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Title: Monitoring for atrial fibrillation prior to patent foramen ovale closure after cryptogenic stroke.
Austin Authors: Diener, Hans-Christoph;Wachter, Rolf;Wong, Andrew;Thijs, Vincent N ;Schnabel, Renate B;Ntaios, George;Kasner, Scott E;Rothwell, Peter M;Passman, Rod;Saver, Jeffrey L;Albers, Bert;Bernstein, Richard A
Affiliation: Neurology Department, Royal Brisbane and Women's Hospital and the University of Queensland, Brisbane, Australia
Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Medical Faculty of the University Duisburg-Essen, Essen, Germany 39081..
Department of Cardiology, University Hospital Leipzig, Leipzig, Germany 70622..
The Florey Institute of Neuroscience and Mental Health
Department of Cardiology, University Heart & Vascular Center Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner site, Hamburg/Kiel/Luebeck, Hamburg, Germany 196169..
Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece..
Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 14640..
Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK..
Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA 12244..
Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA 12222..
Albers Clinical Evidence Consultancy, Winterswijk Woold, The Netherlands..
Department of Neurology, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA 12244..
Issue Date: 1-Sep-2022 2022
Publication information: International Journal of Stroke: 2022: 17474930221124412
Abstract: AbstractAbstractBackground: Patients who had a cryptogenic stroke (CS) suspected to be causally related to a patent foramen ovale (PFO) are candidates for percutaneous PFO closure. In such patients it is important to screen for atrial fibrillation (AF). Limited guidance is available regarding AF monitoring strategies in CS patients with PFO addressing optimal monitoring technology and duration. To provide a narrative review of cardiac rhythm monitoring in CS patients considered for PFO closure, including current practices, stroke recurrences after CS, findings from monitoring studies in CS patients, and predictors for AF detection published in the literature. To propose an personalized strategy for cardiac monitoring in CS patients, accounting for aspects predicting AF detection. AF detection in CS patients is predicted by age, left atrial enlargement, prolonged PR interval, frequent premature atrial contractions, interatrial conduction block, diabetes, prior brain infarctions, leukoaraiosis, elevated BNP/NT-proBNP levels, and a family history of AF, as well as composed scores (e.g., CHA2DS2-VASc, AF-ESUS). The causal role of the PFO may be accounted for by the RoPE score and/or the PASCAL classification. A personalized approach to AF detection in CS patients is proposed, accounting for the likelihood of AF detection and aimed at obtaining sufficient confidence regarding the absence of AF in patients considered for PFO closure. Additionally, the impact of high risk PFO features on the monitoring strategy is discussed.
DOI: 10.1177/17474930221124412
PubMed URL: 36050817
Type: Journal Article
Subjects: Atrial fibrillation
Cardiac rhythm monitoring
Cryptogenic stroke
Monitoring strategy
Patent foramen ovale closure
Stroke recurrence
Appears in Collections:Journal articles

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