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CRYPTOGENIC STROKE CARDIAC DIAGNOSTICS & MONITORING

Atrial fibrillation detection and treatment matters

THE CRYPTOGENIC STROKE CHALLENGE

Stroke as a healthcare issue1

cryptogenic stroke challenge

Recurrent Stroke Rate among Patients Discharged with a Primary Diagnosis of Stroke2

recurrent stroke rate among patient discharged with primary stroke

THE LINK BETWEEN STROKE AND ATRIAL FIBRILLATION 

Why AF Detection and Treatment Matters for Cryptogenic Stroke Patients

AF Detection Matters Chart


2016 ESC Atrial Fibrillation Guidelines6

Long-term cardiac monitoring recommended for cryptogenic stroke patients

  • Guidelines developed by the Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC)
  • Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC
  • Endorsed by the European Stroke Organisation (ESO)
Class Level Recommendation

IIa

B

In stroke patients, additional ECG monitoring by long-term non- invasive ECG monitors or implanted loop recorders should be considered to document silent atrial fibrillation. 


30 Days of Cardiac Monitoring Is Not Long Enough in Cryptogenic Stroke Patients7

Atrial Fibrillation is frequently asymptomatic and/or paroxysmal

The CRYSTAL-AF Study found that short- and intermediate-term cardiac monitoring may miss many patients with paroxysmal AF.

Crystal AF Boxes Chart


REVEAL LINQ™ ICM Patient Selection Considerations

Indications*

  • Patients with clinical syndromes or situations at increased risk of cardiac arrhythmias

Appropriate

  • Stroke detected by CT or MRI that is not lacunar8
  • Absence of extracranial or intracranial atherosclerosis causing8
  • ≥ 50% luminal stenosis in arteries supplying the area of ischaemia8 
  • No major-risk cardioembolic source of embolism
  • No other specific cause of stroke identified (e.g., arteritis, dissection, migraine/vasospasm, drug misuse)8
  • Any age
  • CHADS2 score ≥ 2 (Minimal risk factors)

Not Appropriate

  • Indication for chronic anticoagulation or already on anticoagulation
  • Patients with a relative contraindication for long-term anticoagulation and not appropriate for LAA closure device

* See full brief statement for complete indications for use.


1

Wilkins E, Wilson L, Wickramasinghe K, et al. European Cardiovascular Disease Statistics 2017 edition. Eur Heart Network 2017:192

2

Feng W, Hendry RM, Adams RJ. Risk of recurrent stroke, myocardial infarction, or death in hospitalized stroke patients. Neurology. 2010;74:588–593.

3

Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. September 1987;147(9):1561-1564.

4

Lin HJ, Kelly-Hayes M, Beiser AS, et al. Stroke Severity in Atrial Fibrillation: The Framingham Study. Stroke. 1996; 27: 1760-1764.

5

Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation. August 1991;84(2):527-539.

6

Kirchhof P, Benussi, S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. Published online August 27, 2016. Accessed online August 31, 2016 at: http://eurheartj.oxfordjournals.org/content/early/2016/08/26/eurheartj.ehw210.

7

Sanna T, Diener HC, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. June 26, 2014;370(26):2478-2486.

8

Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. April 2014;13(4):429-438.