Diagnosis of AFib After Stroke and TIA | Ten Points to Remember

Sposato LA, Cipriano LE, Saposnik G, Vargas ER, Riccio PM, Hachinskiet V.
Diagnosis of Atrial Fibrillation After Stroke and Transient Ischaemic Attack: A Systematic Review and Meta-Analysis. Lancet Neurol 2015;Mar 4:[Epub ahead of print].

The following are 10 points to remember from this meta-analysis of 50 studies dealing with the diagnosis of atrial fibrillation (AF) after stroke and transient ischemic attack (TIA):

  1. AF is associated with a fivefold increase in the risk of stroke.
  2. Approximately 20% of patients with ischemic stroke already are known to have AF.
  3. Clinically unrecognized episodes of AF can be the cause of stroke/TIA of unclear origin.
  4. Electrocardiograms (ECGs) and monitoring in the emergency room detect AF in 7.7% of patients who present with stroke/TIA and no known history of AF.
  5. Serial ECGs and continuous monitoring during hospitalization for stroke result in the detection of previously unrecognized AF in 5.1% of patients.
  6. Outpatient Holter monitoring for 1-7 days detects post-stroke AF in 10.7% of patients.
  7. Mobile outpatient telemetry, external loop recorders, and implantable loop recorders detect post-stroke AF in 16.9% of patients.
  8. After sequential screening with the modalities described in points 4-7, the overall proportion of patients diagnosed with post-stroke AF is 23.7%.
  9. It is presumed, but not proven, that anticoagulation in patients with stroke/TIA who are found to have post-stroke AF reduces the risk of recurrent AF.
  10. AF early after stroke can be caused by a transient neurogenic mechanism, and AF several months post-stroke can be an incidental finding; therefore, it cannot be concluded that the cause of cryptogenic stroke has been identified in all patients found to have post-stroke AF.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Anticoagulation Management and Atrial Fibrillation, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Atrial Fibrillation, Stroke, Ischemic Attack, Transient, Electrocardiography, Electrocardiography, Ambulatory, Emergency Service, Hospital, Hospitalization, Outpatients, Anticoagulants, Incidental Findings, Risk, Telemetry, Meta-Analysis

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