Stroke: cardiac causes and their management

Download the Issue @ a Glance podcast Subscribe to the EHJ Podcast Acute ischaemic stroke ranks high in morbidity and mortality statistics worldwide.1 Unfortunately, even today, only a minority of patients receive interventional treatment.2 Recent advances in imaging, mechanical thrombectomy, and logistics demonstrated a better outcome in stroke patients managed invasively.3 This issue begins with a timely Current Opinion article entitled ‘Ischaemic stroke and ST-segment elevation myocardial infarction: fast-track single-stop approach’ by Peter Lanzer from the Health Care Center in Bitterfeld, Germany.4 In it, the authors propose a streamlined fast-track single-stop approach to treat patients with ischaemic stroke based on modified ST-segment elevation myocardial infarction (STEMI) logistics to improve further the outcome of this devastating condition. In addition to atrial fibrillation,5 atrial flutter is also a potential cause of stroke.6,7 Since its first description about a century ago, our understanding of atrial flutter circuits has evolved considerably. One atrial flutter circuit can have variable ECG manifestations, depending on the presence of a pre-existing atrial lesion or an altered atrial substrate. Conversely, different right-sided or even left-sided atrial circuits including different mechanisms, for instance macro re-entrant, micro re-entrant, or focal circuits, can present with a very a similar surface ECG. The development of efficient high-resolution electroanatomical mapping systems has improved our knowledge about atrial flutter, as well as facilitated its treatment with radiofrequency catheter ablation. Sok-Sithikun Bun and co-workers from the Princess Grace Hospital in Monaco provide a comprehensive Clinical Review entitled ‘Atrial flutter: more than just one of a kind.’8 In it, the authors review ECG features of typical and atypical flutter and emphasize the limitations for circuit location from the surface ECG.