients may shed insight into the cause of the index stroke, but is also important to identify an important cause of secondary stroke. There is accumulating evidence indicating that monitoring for durations beyond the guideline recommended 30 day-period results in greater atrial fibrillation yield...
November 17, 2016: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/27756556/silent-atrial-fibrillation-and-cryptogenic-strokes
#3
REVIEW
James E Dalen, Joseph S Alpert
A new suspected cause of cryptic strokes is "silent atrial fibrillation." Pacemakers and other implanted devices allow continuous recording of cardiac rhythm for months or years. They have discovered that short periods of atrial fibrillation lasting minutes or hours are frequent and usually are asymptomatic. A meta-analysis of 50 studies involving more than 10,000 patients with a recent stroke found that 7.7% had new atrial fibrillation on their admitting electrocardiogram. In 3 weeks during and after hospitalization, another 16...
October 15, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27681890/cardiac-monitoring-for-detection-of-atrial-fibrillation-after-tia-a-systematic-review-and-meta-analysis
#4
Eleni Korompoki, Angela Del Giudice, Steffi Hillmann, Uwe Malzahn, David J Gladstone, Peter Heuschmann, Roland Veltkamp
BACKGROUND AND PURPOSE: The detection rate of atrial fibrillation has not been studied specifically in transient ischemic attack (TIA) patients although extrapolation from ischemic stroke may be inadequate. We conducted a systematic review and meta-analysis to determine the rate of newly diagnosed atrial fibrillation using different methods of ECG monitoring in TIA. METHODS: A comprehensive literature search was performed following a pre-specified protocol the PRISMA statement...
September 28, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27671319/detection-of-atrial-fibrillation-among-patients-with-stroke-due-to-large-or-small-vessel-disease-a-meta-analysis
#5
Jelle Demeestere, Steffen Fieuws, Maarten G Lansberg, Robin Lemmens
BACKGROUND: Recent trials have demonstrated that extended cardiac monitoring increases the yield of paroxysmal atrial fibrillation (AF) detection in patients with cryptogenic stroke. The utility of extended cardiac monitoring is uncertain among patients with stroke caused by small and large vessel disease. We conducted a meta-analysis to estimate the yield of AF detection in this population. METHODS AND RESULTS: We searched PubMed, Cochrane, and SCOPUS databases for studies on AF detection in stroke patients and excluded studies restricted to patients with cryptogenic stroke or transient ischemic attack...
2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27617093/holter-monitoring-and-loop-recorders-from-research-to-clinical-practice
#6
Alessio Galli, Francesco Ambrosini, Federico Lombardi
Holter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. Despite the fact their use is widely prescribed by general practitioners, little is known about their evolving role in the management of patients with cryptogenic stroke, paroxysmal atrial fibrillation, unexplained recurrent syncope and risk stratification in implantable cardioverter defibrillator or pacemaker candidates. New Holter monitoring technologies and loop recorders allow prolonged monitoring of heart rhythm for periods from a few days to several months, making it possible to detect infrequent arrhythmias in patients of all ages...
August 2016: Arrhythmia & Electrophysiology Review
https://www.readbyqxmd.com/read/27559092/new-perspectives-on-atrial-fibrillation-and-stroke
#7
Nazem Akoum
Atrial fibrillation (AF) is directly implicated in embolic stroke and suspected in a large proportion of cryptogenic stroke. The current stroke-prevention strategy in embolic and cryptogenic stroke starts with arrhythmia detection, followed by risk stratification and treatment for those deemed to be at increased risk. This approach is practical and widespread; however, more recent findings have questioned its validity. Arrhythmia detection is dependent on the length and fidelity of monitoring. Long-term monitoring using implanted recorders improves arrhythmia detection in patients with cryptogenic stroke...
August 24, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27541997/total-atrial-conduction-time-to-predict-occult-atrial-fibrillation-after-cryptogenic-stroke
#8
Patrick Müller, Vladimir Ivanov, Kaffer Kara, Oliver Klein-Wiele, Mathias Forkmann, Christopher Piorkowski, Christian Blockhaus, Dimitrios Dimitroulis, Shazia Afzal, Dong-In Shin, Malte Kelm, Hisaki Makimoto, Andreas Mügge
BACKGROUND: Insertable cardiac monitor (ICM) increases the detection rate of occult atrial fibrillation (AF) after cryptogenic stroke. The aim of this study was to evaluate the prognostic significance of total atrial conduction time (TACT) assessed by tissue Doppler imaging (PA-TDI interval) to predict AF presence in patients with cryptogenic stroke. METHODS: Ninety patients (57.7 ± 12.3 years, 48 % women) after acute cryptogenic stroke and ICM implantation were prospective recruited at four centers for continuous rhythm monitoring...
