Identification of Covert Atrial Fibrillation in Cryptogenic Ischemic Stroke: Current Clinical Practice in Japan.
OBJECTIVE
A new insertable cardiac monitor, Reveal LINQ (Medtronic, Dublin, Ireland), was approved for clinical use in Japan in March 2016 for detecting atrial fibrillation in patients who develop ischemic stroke with no clearly definable etiology even after extensive workup, so-called cryptogenic ischemic stroke. Cooperation between a specialist of the Japan Stroke Society and a trained cardiologist or cardiac surgeon is needed both for appropriate patient selection and appropriate management of the device. In this paper, the clinical significance of and diagnostic methods for cryptogenic stroke and covert atrial fibrillation are explained, along with our proposal for the clinical indications for this new device.
The majority of cryptogenic ischemic strokes are considered to be embolic. In particular, covert atrial fibrillation is drawing attention as the causal emboligenic disease, and it was identified in 30% of patients with long-term observation using an insertable cardiac monitor. Should atrial fibrillation be present, there is a high risk of recurrent stroke, and the cardioembolic stroke that appears is generally severe. The ability to identify atrial fibrillation would be beneficial for preventing stroke recurrence, as anticoagulants can then be used as an established method of secondary prevention. Because the use of insertable cardiac monitors is somewhat invasive, and long-term care systems are also needed, patients suitable for examination using the new device would need to be identified on the basis of detailed diagnostics in accordance withcurrent medical practice in Japan.
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: toyoda@ncvc.go.jp.
Kazunori
K
Toyoda
Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
Ken
K
Okumura
Department of Neurology, Kumamoto City Hospital, Kumamoto, Kumamoto, Japan.
Yoichiro
Y
Hashimoto
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Ota, Tokyo, Japan.
Takanori
T
Ikeda
Division of Cardio-Angiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University, Morioka, Iwate, Japan.
Takashi
T
Komatsu
Department of Stroke and Cerebrovascular Medicine, Kyorin University Faculty of Medicine, Mitaka, Tokyo, Japan.
Teruyuki
T
Hirano
Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan.
Haruhisa
H
Fukuda
Higashimatsuyama Medical Association Hospital, Higashimatsuyama, Saitama, Japan.
Kazuo
K
Matsumoto
Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka, Fukuoka, Japan.
Masahiro
M
Yasaka
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000209:etiology*; D002545:Brain Ischemia / Q000150:complications; D015716:Electrocardiography, Ambulatory; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008134:Long-Term Care; D008991:Monitoring, Physiologic; D020521:Stroke / Q000150:complications* / Q000209:etiology
Acute stroke; cardioembolism; embolic stroke of undetermined source; insertable cardiac monitor; stroke recurrence