Karl Georg Haeusler1,2,3,4, Serdar Tütüncü5, Renate B Schnabel6,7,8. 1. Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany. georg.haeusler@charite.de. 2. Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany. georg.haeusler@charite.de. 3. Atrial Fibrillation NETwork (AFNET) e.V, Münster, Germany. georg.haeusler@charite.de. 4. Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany. georg.haeusler@charite.de. 5. Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany. 6. Atrial Fibrillation NETwork (AFNET) e.V, Münster, Germany. 7. Abteilung für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany. 8. Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
Abstract
PURPOSE OF REVIEW: To summarize the literature on the detection of atrial fibrillation (AF) in patients with "cryptogenic" stroke, a cohort including about 25% of all ischemic stroke patients and patients with embolic stroke of undetermined source (ESUS). RECENT FINDINGS: A first episode of AF is detected in up to one third of cryptogenic stroke and in up to one fourth of ESUS patients during long-term monitoring. AF prevalence correlates to patient selection, duration, and quality of ECG monitoring. Higher rates of AF were reported in stroke patients with left atrial pathology, specific ECG alterations, or increased natriuretic peptides. While AF detection impacts on medical stroke prevention in the vast majority of patients, patient selection for prolonged monitoring is largely left at the physician's discretion. AF detection after cryptogenic stroke or ESUS is a frequent, potentially causal condition. Whether subsequent oral anticoagulation may improve outcome remains open.
PURPOSE OF REVIEW: To summarize the literature on the detection of atrial fibrillation (AF) in patients with "cryptogenic" stroke, a cohort including about 25% of all ischemic strokepatients and patients with embolic stroke of undetermined source (ESUS). RECENT FINDINGS: A first episode of AF is detected in up to one third of cryptogenic stroke and in up to one fourth of ESUS patients during long-term monitoring. AF prevalence correlates to patient selection, duration, and quality of ECG monitoring. Higher rates of AF were reported in strokepatients with left atrial pathology, specific ECG alterations, or increased natriuretic peptides. While AF detection impacts on medical stroke prevention in the vast majority of patients, patient selection for prolonged monitoring is largely left at the physician's discretion. AF detection after cryptogenic stroke or ESUS is a frequent, potentially causal condition. Whether subsequent oral anticoagulation may improve outcome remains open.
Entities:
Keywords:
Atrial fibrillation; Cryptogenic stroke; ECG monitoring; Embolic stroke of undetermined source; Ischemic stroke; Stroke unit
Authors: Karl Georg Haeusler; Klaus Gröschel; Martin Köhrmann; Stefan D Anker; Johannes Brachmann; Michael Böhm; Hans-Christoph Diener; Wolfram Doehner; Matthias Endres; Christian Gerloff; Hagen B Huttner; Manfred Kaps; Paulus Kirchhof; Darius Günther Nabavi; Christian H Nolte; Waltraud Pfeilschifter; Burkert Pieske; Sven Poli; Wolf Rüdiger Schäbitz; Götz Thomalla; Roland Veltkamp; Thorsten Steiner; Ulrich Laufs; Joachim Röther; Rolf Wachter; Renate Schnabel Journal: Clin Res Cardiol Date: 2018-04-27 Impact factor: 5.460
Authors: Rolf Wachter; Klaus Gröschel; Götz Gelbrich; Gerhard F Hamann; Pawel Kermer; Jan Liman; Joachim Seegers; Katrin Wasser; Anna Schulte; Falko Jürries; Anna Messerschmid; Nico Behnke; Sonja Gröschel; Timo Uphaus; Anne Grings; Tugba Ibis; Sven Klimpe; Michaela Wagner-Heck; Magdalena Arnold; Evgeny Protsenko; Peter U Heuschmann; David Conen; Mark Weber-Krüger Journal: Lancet Neurol Date: 2017-02-08 Impact factor: 44.182
Authors: S Poli; J Diedler; F Härtig; N Götz; A Bauer; T Sachse; K Müller; I Müller; F Stimpfle; M Duckheim; M Steeg; C Eick; J Schreieck; M Gawaz; U Ziemann; C S Zuern Journal: Eur J Neurol Date: 2015-10-16 Impact factor: 6.089
Authors: Natalia Kurka; Tobias Bobinger; Bernd Kallmünzer; Julia Koehn; Peter D Schellinger; Stefan Schwab; Martin Köhrmann Journal: Stroke Date: 2014-12-23 Impact factor: 7.914
Authors: Robert G Hart; Hans-Christoph Diener; Shelagh B Coutts; J Donald Easton; Christopher B Granger; Martin J O'Donnell; Ralph L Sacco; Stuart J Connolly Journal: Lancet Neurol Date: 2014-04 Impact factor: 44.182
Authors: Francisco Purroy; Mikel Vicente-Pascual; Gloria Arque; Robert Begue; Joan Farre; Yhovany Gallego; Maria Pilar Gil-Villar; Gerard Mauri; Nuria Montalà; Cristina Pereira; Coral Torres-Querol; Daniel Vazquez-Justes Journal: Front Neurol Date: 2022-07-14 Impact factor: 4.086