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Expert opinion paper on atrial fibrillation detection after ischemic stroke

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Abstract

This expert opinion paper on atrial fibrillation detection after ischemic stroke includes a statement of the “Heart and Brain” consortium of the German Cardiac Society and the German Stroke Society. This paper was endorsed by the Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork. In patients with ischemic stroke, detection of atrial fibrillation should usually lead to a change in secondary stroke prevention, since oral anticoagulation is superior to antiplatelet drugs. The detection of previously undiagnosed atrial fibrillation can be improved in patients with ischemic stroke to optimize stroke prevention. This paper summarizes the present knowledge on atrial fibrillation detection after ischemic stroke. We propose an interdisciplinary standard for a “structured analysis of ECG monitoring” on the stroke unit as well as a staged diagnostic scheme for the detection of atrial fibrillation. Since the optimal duration and mode of ECG monitoring has not yet been finally established, this paper is intended to give advice to physicians who are involved in stroke care. In line with the nature of an expert opinion paper, labeling of classes of recommendations is not provided, since many statements are based on the expert opinion, reported case series and clinical experience. Therefore, this paper is not intended as a guideline.

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Author information

Authors and Affiliations

  1. Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Karl Georg Haeusler, Matthias Endres & Christian H. Nolte

  2. Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany

    Karl Georg Haeusler, Wolfram Doehner, Matthias Endres & Christian H. Nolte

  3. Atrial Fibrillation NETwork (AFNET) e.V., Münster, Germany

    Karl Georg Haeusler, Paulus Kirchhof & Renate Schnabel

  4. Klinik und Poliklinik für Neurologie, Universitätsmedizin Mainz, Mainz, Germany

    Klaus Gröschel

  5. Department of Neurology, University Hospital Essen, Essen, Germany

    Martin Köhrmann & Hans-Christoph Diener

  6. Abteilung Kardiologie und Stoffwechsel-Herzinsuffizienz, Kachexie and Sarcopenie, Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Stefan D. Anker

  7. Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany

    Stefan D. Anker

  8. Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen (UMG) and Deutsches Zentrum für Kardiovaskuläre Forschung (DZHK), Göttingen, Germany

    Stefan D. Anker

  9. II. Medizinische Klinik, Klinikum Coburg, Coburg, Germany

    Johannes Brachmann

  10. Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany

    Michael Böhm

  11. Klinik für Innere Medizin mit Schwerpunkt Kardiologie, Campus Virchow Klinikum, Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Wolfram Doehner & Burkert Pieske

  12. Berlin Institute of Health, Berlin, Germany

    Matthias Endres, Christian H. Nolte & Ulrich Laufs

  13. Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (DZHK), partner site Berlin, Berlin, Germany

    Matthias Endres, Christian H. Nolte & Burkert Pieske

  14. Deutsches Zentrum für Degenerative Erkrankungen (DZNE), partner site, Berlin, Germany

    Matthias Endres

  15. Department of Neurology, Head- and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Christian Gerloff & Götz Thomalla

  16. Stroke Unit Commission of the German Stroke Society, Berlin, Germany

    Christian Gerloff & Darius Günther Nabavi

  17. Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany

    Hagen B. Huttner

  18. Department of Neurology, Justus-Liebig-University, Giessen, Germany

    Manfred Kaps

  19. Institute of Cardiovascular Sciences, University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, University Hospitals Birmingham NHS Foundation NHS Trust, Birmingham, UK

    Paulus Kirchhof

  20. Klinik für Neurologie, Vivantes Klinikum Neukölln, Berlin, Germany

    Darius Günther Nabavi

  21. Zentrum der Neurologie und Neurochirurgie, Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany

    Waltraud Pfeilschifter

  22. Klinik für Innere Medizin und Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany

    Burkert Pieske

  23. Abteilung Neurologie mit Schwerpunkt neurovaskuläre Erkrankungen und Hertie-Institut für klinische Hirnforschung, Universitätsklinikum Tübingen, Tübingen, Germany

