ESC Working Group on e-Cardiology Position Paper: accuracy and reliability of electrocardiogram monitoring in the detection of atrial fibrillation in cryptogenic stroke patients : In collaboration with the Council on Stroke, the European Heart Rhythm Association, and the Digital Health Committee
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ESC Working Group on e-Cardiology Position Paper: accuracy and reliability of electrocardiogram monitoring in the detection of atrial fibrillation in cryptogenic stroke patients : In collaboration with the Council on Stroke, the European Heart Rhythm Association, and the Digital Health Committee. / Dilaveris, Polychronis E; Antoniou, Christos Konstantinos; Caiani, Enrico G; Casado-Arroyo, Ruben; Climent, Andreu Μ; Cluitmans, Matthijs; Cowie, Martin R; Doehner, Wolfram; Guerra, Federico; Jensen, Magnus T; Kalarus, Zbigniew; Locati, Emanuela Teresa; Platonov, Pyotr; Simova, Iana; Schnabel, Renate B; Schuuring, Mark; Tsivgoulis, Georgios; Lumens, Joost.
In: European heart journal. Digital health, Vol. 3, No. 3, 09.2022, p. 341-358.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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T1 - ESC Working Group on e-Cardiology Position Paper: accuracy and reliability of electrocardiogram monitoring in the detection of atrial fibrillation in cryptogenic stroke patients : In collaboration with the Council on Stroke, the European Heart Rhythm Association, and the Digital Health Committee
AU - Dilaveris, Polychronis E
AU - Antoniou, Christos Konstantinos
AU - Caiani, Enrico G
AU - Casado-Arroyo, Ruben
AU - Climent, Andreu Μ
AU - Cluitmans, Matthijs
AU - Cowie, Martin R
AU - Doehner, Wolfram
AU - Guerra, Federico
AU - Jensen, Magnus T
AU - Kalarus, Zbigniew
AU - Locati, Emanuela Teresa
AU - Platonov, Pyotr
AU - Simova, Iana
AU - Schnabel, Renate B
AU - Schuuring, Mark
AU - Tsivgoulis, Georgios
AU - Lumens, Joost
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2022/9
Y1 - 2022/9
N2 - The role of subclinical atrial fibrillation as a cause of cryptogenic stroke is unambiguously established. Long-term electrocardiogram (ECG) monitoring remains the sole method for determining its presence following a negative initial workup. This position paper of the European Society of Cardiology Working Group on e-Cardiology first presents the definition, epidemiology, and clinical impact of cryptogenic ischaemic stroke, as well as its aetiopathogenic association with occult atrial fibrillation. Then, classification methods for ischaemic stroke will be discussed, along with their value in providing meaningful guidance for further diagnostic efforts, given disappointing findings of studies based on the embolic stroke of unknown significance construct. Patient selection criteria for long-term ECG monitoring, crucial for determining pre-test probability of subclinical atrial fibrillation, will also be discussed. Subsequently, the two major classes of long-term ECG monitoring tools (non-invasive and invasive) will be presented, with a discussion of each method's pitfalls and related algorithms to improve diagnostic yield and accuracy. Although novel mobile health (mHealth) devices, including smartphones and smartwatches, have dramatically increased atrial fibrillation detection post ischaemic stroke, the latest evidence appears to favour implantable cardiac monitors as the modality of choice; however, the answer to whether they should constitute the initial diagnostic choice for all cryptogenic stroke patients remains elusive. Finally, institutional and organizational issues, such as reimbursement, responsibility for patient management, data ownership, and handling will be briefly touched upon, despite the fact that guidance remains scarce and widespread clinical application and experience are the most likely sources for definite answers.
AB - The role of subclinical atrial fibrillation as a cause of cryptogenic stroke is unambiguously established. Long-term electrocardiogram (ECG) monitoring remains the sole method for determining its presence following a negative initial workup. This position paper of the European Society of Cardiology Working Group on e-Cardiology first presents the definition, epidemiology, and clinical impact of cryptogenic ischaemic stroke, as well as its aetiopathogenic association with occult atrial fibrillation. Then, classification methods for ischaemic stroke will be discussed, along with their value in providing meaningful guidance for further diagnostic efforts, given disappointing findings of studies based on the embolic stroke of unknown significance construct. Patient selection criteria for long-term ECG monitoring, crucial for determining pre-test probability of subclinical atrial fibrillation, will also be discussed. Subsequently, the two major classes of long-term ECG monitoring tools (non-invasive and invasive) will be presented, with a discussion of each method's pitfalls and related algorithms to improve diagnostic yield and accuracy. Although novel mobile health (mHealth) devices, including smartphones and smartwatches, have dramatically increased atrial fibrillation detection post ischaemic stroke, the latest evidence appears to favour implantable cardiac monitors as the modality of choice; however, the answer to whether they should constitute the initial diagnostic choice for all cryptogenic stroke patients remains elusive. Finally, institutional and organizational issues, such as reimbursement, responsibility for patient management, data ownership, and handling will be briefly touched upon, despite the fact that guidance remains scarce and widespread clinical application and experience are the most likely sources for definite answers.
U2 - 10.1093/ehjdh/ztac026
DO - 10.1093/ehjdh/ztac026
M3 - SCORING: Review article
C2 - 36712155
VL - 3
SP - 341
EP - 358
JO - European heart journal. Digital health
JF - European heart journal. Digital health
SN - 2634-3916
IS - 3
ER -
