DETECTION OF ATRIAL FIBRILLATION AFTER PROLONGED MONITORING OF HEART-RHYTHM IN PATIENTS WITH CRYPTOGENIC ISCHEMIC STROKE

Abstract

Atrial fibrillation (AF) is a common supraventricular arrhythmias with a high prevalence among the oldest old that has been associated with a high risk of systemic embolism and ischemic stroke (IS). Paroxysmal atrial fibrillation (PAF) can be the underlying pathogenic mechanism of cryptogenic strokes or transient ischemic attacks (TIA). However detecting PAF in everyday clinical practice is difficult, due to its brief duration and usual absence of other symptoms. Furthermore IS with an underlying PAF have been associated with severe neurological presentation as well as high rates of early and late poor functional outcomes. Therefore early and reliable PAF diagnosis is critical for effective primary and secondary stroke prevention. Consequently different types of prolonged monitoring devices (portable or implantable) are being currently used including prolonged continuous Holter monitoring, cardiac outpatient telemetry and implantable event loop recorders. There are several studies showing clear benefit from prolonged monitoring, in detecting PAF compared to conventional screening with 24-hour electrocardiogram (with an estimated incidence of PAF up to 30% among patients with cryptogenic stroke). Nevertheless, to the best of our knowledge there are no specific guidelines concerning the specific diagnostic protocol that should be employed in order to detect asymptomatic PAF in patients with cryptogenic stroke. This study aims to critically review the available literature and present all the advantages and disadvantages of the current prolonged monitoring devices.