    Sven Poli

  24. Klinik für Neurologie, Evangelisches Klinikum Bethel, Bielefeld, Germany

    Wolf Rüdiger Schäbitz

  25. Department of Stroke Medicine, Imperial College London, London, UK

    Roland Veltkamp

  26. Klinik für Neurologie, Alfried Krupp Krankenhaus Essen, Essen, Germany

    Roland Veltkamp

  27. Neurologische Klinik, Klinikum Frankfurt Höchst, Frankfurt, Germany

    Thorsten Steiner

  28. Neurologische Klinik, Universitätsklinik Heidelberg, Heidelberg, Germany

    Thorsten Steiner

  29. Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany

    Ulrich Laufs & Rolf Wachter

  30. Abteilung für Neurologie, Asklepios Klinik Altona, Hamburg, Germany

    Joachim Röther

  31. Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen and Deutsches Zentrum Herz-Kreislauf-Forschung e.V., partner site Göttingen, Göttingen, Germany

    Rolf Wachter

  32. Abteilung für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany

    Renate Schnabel

  33. Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany

    Renate Schnabel

Authors
  1. Karl Georg Haeusler
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  2. Klaus Gröschel
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  3. Martin Köhrmann
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  4. Stefan D. Anker
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  5. Johannes Brachmann
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  6. Michael Böhm
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  7. Hans-Christoph Diener
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  8. Wolfram Doehner
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  9. Matthias Endres
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  10. Christian Gerloff
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  11. Hagen B. Huttner
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  12. Manfred Kaps
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  13. Paulus Kirchhof
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  14. Darius Günther Nabavi
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  15. Christian H. Nolte
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  16. Waltraud Pfeilschifter
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  17. Burkert Pieske
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  18. Sven Poli
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  19. Wolf Rüdiger Schäbitz
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  20. Götz Thomalla
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  21. Roland Veltkamp
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  22. Thorsten Steiner
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  23. Ulrich Laufs
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  24. Joachim Röther
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  25. Rolf Wachter
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  26. Renate Schnabel
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Corresponding author

Correspondence to Karl Georg Haeusler.