August 19, 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/27495831/predictors-of-occult-atrial-fibrillation-in-one-hundred-seventy-one-patients-with-cryptogenic-transient-ischemic-attack-and-minor-stroke
#9
Veronica Sudacevschi, Cathy Bertrand, Marie L Chadenat, Chloé Tarnaud, Fernando Pico
BACKGROUND AND OBJECTIVE: Recent randomized studies have shown the potential of prolonged cardiac rhythm monitoring to detect silent paroxysmal atrial fibrillation (PAF) in patients with cryptogenic stroke. Our aim was to identify clinical and magnetic resonance imaging (MRI) factors that predict the detection of PAF during long-duration rhythm cardiac Holter (LDRCH) monitoring. METHODS: A retrospective analysis was performed using data from 171 patients with cryptogenic stroke or transient ischemic attack who underwent LDRCH monitoring (i...
August 2, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27470989/potential-cost-effectiveness-of-ambulatory-cardiac-rhythm-monitoring-after-cryptogenic-stroke
#10
Jean Hai Ein Yong, Kednapa Thavorn, Jeffrey S Hoch, Muhammad Mamdani, Kevin E Thorpe, Paul Dorian, Mike Sharma, Andreas Laupacis, David J Gladstone
BACKGROUND AND PURPOSE: Prolonged ambulatory ECG monitoring after cryptogenic stroke improves detection of covert atrial fibrillation, but its long-term cost-effectiveness is uncertain. METHODS: We estimated the cost-effectiveness of noninvasive ECG monitoring in patients aged ≥55 years after a recent cryptogenic stroke and negative 24-hour ECG. A Markov model used observed rates of atrial fibrillation detection and anticoagulation from a randomized controlled trial (EMBRACE) and the published literature to predict lifetime costs and effectiveness (ischemic strokes, hemorrhages, life-years, and quality-adjusted life-years [QALYs]) for 30-day ECG (primary analysis) and 7-day or 14-day ECG (secondary analysis), when compared with a repeat 24-hour ECG...
September 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27347225/long-term-arrhythmia-monitoring-in-cryptogenic-stroke-who-how-and-for-how-long
#11
Mayra Montalvo, Rushna Ali, Brian Silver, Muhib Khan
Cryptogenic stroke and transient ischemic attack (TIA) account for approximately one-third of stroke patients [1]. Paroxys-mal atrial fibrillation (PAF) has been suggested as a major etiology of these cryptogenic strokes [2, 3]. PAF can be difficult to diagnose because it is intermittent, often brief, and asymptomatic. PAF might be more prevalent than persistent atrial fibrillation in stroke and TIA patients, especially in younger populations [4, 5]. In patients with atrial fibrillation, anticoagulation provides significant risk reduction [6]...
2016: Open Cardiovascular Medicine Journal
https://www.readbyqxmd.com/read/27333746/-esus-embolic-stroke-of-undetermined-sources
#12
REVIEW
Kazuo Kitagawa
Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. ESUS was proposed for unifying embolic stroke of undetermined sources by Hart et al. in 2014. The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients...
April 2016: Nihon Rinsho. Japanese Journal of Clinical Medicine
https://www.readbyqxmd.com/read/27325256/paroxysmal-atrial-fibrillation-novel-strategies-for-monitoring-and-implications-for-treatment-in-stroke
#13
REVIEW
Scott B Silverman
In cryptogenic stroke, prolonged cardiac monitoring is often employed to search for and diagnose atrial fibrillation (AF). Multiple monitoring modalities with multiple durations of monitoring exist. Finding atrial fibrillation after an ischemic stroke is extremely important as anticoagulation is the standard of care and results in the lowest stroke recurrence rate. The protocol at our institution is to carry out 30-day mobile cardiac outpatient telemetry (MCOT) in all patients with cryptogenic stroke. If this MCOT fails to reveal AF, yet the suspicion is high based on the presence of clinical, biochemical, electrocardiographic, and echocardiographic factors, we may proceed to use an implantable cardiac monitor...
