Searching for Atrial Fibrillation Poststroke: A White Paper of the AF-SCREEN International Collaboration
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Searching for Atrial Fibrillation Poststroke: A White Paper of the AF-SCREEN International Collaboration. / Schnabel, Renate B; Haeusler, Karl Georg; Healey, Jeffrey S; Freedman, Ben; Boriani, Giuseppe; Brachmann, Johannes; Brandes, Axel; Bustamante, Alejandro; Casadei, Barbara; Crijns, Harry J G M; Doehner, Wolfram; Engström, Gunnar; Fauchier, Laurent; Friberg, Leif; Gladstone, David J; Glotzer, Taya V; Goto, Shinya; Hankey, Graeme J; Harbison, Joseph A; Hobbs, F D Richard; Johnson, Linda S B; Kamel, Hooman; Kirchhof, Paulus; Korompoki, Eleni; Krieger, Derk W; Lip, Gregory Y H; Løchen, Maja-Lisa; Mairesse, Georges H; Montaner, Joan; Neubeck, Lis; Ntaios, George; Piccini, Jonathan P; Potpara, Tatjana S; Quinn, Terence J; Reiffel, James A; Ribeiro, Antonio Luiz Pinho; Rienstra, Michiel; Rosenqvist, Mårten; Themistoclakis, Sakis; Sinner, Moritz F; Svendsen, Jesper Hastrup; Van Gelder, Isabelle C; Wachter, Rolf; Wijeratne, Tissa; Yan, Bernard.
in: CIRCULATION, Jahrgang 140, Nr. 22, 26.11.2019, S. 1834-1850.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Searching for Atrial Fibrillation Poststroke: A White Paper of the AF-SCREEN International Collaboration
AU - Schnabel, Renate B
AU - Haeusler, Karl Georg
AU - Healey, Jeffrey S
AU - Freedman, Ben
AU - Boriani, Giuseppe
AU - Brachmann, Johannes
AU - Brandes, Axel
AU - Bustamante, Alejandro
AU - Casadei, Barbara
AU - Crijns, Harry J G M
AU - Doehner, Wolfram
AU - Engström, Gunnar
AU - Fauchier, Laurent
AU - Friberg, Leif
AU - Gladstone, David J
AU - Glotzer, Taya V
AU - Goto, Shinya
AU - Hankey, Graeme J
AU - Harbison, Joseph A
AU - Hobbs, F D Richard
AU - Johnson, Linda S B
AU - Kamel, Hooman
AU - Kirchhof, Paulus
AU - Korompoki, Eleni
AU - Krieger, Derk W
AU - Lip, Gregory Y H
AU - Løchen, Maja-Lisa
AU - Mairesse, Georges H
AU - Montaner, Joan
AU - Neubeck, Lis
AU - Ntaios, George
AU - Piccini, Jonathan P
AU - Potpara, Tatjana S
AU - Quinn, Terence J
AU - Reiffel, James A
AU - Ribeiro, Antonio Luiz Pinho
AU - Rienstra, Michiel
AU - Rosenqvist, Mårten
AU - Themistoclakis, Sakis
AU - Sinner, Moritz F
AU - Svendsen, Jesper Hastrup
AU - Van Gelder, Isabelle C
AU - Wachter, Rolf
AU - Wijeratne, Tissa
AU - Yan, Bernard
PY - 2019/11/26
Y1 - 2019/11/26
N2 - Cardiac thromboembolism attributed to atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes. Stroke may be the first manifestation of previously undetected AF. Given the efficacy of oral anticoagulants in preventing AF-related ischemic strokes, strategies of searching for AF after a stroke using ECG monitoring followed by oral anticoagulation (OAC) treatment have been proposed to prevent recurrent cardioembolic strokes. This white paper by experts from the AF-SCREEN International Collaboration summarizes existing evidence and knowledge gaps on searching for AF after a stroke by using ECG monitoring. New AF can be detected by routine plus intensive ECG monitoring in approximately one-quarter of patients with ischemic stroke. It may be causal, a bystander, or neurogenically induced by the stroke. AF after a stroke is a risk factor for thromboembolism and a strong marker for atrial myopathy. After acute ischemic stroke, patients should undergo 72 hours of electrocardiographic monitoring to detect AF. The diagnosis requires an ECG of sufficient quality for confirmation by a health professional with ECG rhythm expertise. AF detection rate is a function of monitoring duration and quality of analysis, AF episode definition, interval from stroke to monitoring commencement, and patient characteristics including old age, certain ECG alterations, and stroke type. Markers of atrial myopathy (eg, imaging, atrial ectopy, natriuretic peptides) may increase AF yield from monitoring and could be used to guide patient selection for more intensive/prolonged poststroke