Long-term ECG monitoring, particularly using implantable cardiac monitors, is favored for detecting subclinical atrial fibrillation in patients with cryptogenic stroke.
What is the role and accuracy of long-term ECG monitoring in detecting subclinical atrial fibrillation in cryptogenic stroke patients?
This ESC position paper outlines the current evidence and recommendations for long-term ECG monitoring to detect subclinical atrial fibrillation in patients with cryptogenic stroke, favoring implantable cardiac monitors.
Abstract The role of subclinical atrial fibrillation as a cause of cryptogenic stroke is unambiguously established. Long-term electrocardiogram (ECG) monitoring remains the sole method for determining its presence following a negative initial workup. This position paper of the European Society of Cardiology Working Group on e-Cardiology first presents the definition, epidemiology, and clinical impact of cryptogenic ischaemic stroke, as well as its aetiopathogenic association with occult atrial fibrillation. Then, classification methods for ischaemic stroke will be discussed, along with their value in providing meaningful guidance for further diagnostic efforts, given disappointing findings of studies based on the embolic stroke of unknown significance construct. Patient selection criteria for long-term ECG monitoring, crucial for determining pre-test probability of subclinical atrial fibrillation, will also be discussed. Subsequently, the two major classes of long-term ECG monitoring tools (non-invasive and invasive) will be presented, with a discussion of each method’s pitfalls and related algorithms to improve diagnostic yield and accuracy. Although novel mobile health (mHealth) devices, including smartphones and smartwatches, have dramatically increased atrial fibrillation detection post ischaemic stroke, the latest evidence appears to favour implantable cardiac monitors as the modality of choice; however, the answer to whether they should constitute the initial diagnostic choice for all cryptogenic stroke patients remains elusive. Finally, institutional and organizational issues, such as reimbursement, responsibility for patient management, data ownership, and handling will be briefly touched upon, despite the fact that guidance remains scarce and widespread clinical application and experience are the most likely sources for definite answers.
Dilaveris et al. (Wed,) conducted a review in Cryptogenic stroke and subclinical atrial fibrillation. Long-term ECG monitoring was evaluated. Long-term ECG monitoring, particularly using implantable cardiac monitors, is favored for detecting subclinical atrial fibrillation in patients with cryptogenic stroke.
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