Searching for Atrial Fibrillation Poststroke : A White Paper of the AF-SCREEN International Collaboration

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Searching for Atrial Fibrillation Poststroke : A White Paper of the AF-SCREEN International Collaboration

Schnabel, Renate B. (författare): German Centre for Cardiovascular Research,University Medical Center Hamburg-Eppendorf

Haeusler, Karl Georg (författare): University Hospital of Wϋrzburg

Healey, Jeffrey S. (författare): McMaster University

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Freedman, Ben (författare): University of Sydney

Boriani, Giuseppe (författare): University of Modena and Reggio Emilia

Brachmann, Johannes (författare): Klinikum Coburg

Brandes, Axel (författare): Odense University Hospital

Bustamante, Alejandro (författare): Vall d'Hebron University Hospital

Casadei, Barbara (författare): University of Oxford

Crijns, Harry J.G.M. (författare): Maastricht University Medical Centre

Doehner, Wolfram (författare): Charité - University Medicine Berlin,German Centre for Cardiovascular Research

Engström, Gunnar (författare): Lund University,Lunds universitet,Kardiovaskulär forskning - epidemiologi,Forskargrupper vid Lunds universitet,Cardiovascular Research - Epidemiology,Lund University Research Groups

Fauchier, Laurent (författare): University Hospital of Tours,University Of Tours

Friberg, Leif (författare): Karolinska Institute

Gladstone, David J. (författare): Sunnybrook Health Sciences Centre,University of Toronto

Glotzer, Taya V. (författare): Hackensack University Medical Center

Goto, Shinya (författare): Tokai University

Hankey, Graeme J. (författare): Sir Charles Gairdner Hospital,University of Western Australia, Perth

Harbison, Joseph A. (författare): Trinity College Dublin

Hobbs, F. D.Richard (författare): University of Oxford

Johnson, Linda S.B. (författare): Lund University,Lunds universitet,Kardiovaskulär forskning - epidemiologi,Forskargrupper vid Lunds universitet,Cardiovascular Research - Epidemiology,Lund University Research Groups

Kamel, Hooman (författare): Cornell University

Kirchhof, Paulus (författare): University of Birmingham,University Hospitals Birmingham

Korompoki, Eleni (författare): Imperial College London

Krieger, Derk W. (författare): Mohammed Bin Rashid University of Medicine and Health Sciences,Mediclinic City Hospital, Dubai

Lip, Gregory Y.H. (författare): Liverpool Heart and Chest Hospital,University of Liverpool

Løchen, Maja Lisa (författare): University Hospital of North Norway

Mairesse, Georges H. (författare): Cliniques du Sud Luxembourg

Montaner, Joan (författare): Vall d'Hebron University Hospital

Neubeck, Lis (författare): Edinburgh Napier University

Ntaios, George (författare): University of Thessaly

Piccini, Jonathan P. (författare): Duke Clinical Research Institute (DCRI),Duke University Medical Center

Potpara, Tatjana S. (författare): University of Belgrade

Quinn, Terence J. (författare): University of Glasgow

Reiffel, James A. (författare): Columbia University

Ribeiro, Antonio Luiz Pinho (författare): Federal University of Minas Gerais,Hospital das Clínicas da Universidade Federal de Minas Gerais

Rienstra, Michiel (författare): University Medical Center Groningen,University of Groningen

Rosenqvist, Mårten (författare): Karolinska Institute

Sakis, Themistoclakis (författare): Venice-Mestre Hospital (Ospedale dell'Angelo)

Sinner, Moritz F. (författare): German Centre for Cardiovascular Research,Ludwig-Maximilian University of Munich,University Hospital Munich

Svendsen, Jesper Hastrup (författare): University of Copenhagen,Copenhagen University Hospital

Van Gelder, Isabelle C. (författare): University Medical Center Groningen,University of Groningen

Wachter, Rolf (författare): German Centre for Cardiovascular Research,University Hospital Leipzig,University Medical Center Göttingen

Wijeratne, Tissa (författare): Sunshine Hospital, St Albans,University of Melbourne

Yan, Bernard (författare): Royal Melbourne Hospital

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(creator_code:org_t)

2019
2019
Engelska 17 s.
Ingår i: Circulation. - 1524-4539. ; 140:22, s. 1834-1850

Relaterad länk:: http://dx.doi.org/10...; visa fler...; https://lup.lub.lu.s...; https://doi.org/10.1...; http://kipublication...; visa färre...

Tidskriftsartikel (refereegranskat)

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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 from monitoring and could be used to guide patient selection for more intensive/prolonged poststroke ECG monitoring. Atrial myopathy without detected AF is not currently sufficient to initiate OAC. The concept of embolic stroke of unknown source is not proven to identify patients who have had a stroke benefitting from empiric OAC treatment. However, some embolic stroke of unknown source subgroups (eg, advanced age, atrial enlargement) might benefit more from non-vitamin K-dependent OAC therapy than aspirin. Fulfilling embolic stroke of unknown source criteria is an indication neither for empiric non-vitamin K-dependent OAC treatment nor for withholding prolonged ECG monitoring for AF. Clinically diagnosed AF after a stroke or a transient ischemic attack is associated with significantly increased risk of recurrent stroke or systemic embolism, in particular, with additional stroke risk factors, and requires OAC rather than antiplatelet therapy. The minimum subclinical AF duration required on ECG monitoring poststroke/transient ischemic attack to recommend OAC therapy is debated.

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Av författaren/redakt...: Schnabel, Renate ...; Haeusler, Karl G ...; Healey, Jeffrey ...; Freedman, Ben; Boriani, Giusepp ...; Brachmann, Johan ...; visa fler...; Brandes, Axel; Bustamante, Alej ...; Casadei, Barbara; Crijns, Harry J. ...; Doehner, Wolfram; Engström, Gunnar; Fauchier, Lauren ...; Friberg, Leif; Gladstone, David ...; Glotzer, Taya V.; Goto, Shinya; Hankey, Graeme J ...; Harbison, Joseph ...; Hobbs, F. D.Rich ...; Johnson, Linda S ...; Kamel, Hooman; Kirchhof, Paulus; Korompoki, Eleni; Krieger, Derk W.; Lip, Gregory Y.H ...; Løchen, Maja Lis ...; Mairesse, George ...; Montaner, Joan; Neubeck, Lis; Ntaios, George; Piccini, Jonatha ...; Potpara, Tatjana ...; Quinn, Terence J ...; Reiffel, James A ...; Ribeiro, Antonio ...; Rienstra, Michie ...; Rosenqvist, Mårt ...; Sakis, Themistoc ...; Sinner, Moritz F ...; Svendsen, Jesper ...; Van Gelder, Isab ...; Wachter, Rolf; Wijeratne, Tissa; Yan, Bernard; visa färre...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kardiologi

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Av lärosätet: Lunds universitet; Karolinska Institutet

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Searching for Atrial Fibrillation Poststroke : A White Paper of the AF-SCREEN International Collaboration

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