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Use of Prolonged Cardiac Rhythm Monitoring to Identify Atrial Fibrillation After Cryptogenic Stroke

  • Invasive Electrophysiology and Pacing (E. Kevin Heist, Section Editor)
  • Published:
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Abstract

Purpose of Review

Prolonged cardiac monitoring (PCM) improves detection of atrial fibrillation (AF) after cryptogenic stroke. We summarize current research supporting the use of PCM as part of the cryptogenic stroke evaluation, while highlighting areas that require more investigation.

Recent Findings

Despite increased AF detection with longer durations of PCM, more definitive research is needed to demonstrate how PCM improves clinical outcomes. The optimal type, timing, and length of cardiac monitoring after cryptogenic stoke remains unknown. Clinical calculators will be important to risk stratify which cryptogenic stroke patients are most likely to benefit from PCM. Currently, AF detection after cryptogenic stroke should prompt consideration of anticoagulation, but it is unclear if all durations and timing of AF after stroke should be treated the same.

Summary

PCM remains an important part of the cryptogenic stroke work up, and detection of AF allows for anticoagulation initiation. Additional research is needed to further refine our application of PCM to cryptogenic stroke.

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Funding

Dr. Singhal has received research/grant support from the National Institutes of Health/National Institute of Neurological Disorders and Stroke (R01NS105875, U10NS086729, U01NS095869) and the CRICO Risk Management Foundation; publishing royalties/honoraria from MedLink, LLC and UpToDate, Inc.; and provided expert legal testimony. Dr. Schwamm reports consulting to companies on the topic of stroke prevention in atrial fibrillation to Medtronic regarding trial design and conduct for stroke prevention in atrial fibrillation (National PI for Stroke AF NCT02700945), continuing medical education curriculum development and presentations (sponsored by Medtronic, MedScape, and MediaSphere), stroke systems of care consulting to the Massachusetts Department of Public Health, and funding from the NIH (U24NS107243, R01NS111952, R01AG062770) and PCORI (R-1609–35,995).

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  1. Stroke Service, Department of Neurology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA

    Alexis T. Roy, Lee H. Schwamm & Aneesh B. Singhal

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  1. Alexis T. Roy
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  2. Lee H. Schwamm
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Correspondence to Aneesh B. Singhal.

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This article is part of the Topical Collection on Invasive Electrophysiology and Pacing

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Roy, A.T., Schwamm, L.H. & Singhal, A.B. Use of Prolonged Cardiac Rhythm Monitoring to Identify Atrial Fibrillation After Cryptogenic Stroke. Curr Cardiol Rep 24, 337–346 (2022). https://doi.org/10.1007/s11886-022-01652-1

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