• Taya V Glotzer and Paul D Ziegler.
• Hackensack University Medical Center, Hackensack, New Jersey,. Electronic address: TayaVG@aol.com.
• Heart Rhythm. 2015 Jan 1; 12 (1): 234-41.

BackgroundStroke without an identifiable cause is frightening to patients and their families and is frustrating for the caring physician. Approximately 30% of patients with cardiac implanted electronic devices have some evidence of atrial fibrillation (AF), and much of it is silent: asymptomatic, and previously unrecognized.ObjectiveThe purpose of this review is to examine "silent AF" as a potential cause of cryptogenic stroke.Methods/ResultsWe begin by reviewing most of the published literature on screening for AF with different monitoring technologies in the setting of cryptogenic stroke. We present the results of 2 recent large randomized trials, CRYSTAL AF and EMBRACE, which compare standard of care monitoring in cryptogenic stroke patients to invasive and noninvasive monitoring strategies, respectively. Finally, we review the relationship of silent AF to stroke in the cardiac implanted electronic device population. Patient selection, duration of monitoring, sensitivity and specificity of monitoring technology, patient compliance, and several other factors affect the yield of AF detection during monitoring.ConclusionData suggest that silent AF is identified in approximately 30% of cryptogenic stroke patients and has important therapeutic implications. Oral anticoagulation likely should be prescribed when silent AF is detected.Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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