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Clinical Articles, News & Views

Cryptogenic stroke: is silent atrial fibrillation the culprit?

Data suggests that silent atrial fibrillation (AF) is identified in about 30% of cryptogenic stroke patients and has important therapeutic implications, according to a report published recently in Heart Rhythm.1 Oral anticoagulation should likely be prescribed when silent AF is detected, the authors conclude.

The study examines “silent AF” as a potential cause of cryptogenic stroke. The authors review most of the published literature on screening for AF with different monitoring technologies in the setting of cryptogenic stroke. They also present the results of two recent large randomised trials: CRYSTAL AF (Cryptogenic Stroke and Underlying AF) and EMBRACE (30-Day Cardiac Event Monitor Belt for Recording Atrial Fibrillation After a Cerebral Ischemic Event), which compare standard of care monitoring in cryptogenic stroke patients to invasive and noninvasive monitoring strategies, respectively.

Finally, the authors review the relationship of silent AF to stroke in the cardiac implanted electronic device population. Patient selection, duration of monitoring, sensitivity and specificity of the monitoring technology, patient compliance, and several other factors affect the yield of AF during monitoring.

Stroke without an identifiable cause is frightening to patients and their families, and frustrating for the caring physician. Approximately 30% of patients with cardiac implanted electronic devices have some evidence of AF, and much of it is silent; asymptomatic and previously unrecognised, say the authors.

References

1. Glotzer TV, Ziegler PD. Cryptogenic stroke: is silent atrial fibrillation the culprit? Heart Rhythm 2014;pii:S1547–5271(14)01122-9. http://dx.doi.org/10.1016/j.hrthm.2014.09.058

Published on: October 31, 2014

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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