Searching for Atrial Fibrillation Poststroke

作者：Renate B. Schnabel, Karl Georg Hæusler, Jeff S. Healey, Ben Freedman, Giuseppe Boriani, Johannes Brachmann, Axel Brandes, Alejandro Bustamante, Barbara Casadei, Harry J.G.M. Crijns, Wolfram Doehner, Gunnar Engström, Laurent Fauchier, Leif Friberg, David J. Gladstone, Taya V. Glotzer, Shinya Goto, Graeme J. Hankey, Joseph Harbison, Richard Hobbs, Linda Johnson, Hooman Kamel, Paulus Kirchhof, Eleni Korompoki, Derk Krieger, Gregory Y.H. Lip, Maja‐Lisa Løchen, Georges H. Mairesse, Joan Montaner, Lis Neubeck, George Ntaios, Jonathan P. Piccini, Tatjana Potpara, Terence J. Quinn, James A. Reiffel, Antônio Luiz Pinho Ribeiro, Michiel Rienstra, Mårten Rosenqvist, Sakis Themistoclakis, Moritz F. Sinner, Jesper Hastrup Svendsen, Isabelle C. Van Gelder, Rolf Wachter, Tissa Wijeratne, Bernard Yan · 发表于：Circulation · 年份：2019 · DOI：10.1161/circulationaha.119.040267 · 被引用次数：249 · 研究领域：Atrial Fibrillation Management and Outcomes、Acute Ischemic Stroke Management、Cardiac Imaging and Diagnostics

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...