• J Cardiovasc Med (Hagerstown) · Dec 2016

    Cryptogenic ischemic stroke and prevalence of asymptomatic atrial fibrillation: a prospective study.

    • Marcella Jorfida, Marina Antolini, Enrico Cerrato, Maria Giovanna Caprioli, Davide Castagno, Paolo Garrone, Carlo Budano, Paolo Cerrato, and Fiorenzo Gaita.
    • aDivision of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and Department of Medical Sciences bStroke Unit, 'Città della Salute e della Scienza' Hospital and University of Turin, Turin, Italy.
    • J Cardiovasc Med (Hagerstown). 2016 Dec 1; 17 (12): 863-869.

    BackgroundAtrial fibrillation is responsible for up to one-third of ischemic strokes, and is also associated with silent cerebral infarctions and transient ischemic attacks (TIAs). The self-terminating and often asymptomatic nature of paroxysmal atrial fibrillation (PAF) may lead to its underdiagnosis. A continuous and long-term heart rhythm monitoring can be useful in unmasking PAF episodes.ObjectivePrevalence of asymptomatic PAF in patients suffering a cryptogenic stroke, at risk for atrial fibrillation but without any history of arrhythmia or palpitations, using a continuous electrocardiographic monitoring.MethodsOne hundred and forty-two consecutive patients were admitted to the Stroke Unit of 'Città della Salute e della Scienza' Hospital of Turin between June 2010 and March 2013 and discharged with the diagnosis of ischemic cryptogenic stroke. Sixty fulfilled predefined inclusion criteria. Follow-up was carried on and completed for the 54 patients who consented to implantable loop recorder (ILR) implantation. After ILR implantation, trans-telephonic data were collected monthly.ResultsAtrial fibrillation episodes lasting more than 5 min were recorded in 25 patients (46%), median detection time was 5.4 months (range 1-18) and median duration of atrial fibrillation episodes was 20 h (range 7 min-8 days) with 19 patients (76%) remaining asymptomatic and the others experiencing weakness and dyspnoea but not palpitations.ConclusionLong-term heart rhythm monitoring is successful in unmasking silent atrial fibrillation in 46% of patients suffering a cryptogenic stroke with concomitant atrial fibrillation risk factors, but without history of arrhythmia or palpitations.

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