Abstract WP202: A Simple Score That Predicts Paroxysmal Atrial Fibrillation on Outpatient Cardiac Monitoring After Embolic Stroke of Unknown Source

The paper considers the epidemiology and general etiological characteristics of cryptogenic stroke (CS). It discusses the concept of embolic stroke with an unknown source of embolism. It also characterizes the most significant causes of CS, such as paroxysmal atrial fibrillation, atrial cardiopathy, aortic atheroma, non-stenotic cerebral atherosclerotic plaques, and malignant neoplasms. The paper describes approaches to the diagnosis and secondary prevention of CS and proposes etiological and neuroimaging diagnostic algorithms for CI. Clinical cases are also presented.

Download Full-text

Cryptogenic Stroke

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.ca1.62 ◽

2017 ◽

pp. 62

Author(s):

Mohammad Saadatnia

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Brain Infarction ◽

Significant Proportion ◽

Cryptogenic Stroke ◽

Paradoxical Embolism ◽

Embolic Stroke ◽

Cardiac Monitoring ◽

Large Artery ◽

Extensive Evaluation

Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge.The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease. Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS) was planned for unifying embolic stroke of undetermined source. 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. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.

Download Full-text

IMPACT OF SIGNAL LOSS ON THE DETECTION OF PAROXYSMAL ATRIAL FIBRILLATION IN A IN-HOUSE STROKE UNIT CARDIAC MONITORING SERVICE

10.26226/morressier.58e389b1d462b80292384f1f ◽

2017 ◽

Author(s):

Wai Meng Yu

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Stroke Unit ◽

Cardiac Monitoring ◽

Signal Loss ◽

Monitoring Service

Download Full-text

IMPORTANCE OF PAROXYSMAL ATRIAL FIBRILLATION FOR THE PREVENTION OF EMBOLIC STROKE IN HYPERTROPHIC CARDIOMYOPATHY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)31364-4 ◽

2020 ◽

Vol 75 (11) ◽

pp. 737

Author(s):

Junya Komatsu ◽

Takako Fujita ◽

Yuki Nishimura ◽

Ryuichirou Imai ◽

Yoko Nakaoka ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Paroxysmal Atrial Fibrillation ◽

Embolic Stroke

Download Full-text

Predictors of Occult Paroxysmal Atrial Fibrillation in Cryptogenic Strokes Detected by Long-Term Noninvasive Cardiac Monitoring

Stroke Research and Treatment ◽

10.4061/2011/172074 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 14

Author(s):

Archit Bhatt ◽

Arshad Majid ◽

Anmar Razak ◽

Mounzer Kassab ◽

Syed Hussain ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Cryptogenic Stroke ◽

Cardiac Monitoring ◽

High Signal ◽

Detection Rates ◽

Non Invasive ◽

Patient Reported ◽

Premature Beats

Background and Purpose. Paroxysmal Atrial fibrillation/Flutter (PAF) detection rates in cryptogenic strokes have been variable. We sought to determine the percentage of patients with cryptogenic stroke who had PAF on prolonged non-invasive cardiac monitoring.Methods and Results. Sixty-two consecutive patients with stroke and TIA in a single center with a mean age of 61 (+/− 14) years were analyzed. PAF was detected in 15 (24%) patients. Only one patient reported symptoms of shortness of breath during the episode of PAF while on monitoring, and 71 (97%) of these 73 episodes were asymptomatic. A regression analysis revealed that the presence of PVCs (ventricular premature beats) lasting more than 2 minutes (OR 6.3, 95% CI, 1.11–18.92;P=.042) and strokes (high signal on Diffusion Weighted Imaging) (OR 4.3, 95% CI, 5–36.3;P=.041) predicted PAF. Patients with multiple DWI signals were more likely than solitary signals to have PAF (OR 11.1, 95% CI, 2.5–48.5,P<.01).Conclusion. Occult PAF is common in cryptogenic strokes, and is often asymptomatic. Our data suggests that up to one in five patients with suspected cryptogenic strokes and TIAs have PAF, especially if they have PVCs and multiple high DWI signals on MRI.

