Optimal Duration of Monitoring for Atrial Fibrillation in Cryptogenic Stroke: A Nonsystematic Review.
Atrial fibrillation (AF) is the most common form of cardiac arrhythmias and an independent risk factor for stroke. Despite major advances in monitoring strategies, clinicians tend to miss the diagnoses of AF and especially paroxysmal AF due mainly to its asymptomatic presentation and the rather limited duration dedicated for monitoring for AF after a stroke, which is 24 hours as per the current recommended guidelines. Hence, determining the optimal duration of monitoring for paroxysmal atrial fibrillation after acute ischemic stroke remains a matter of debate. Multiple trials were published in regard to this matter using both invasive and noninvasive monitoring strategies for different monitoring periods. The data provided by these trials showcase strong evidence suggesting a longer monitoring strategy beyond 24 hours is associated with higher detection rates of AF, with the higher percentage of patients detected consequently receiving proper secondary stroke prevention with anticoagulation and thus justifying the cost-effectiveness of such measures. Overall, we thus conclude that increasing the monitoring duration for AF after a cryptogenic stroke to at least 72 hours will indeed enhance the detection rates, but the cost-effectiveness of this monitoring strategy compared to longer monitoring durations is yet to be established.
School of Medicine, Lebanese American University, P.O. Box 36, Byblos, Lebanon.
Essa
E
Hariri
Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, 6th Floor, P.O. Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.
Ahmad
A
Hachem
Faculty of Medicine, Lebanese University, P.O. Box 6573/14, Badaro, Museum, Beirut, Lebanon.
Georges
G
Sarkis
Department of Cardiology, Mount Lebanon Hospital-Gharios Medical Center, P.O. Box 470, Camil Chamoun Boulevard, Hazmieh, Lebanon.
Samer
S
Nasr
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis*; D003422:Critical Care; D003937:Diagnosis, Differential; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology*; D057832:Watchful Waiting / Q000379:methods*