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Conflict of interest

A German version of this expert opinion paper of the “Heart and Brain” consortium of the German Cardiac Society and the German Stroke Society has been published previously [36]. KGH received lecture honoraria from Bayer HealthCare, Sanofi-Aventis, Pfizer, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Medtronic; honoraria for consulting from Edwards Lifesciences, Bayer HealthCare, Pfizer, EIP Pharma as well as research Grants from Bayer HealthCare and Sanofi-Aventis. KG received lecture honoraria, honoraria for consulting or travel Grants from Bayer HealthCare, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo and Pfizer. MKö received lecture honoraria and honoraria for consulting from Bayer HealthCare, Pfizer, Bristol-Myers Squibb and Boehringer Ingelheim. SDA received honoraria from Bayer, Boehringer Ingelheim, Novartis, Servier and Vifor Int. and research Grants from Abbott Vascular and Vifor Int. MB received research honoraria and lecture honoraria from Boehringer-Ingelheim, Medtronic, St. Jude, Servier, AstraZeneca and Vifor Pharma. JB received lecture honoraria, honoraria for consulting or travel costs from Bayer HealthCare, Daiichi Sankyo, Boehringer Ingelheim, Novartis, Sanofi-Aventis, Pfizer, Bristol-Myers Squibb, Medtronic, Biotronik. HCD has received honoraria for the participation in clinical studies and collaboration on advisory boards and lectures from: Abbott, Allergan, AstraZeneca, Bayer Vital, Bristol-Meyers-Squibb, Boehringer Ingelheim, BrainsGate, CoAxia, Corimmun, Covidien, Daiichi-Sankyo, D-Pharm, Fresenius, GlaxoSmithKline, Janssen Cilag, Lilly, Lundbeck, Medtronic, MSD, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, Portola, Sanofi-Aventis, Schering, Servier, Solvay, St-Jude, Syngis, Tacrelis, Thrombogenics and Wyeth. Revenues were transferred to the Essen University Clinical Center to finance research bodies for the Headache Center, the Vertigo Center and the Department of Neurology: AstraZeneca, GSK, Boehringer Ingelheim, Novartis, Janssen-Cilag and SanofiAventis. The University Department of Neurology has received research funding from the following institutions: DFG, BMBF, EU, NIH, EAST-AFnet, Bertelsmann Stiftung and Heinz-Nixdorf Stiftung. HCD owns no shares or shares of pharmaceutical companies or medical technology companies. HCD was involved in the development of guidelines of the DGN, the DSG, the ESC and EHRA. ME received research Grants from Bayer and Roche as well as fees to the Charité by Amgen, Bayer, BMS, Boehringer-Ingelheim, Ever, GSK, MSD, Novartis, Pfizer and Sanofi. CG received research Grants for stroke studies from the DFG and the EU as well as honoraria for Consulting from Bayer Vital, Boehringer Ingelheim, GlaxoSmithKline, Pfizer, Bristol-Myers Squibb, Sanofi Aventis, Amgen and Prediction BioSciences. HBH received lecturer and consultant honoraria and travel Grants as well as research funding from Bayer HealthCare, Boehringer-Ingelheim, Novartis and Medtronic. CHN received honoraria for lectures and consulting as well as travel Grants from Boehringer Ingelheim, Bayer HealthCare, Sanofi-Aventis, Pfizer, Bristol-Myers Squibb and Gore. MKa received honoraria for lectures and consulting from Bayer, Boehringer Ingelheim, Daiichi Sankyo. DGN received lecture honoraria from Bayer HealthCare, Sanofi-Aventis, Pfizer, Bristol-Myers Squibb, Boehringer Ingelheim, Medtronic; honoraria for lectures and travel Grants from AstraZeneca, Bayer HealthCare, Bristol-Myers Squibb and Pfizer. PK received research support from the European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK), DZHK and pharmaceutical companies. A detailed declaration of interest, updated annually, is publicly available on the ESC web site. WP received honoraria for consulting and travel Grants from Sanofi Aventis, research and lecture honoraria from Boehringer Ingelheim, travel Grants from Bayer, lecture honoraria, research Grants and travel Grants from Stryker Neurovascular, research Grants from Novartis Pharma. BP received honoraria for consulting and participation in study committees from Bayer Healthcare, MSD, Novartis, Stealth Peptides, Astra-Zeneca, Menarini and BMS. SP received honoraria for lectures, consulting and travel Grants from Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Pfizer, Daiichi Sankyo and Werfen as well as research Grants from Bristol-Myers Squibb, Pfizer, Boehringer-Ingelheim, Daiichi Sankyo und Helena Laboratories. WRS received honoraria for lectures, consulting and travel Grants from Bayer HealthCare, Daiichi Sankyo, Boehringer Ingelheim, Sanofi-Aventis, Pfizer, Bristol-Myers Squibb and Medtronic. TS received honoraria from Bayer HealthCare, Bristol-Myers Squibb, Pfizer, Boehringer Ingelheim, Daiichy Sankyo and consulting honoraria from Bayer, Bristol-Myers Squibb, Pfizer, Boehringer Ingelheim, Daiichy Sankyo and Medtronic. GT received consulting honoraria for participation in adisory boards, for lectures by Acandis, Bristol-Myers Squibb/Pfizer, Boehringer Ingelheim, Daichii Sankyo, GlaxoSmithKline and Stryker as well as research Grants from Bayer Vital. RV received honoraria for lectures and consulting from Bayer, Boehringer Ingelheim, Daiichi Sankyo, BMS, Pfizer, Medtronic, ApoplexMedical Technologies, Biogen, Amgen, Morphosys, Sanofi, AZT Therapeutics, Portola as well as research Grants from Bayer, Boehringer Ingelheim, BMS, Pfizer, Daiicihi Sankyo, Biogen, ApoplexMedical Technologies. UL received honoraria for lectures and consulting from Amgen, Bayer, Berlin-Chemie, Boehringer-Ingelheim, Daiichi-Sankyo, MSD, Sanofi and Servier. JR received honoraria for lectures and/or consulting from Sanofi-Aventis, Pfizer, Lundbeck, Boehringer Ingelheim, BMS, Bayer Vital, Servier as well as the Deutsche Allgemeine Krankenversicherung (DAK) and is PI of studies by Astra Zeneca and Servier. RW received honoraria for consulting and lectures and the care of patients involved in clinical studies from Bayer, Berlin Chemie, Boehringer Ingelheim, Bristol-Myers Squibb, CVRx, Johnson&Johnson, Medtronic, Novartis, Pfizer, Sanofi and Servier.

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Haeusler, K.G., Gröschel, K., Köhrmann, M. et al. Expert opinion paper on atrial fibrillation detection after ischemic stroke. Clin Res Cardiol 107, 871–880 (2018). https://doi.org/10.1007/s00392-018-1256-9

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