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2022 ESO Guidelines: "Screening for subclinical atrial fibrillation after unexplained ischemic stroke or transient ischemic attack" released

 Last Update: 2023-01-06
 Source: Internet
 Author: User

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In September 2022, the European Stroke Organization (ESO) published screening guidelines
for subclinical atrial fibrillation following unexplained ischaemic stroke or transient ischemic attack.
This article provides guidance for screening for subclinical atrial fibrillation (AF) in patients with unexplained ischemic stroke or transient ischemic attack (TIA
).

Yimaitong compiles and arranges, please do not reprint
without authorization.

Question 1: Does longer duration of rhythm monitoring increase the detection rate of subclinical AF compared with shorter periods of rhythm monitoring in adult patients with unexplained ischaemic stroke or TIA? Improved anticoagulation rates, reduced recurrent stroke or systemic embolism, intracranial hemorrhage, any major bleeding, mortality, and improved functional outcomes?

Evidence-based recommendation: for adult patients with unexplained ischaemic stroke or TIA, prolonged cardiac monitoring rather than standard 24-hour monitoring is recommended to increase the detection rate of subclinical AF
。 (Quality of evidence: moderate, strength of recommendation: strong).

Expert consensus states: For adult patients with unexplained ischemic stroke or TIA, extended heart rhythm monitoring for more than
48 hours is recommended.

Question 2: For adult patients with unexplained ischemic stroke or TIA, does increasing outpatient rhythm monitoring increase the detection rate of subclinical AF, improve anticoagulation rate, and reduce recurrent stroke or systemic embolism compared with in-hospital rhythm monitoring alone , intracranial hemorrhage, any major bleeding, mortality, and improved functional prognosis?

Evidence-based recommendation: for adult patients with unexplained ischaemic stroke or TIA, additional outpatient monitoring rather than in-hospital rhythm monitoring alone is recommended to increase the detection
of subclinical AF.
(Quality of evidence: very low, strength of recommendation: weak).

Expert consensus states: For adult patients with unexplained ischemic stroke or TIA, ECG monitoring is recommended as early as possible during hospitalization to improve AF detection
.

Question 3: For adult patients with unexplained ischaemic stroke or TIA, does an implantable monitoring device increase the detection rate of subclinical AF, improve anticoagulation rate, reduce recurrent stroke or systemic embolism, intracranial hemorrhage, any major bleeding, mortality compared with any non-implantable external monitoring device, And improved functional prognosis?

Evidence-based recommendation: for adult patients with unexplained ischaemic stroke or TIA, cardiac monitoring with an implantable device instead of a non-implantable external device is recommended to increase the detection
of subclinical AF.
(Quality of evidence: low, strength of recommendation: strong).

Question 4: For adult patients with unexplained ischemic stroke or TIA, does the presence of blood, ultrasonography, electrocardiogram or brain imaging, and biomarkers increase the detection rate of subclinical AF and improve the anticoagulation rate compared with their deficiency? Reduced recurrent stroke or systemic embolism, intracranial hemorrhage, any major bleeding, mortality, and improved functional outcomes?

Evidence-based recommendation: the advantages of using blood, echocardiography, electrocardiogram or brain imaging, and biomarkers to increase subclinical AF testing in adults with unexplained ischaemic stroke or TIA remain uncertain
.
(Quality of evidence: -, strength of recommendation: -)

Expert consensus states: The presence of underlying blood, echocardiography, ECG or brain imaging, and biomarkers may increase AF detection in adult patients with unexplained ischaemic stroke or TIA, but their use is recommended to be avoided to exclude patients from
long-term ECG monitoring given the limited evidence available.

Question 5: For adults with unexplained ischaemic stroke or TIA and patent foramen ovale (PFO), do implantable surveillance devices increase the detection rate of subclinical AF, improve anticoagulation rates, reduce recurrent stroke or systemic embolism, intracranial hemorrhage, any major bleeding, mortality, and improve functional outcomes compared with any non-implantable external monitoring device?

Evidence-based recommendation: the risk and benefit of using an implantable surveillance device compared with any non-implantable external monitoring device for the increased risk and benefit of subclinical AF testing in adult patients with unexplained ischaemic stroke or TIA and PFO remains uncertain
。 (Quality of evidence: -, strength of recommendation: -)

Expert consensus states: For adult patients with unexplained ischemic stroke or TIA and PFO, patients over 55 years of age are advised to extend heart rhythm monitoring for more than 48 hours to increase the detection
of subclinical AF.

Expert consensus statement: Extended heart rhythm monitoring is recommended in patients with unexplained ischemic stroke and PFO older than 55 years of age to improve anticoagulation rates or reduce unnecessary PFO closure device implantation
.

Expert Consensus Statement: MWG recommends the use of implantable surveillance devices to detect paroxysmal AF
in patients over 55 years of age with unexplained ischemic stroke and PFO compared to any non-implantable external monitoring device.

Expert consensus states: For patients younger than 55 years with unexplained ischaemic stroke and PFO, we suggest basic cardiac monitoring by telemetry or Holter-ECG within 24 hours to exclude subclinical AF, but features of
clinical, stroke, and PFO should be considered.

Compiled from: European Stroke Organisation (ESO) guideline on screening for subclinical atrial fibrillation after stroke or transient ischaemic attack of undetermined origin

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