Atrial fibrillation detection and treatment matters
Cryptogenic stroke accounts for approximately one-third of ischemic strokes in the modern stroke registries and databases.2
Cryptogenic stroke is as prevalent as large vessel stroke.
The 2019 AHA/ACC/HRS atrial fibrillation guidelines provide a Class IIa, Level B-R recommendation for device detection of AF in patients with cryptogenic stroke (i.e., stroke of unknown cause).6
Class of Recommendation (COR)
Level of Evidence (LOE)
|I||B-NR||1. In patients with cardiac implantable electronic devices (pacemakers or implanted cardioverter-defibrillators), the presence of recorded atrial high-rate episodes (AHREs) should prompt further evaluation to document clinically relevant to AF to guide treatment decisions (S7.12-1-S7.12-5).|
|IIa*||B-R||2. In patients with cryptogenic stroke (i.e., stroke of unknown cause) in whom external ambulatory monitoring is inconclusive, implantation of a cardiac monitor (loop recorder) is reasonable to optimize detection of silent AF (S7.12-6).|
The CRYSTAL-AF Study found that short- and intermediate-term cardiac monitoring may miss many patients with paroxysmal AF.
Class IIa is Benefit >> Risk and LOE B-R is moderate quality of evidence from 1 or more RCTs or meta-analyses of moderate quality RCTs.
See full brief statement for complete indications for use.
ABCD2 Score > 5.
Mozzafarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics – 2015 update: a report from the American Heart Association. Circulation. January 27, 2015;131(4):e29-e322.
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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.
Lin HJ, Kelly-Hayes M, Beiser AS, et al. Stroke Severity in Atrial Fibrillation: The Framingham Study. Stroke. October 1996;27(10):1760-1764.
Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation. August 1991;84(2):527-539.
January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. Published online January 28, 2019.
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. October 7, 2016;37(38):2893-2962.
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.
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.