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Atrial fibrillation detection and treatment matters
TO MAXIMIZE THE RATE OF AF DETECTION, ESO GUIDELINES RECOMMEND THAT CLINICIANS SHOULD MONITOR CRYPTOGENIC STROKE AND T.I.A. PATIENTS WITH IMPLANTABLE CARDIAC MONITORS, STARTING AS SOON AS POSSIBLE7:
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.
Reveal LINQ™ is recommended as an option to help detect atrial fibrillation after cryptogenic stroke, including transient ischaemic attacks (TIA), only if:
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.11
This meta-analysis11 found that patients who underwent PCM compared to conventional cardiac monitoring showed:
WATCH Paul Ziegler, scientist and Bakken Fellow, explain the objectives, methodology and primary findings of this meta-analysis.
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.
In line with the NICE Diagnostics Guidance 419, Salford Royal NHS Foundation Trust added the use of an implantable cardiac monitor in cryptogenic stroke patients to their post-stroke aftercare pathways to help increase the detection of Atrial fibrillation (AF).
The Reveal LINQ™ ICM is an insertable, automatically-activated and patient-activated monitoring system that records subcutaneous ECG and is indicated in the following cases:
* See full brief statement for complete indications, contra indications, warnings and precautions.
Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics — 2017 Update. A Report From the American Heart Association. Circulation. March 7, 2017;135(10):e146-e603.
Lin HJ, Kelly-Hayes M, Beiser AS, et al. Stroke severity in atrial fibrillation: The Framingham Study. Stroke. October 1996;27(10):1760-1764
Kolominsky-Rabas PL, Heuschmann PU, Marschall D, et al. Lifetime cost of ischemic stroke in Germany: results and national projections from a population-based stroke registry. Stroke. May 2006;37(5): 1179-1183.
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. 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.
Rubiera M, Aires A, Antonenko K, et al. European Stroke Organisation (ESO) guideline on screening for subclinical atrial fibrillation after stroke or transient ischaemic attack of undetermined origin. European Stroke Journal. June 2022. doi:10.1177/23969873221099478
Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation. August 1991;84(2):527- 539.
NICE Diagnostics Guidance 41: Implantable cardiac monitors to detect atrial fibrillation after cryptogenic stroke. September 2020 © NICE 2020.
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.