August 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27314027/optimal-duration-of-monitoring-for-atrial-fibrillation-in-cryptogenic-stroke-a-nonsystematic-review
#14
REVIEW
Essa Hariri, Ahmad Hachem, Georges Sarkis, Samer Nasr
Atrial fibrillation (AF) is the most common form of cardiac arrhythmias and an independent risk factor for stroke. Despite major advances in monitoring strategies, clinicians tend to miss the diagnoses of AF and especially paroxysmal AF due mainly to its asymptomatic presentation and the rather limited duration dedicated for monitoring for AF after a stroke, which is 24 hours as per the current recommended guidelines. Hence, determining the optimal duration of monitoring for paroxysmal atrial fibrillation after acute ischemic stroke remains a matter of debate...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27283276/how-and-when-to-screen-for-atrial-fibrillation-after-stroke-insights-from-insertable-cardiac-monitoring-devices
#15
REVIEW
Francesca Bridge, Vincent Thijs
The introduction of insertable cardiac monitoring devices has dramatically altered our understanding of the role of intermittent atrial fibrillation in cryptogenic stroke. In this narrative review we discuss the incidence, timing and relationship between atrial fibrillation and cryptogenic stroke, how to select patients for monitoring and the value and limitations of different monitoring strategies. We also discuss the role of empirical anticoagulation, and atrial fibrillation burden as a means of tailoring anticoagulation in patients at high risk of bleeding...
May 2016: Journal of Stroke
https://www.readbyqxmd.com/read/27282299/identification-of-covert-atrial-fibrillation-in-cryptogenic-ischemic-stroke-current-clinical-practice-in-japan
#16
REVIEW
Kazunori Toyoda, Ken Okumura, Yoichiro Hashimoto, Takanori Ikeda, Takashi Komatsu, Teruyuki Hirano, Haruhisa Fukuda, Kazuo Matsumoto, Masahiro Yasaka
BACKGROUND AND AIM: A new insertable cardiac monitor, Reveal LINQ (Medtronic, Dublin, Ireland), was approved for clinical use in Japan in March 2016 for detecting atrial fibrillation in patients who develop ischemic stroke with no clearly definable etiology even after extensive workup, so-called cryptogenic ischemic stroke. Cooperation between a specialist of the Japan Stroke Society and a trained cardiologist or cardiac surgeon is needed both for appropriate patient selection and appropriate management of the device...
August 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27223148/clinical-practice-cryptogenic-stroke
#17
REVIEW
Jeffrey L Saver
No abstract text is available yet for this article.
May 26, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27165694/real-world-performance-of-an-enhanced-atrial-fibrillation-detection-algorithm-in-an-insertable-cardiac-monitor
#18
Suneet Mittal, John Rogers, Shantanu Sarkar, Jodi Koehler, Eduardo N Warman, Todd T Tomson, Rod S Passman
BACKGROUND: Insertable cardiac monitors (ICMs) are used for long-term ECG monitoring. The Reveal LINQ ICM has an improved atrial fibrillation (AF) detection algorithm. OBJECTIVE: The purpose of this study was to investigate the algorithm's real-world performance in patients with syncope, cryptogenic stroke, and known AF. METHODS: Consecutive patients with implanted ICM and AF detection parameters automatically set and maintained depending on the indication for monitoring were included...
August 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/27150177/cardiac-monitoring-for-atrial-fibrillation-in-cryptogenic-stroke
#19
REVIEW
Sukit M Ringwala, Todd T Tomson, Rod S Passman
Despite an extensive initial evaluation, the cause of up to a third of ischemic strokes remains undetermined. The detection of atrial fibrillation (AF) in these patients with cryptogenic stroke is critical as the diagnosis of AF would warrant anticoagulation to reduce the risk of recurrent stroke. Observational studies and prospective randomized controlled trials have shown that a substantial proportion of patients with cryptogenic stroke have AF detected by post-stroke cardiac monitoring with higher AF detection rates observed with longer monitoring periods...
May 2016: Cardiology Clinics
https://www.readbyqxmd.com/read/26923607/the-evolution-and-application-of-cardiac-monitoring-for-occult-atrial-fibrillation-in-cryptogenic-stroke-and-tia
#20
Daniel J Miller, Kavit Shah, Sumul Modi, Abhimanyu Mahajan, Salman Zahoor, Muhammad Affan
The evaluation of the stroke and transient ischemic attack (TIA) patient has been historically predominated by the initial evaluation in the hospital setting. As the etiology of stroke has eluded us in approximately one third of all acute events, the medical community has been eager to seek the answer to this mystery. In recent years, we have seen an explosion of innovations and trends allowing for a more detailed post stroke assessment strategy aimed at the identification of occult atrial fibrillation as the etiologic cause for the cryptogenic event...
April 2016: Current Treatment Options in Neurology
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