Download Full-text

Predictors of Development of Atrial Fibrillation in Patients With Embolic Stroke Of Undetermined Source: An Analysis of the RE-SPECT ESUS Trial

Circulation ◽

10.1161/circulationaha.121.055176 ◽

2021 ◽

Author(s):

Maria Cecilia Bahit ◽

Ralph L. Sacco ◽

J. Donald Easton ◽

Juliane Meyerhoff ◽

Lisa Cronin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Body Mass ◽

Recurrent Stroke ◽

Controlled Trial ◽

Clinical Care ◽

Important Variable ◽

Older Age ◽

Embolic Stroke ◽

Cardiac Monitoring

Background: A proportion of patients with embolic stroke of undetermined source (ESUS) have silent atrial fibrillation (AF) or develop AF after the initial evaluation. Better understanding of risk for development of AF is critical to implement optimal monitoring strategies with the goal of preventing recurrent stroke due to underlying AF. The RE-SPECT ESUS trial provides an opportunity to assess predictors for developing AF and associated recurrent stroke. Methods: RE-SPECT ESUS was a randomized, controlled trial (564 sites, 42 countries) assessing dabigatran versus aspirin for the prevention of recurrent stroke in patients with ESUS. Of 5390 patients enrolled and followed for a median of 19 months, 403 (7.5%) were found to develop AF reported as an adverse event or using cardiac monitoring per standard clinical care. Univariable and multivariable regression analyses were performed to define predictors of AF. Results: In the multivariable model, older age (odds ratio [OR] for 10-year increase 1.99 [1.78-2.23]; P<0.001), hypertension (1.36 [1.03-1.79]; P=0.0304), diabetes (OR 0.74 [0.56-0.96]; P=0.022), and body mass index (OR for 5-unit increase 1.29 [1.16-1.43]; P<0.001) were independent predictors of AF during the study. In a sensitivity analysis restricted to 1117 patients with baseline N-terminal prohormone of brain natriuretic peptide (NT-proBNP) measurements, only older age and higher NT-proBNP were significant independent predictors of AF. Performances of several published predictive models were assessed, including the HAVOC and CHA2DS2-VASc scores, and higher scores were associated with higher rates of developing AF. Conclusions: Besides age as the most important variable, several other factors, including hypertension, higher body mass index, and lack of diabetes, are independent predictors of AF after ESUS. When baseline NT-proBNP was available, only older age and elevation of this biomarker were predictive of subsequent AF. Understanding who is at higher risk of developing AF will assist in identifying patients who may benefit from more intense, long-term cardiac monitoring.

Download Full-text

Abstract 3648: Detection Of Paroxysmal Atrial Fibrillation In Patient With Acute Brain Ischemia Combining Cardiac And Holter Monitoring: Prevalence And Predictors

Stroke ◽

10.1161/str.43.suppl_1.a3648 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Patricia Martinez-Sanchez ◽

Elisa Correas Callero ◽

Andres Cruz Herranz ◽

Blanca Fuentes Gimeno ◽

Angel Martin Montes ◽

...

Keyword(s):

Atrial Fibrillation ◽

Brain Ischemia ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Duplex Ultrasound ◽

Unknown Origin ◽

Holter Monitoring ◽

Cardiac Monitoring ◽

Stroke Severity ◽

Carotid Plaques

INTRODUCTION: The yield of serial electrocardiograms (ECG) plus 72-hour cardiac monitoring and Holter monitoring in detection of paroxysmal atrial fibrillation (PAF) is not well known. METHODS: consecutive patients with stroke or transient ischemic attack (TIA) admitted to a Stroke Unit (SU) during January 2009-June 2010 were studied. Patients underwent serial ECG and cardiac monitoring in the first 72 hours. Furthermore, 24-hours Holter monitoring were performed in patient with brain ischemia of unknown origin or if cardiac embolism was suspected. The presence of atrial fibrillation (AF) and PAF was recorded. RESULTS: 537 patients were included, 59.6% males. Mean age 69.1 (SD 13.5) years. Previous AF was present in 15.8% patients. ECG on admission showed not previously known AF in 22 (4%) patients. Cardiac monitoring and serial ECG in the SU detected PAF in 12 (2.2%) cases more. 24-hours Holter monitoring was completed in 156 patients, in 42 cases PFA was detected, of them 6 had been previously detected by serial ECG/cardiac monitoring. One case of PAF detected by serial ECG was not confirmed by Holter monitoring. In total, 10.8% of patients were diagnosed with new PAF. In multivariate analyses, NIHSS on admission (OR 1.1 for each 1 point increase; 95% CI, 1-1.2), enlarged left atrial (OR 5.8; 95% CI, 2.8-12), absence of carotid plaques by duplex ultrasound (OR 2.1; 95% CI 1-4.4) and hyperlipidemia (OR 2.4; 95% CI 1.119-5) were predictors of PAF. CONCLUSIONS: 24-hours Holter monitoring increased by 6 fold the detection of PAF as compared to ECG plus cardiac monitoring in acute stroke patients. Stroke severity, enlarged left atrial, absence of carotid plaques and hyperlipidemia are associated with PAF.

Download Full-text