ECG monitoring. Atrial myopathy without detected AF is not currently sufficient to initiate OAC. The concept of embolic stroke of unknown source is not proven to identify patients who have had a stroke benefitting from empiric OAC treatment. However, some embolic stroke of unknown source subgroups (eg, advanced age, atrial enlargement) might benefit more from non-vitamin K-dependent OAC therapy than aspirin. Fulfilling embolic stroke of unknown source criteria is an indication neither for empiric non-vitamin K-dependent OAC treatment nor for withholding prolonged ECG monitoring for AF. Clinically diagnosed AF after a stroke or a transient ischemic attack is associated with significantly increased risk of recurrent stroke or systemic embolism, in particular, with additional stroke risk factors, and requires OAC rather than antiplatelet therapy. The minimum subclinical AF duration required on ECG monitoring poststroke/transient ischemic attack to recommend OAC therapy is debated.
AB - Cardiac thromboembolism attributed to atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes. Stroke may be the first manifestation of previously undetected AF. Given the efficacy of oral anticoagulants in preventing AF-related ischemic strokes, strategies of searching for AF after a stroke using ECG monitoring followed by oral anticoagulation (OAC) treatment have been proposed to prevent recurrent cardioembolic strokes. This white paper by experts from the AF-SCREEN International Collaboration summarizes existing evidence and knowledge gaps on searching for AF after a stroke by using ECG monitoring. New AF can be detected by routine plus intensive ECG monitoring in approximately one-quarter of patients with ischemic stroke. It may be causal, a bystander, or neurogenically induced by the stroke. AF after a stroke is a risk factor for thromboembolism and a strong marker for atrial myopathy. After acute ischemic stroke, patients should undergo 72 hours of electrocardiographic monitoring to detect AF. The diagnosis requires an ECG of sufficient quality for confirmation by a health professional with ECG rhythm expertise. AF detection rate is a function of monitoring duration and quality of analysis, AF episode definition, interval from stroke to monitoring commencement, and patient characteristics including old age, certain ECG alterations, and stroke type. Markers of atrial myopathy (eg, imaging, atrial ectopy, natriuretic peptides) may increase AF yield from monitoring and could be used to guide patient selection for more intensive/prolonged poststroke ECG monitoring. Atrial myopathy without detected AF is not currently sufficient to initiate OAC. The concept of embolic stroke of unknown source is not proven to identify patients who have had a stroke benefitting from empiric OAC treatment. However, some embolic stroke of unknown source subgroups (eg, advanced age, atrial enlargement) might benefit more from non-vitamin K-dependent OAC therapy than aspirin. Fulfilling embolic stroke of unknown source criteria is an indication neither for empiric non-vitamin K-dependent OAC treatment nor for withholding prolonged ECG monitoring for AF. Clinically diagnosed AF after a stroke or a transient ischemic attack is associated with significantly increased risk of recurrent stroke or systemic embolism, in particular, with additional stroke risk factors, and requires OAC rather than antiplatelet therapy. The minimum subclinical AF duration required on ECG monitoring poststroke/transient ischemic attack to recommend OAC therapy is debated.
KW - Aged
KW - Atrial Fibrillation/diagnosis
KW - Brain Ischemia/complications
KW - Electrocardiography
KW - Female
KW - Humans
KW - Male
KW - Stroke/complications
KW - Thromboembolism/diagnosis
U2 - 10.1161/CIRCULATIONAHA.119.040267
DO - 10.1161/CIRCULATIONAHA.119.040267
M3 - SCORING: Review article
C2 - 31765261
VL - 140
SP - 1834
EP - 1850
JO - CIRCULATION
JF - CIRCULATION
SN - 0009-7322
IS - 22
ER -