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Atrial fibrillation detection and treatment matters
In stroke patients, additional ECG monitoring by long-term non- invasive ECG monitors or implanted loop recorders should be considered to document silent atrial fibrillation.
The CRYSTAL-AF Study found that short- and intermediate-term cardiac monitoring may miss many patients with paroxysmal AF.
In June 2019, Prof George Tsivgoulis et al. published new data which showed that prolonged cardiac monitoring (PCM) has a significant impact on secondary stroke prevention.8
This meta-analysis8 found that patients who underwent PCM compared to conventional cardiac monitoring showed:
After initial stroke discharge, many cryptogenic stroke patients are at risk of secondary stroke but don’t receive additional cardiac monitoring. Establishing a monitoring pathway to detect and treat AF can significantly reduce a patient's risk.
WATCH THE WEBINAR and learn about the latest clinical evidence and best practices for implementing a stroke pathway.
* See full brief statement for complete indications, contra indications, warnings and precautions.
Landman SR and Sarkar S. Characterization of cardiac diagnostic care pathways by indication and physician specialty in a real-world dataset of 314,554 patients. Presented at ESC 2019.
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983-988.
Diener HC, Connolly SJ, Ezekowitz MD, et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial. Lancet Neurol 2010; 9: 1157–1163.
Saver JL. Cryptogenic Stroke. N Engl J Med. May 26, 2016;374(21):2065-2074.
Tsivgoulis G, Katsanos AH, Grory BM, et al. Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia. Stroke. 2019;50:2175-2180.
Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation. August 1991;84(2):527-539.
Sanna T, Diener HC, Passman RS, et al. Cryptogenic Stroke and Underlying Atrial Fibrillation (CRYSTAL AF). N Engl J Med. 2014; 370(26):2478-2486.
Tsivgoulis G, Katsanos AH, Grory BM, et al. Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia. Stroke. Published online June 20, 2019.
Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. April 2014;13(4):429-438.
Mozzafarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics – 2015 update: a report from the American Heart Association. Circulation. January 27, 2015;131(4):e29-e322.