Searching for Atrial Fibrillation Poststroke: A White Paper of the AF-SCREEN International Collaboration

Renate Schnabel, Karl Georg Häusler, Jeffrey S Healey, S Ben Freedman*, Giuseppe Boriani, Johannes Brachmann, Axel Brandes, Alejandro Bustamante, Barbara Casadei, Harry J G M Crijns, Wolfram Doehner, Gunnar Engström, Laurent Fauchier, Leif Friberg, David J Gladstone, Taya V Glotzer, Shinya Goto, Graeme J Hankey, Joseph A. Harbison, F D Richard Hobbs Linda  S.B. Johnson, Hooman Kamel, Paulus Kirchhof, Eleni Korompoki, Derk Wolfgang Krieger, Gregory Y H Lip, M L Lochen, Georges H Mairesse, Joan Montaner, Lis Neubeck, George Ntaios, Jonathan P Piccini, Tatjana S Potpara, Terence J Quinn, James Reiffel, Antonio Luiz Pinho Ribeiro, Michiel Rienstra, Mårten Rosenqvist, Sakis Themistoclakis, Moritz F Sinner, Jesper Hastrup Svendsen, Isabelle C Van Gelder, Rolf Wachter, Tissa Wijeratne, Bernard Yan

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Cardiac thromboembolism attributed to atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes. Stroke may be the first manifestation of previously undetected AF. Given the efficacy of oral anticoagulants in preventing AF-related ischemic strokes, strategies of searching for AF after a stroke using ECG monitoring followed by oral anticoagulation (OAC) treatment have been proposed to prevent recurrent cardioembolic strokes. This white paper by experts from the AF-SCREEN International Collaboration summarizes existing evidence and knowledge gaps on searching for AF after a stroke by using ECG monitoring. New AF can be detected by routine plus intensive ECG monitoring in approximately one-quarter of patients with ischemic stroke. It may be causal, a bystander, or neurogenically induced by the stroke. AF after a stroke is a risk factor for thromboembolism and a strong marker for atrial myopathy. After acute ischemic stroke, patients should undergo 72 hours of electrocardiographic monitoring to detect AF. The diagnosis requires an ECG of sufficient quality for confirmation by a health professional with ECG rhythm expertise. AF detection rate is a function of monitoring duration and quality of analysis, AF episode definition, interval from stroke to monitoring commencement, and patient characteristics including old age, certain ECG alterations, and stroke type. Markers of atrial myopathy (eg, imaging, atrial ectopy, natriuretic peptides) may increase AF yield from monitoring and could be used to guide patient selection for more intensive/prolonged poststroke ECG monitoring. Atrial myopathy without detected AF is not currently sufficient to initiate OAC. The concept of embolic stroke of unknown source is not proven to identify patients who have had a stroke benefitting from empiric OAC treatment. However, some embolic stroke of unknown source subgroups (eg, advanced age, atrial enlargement) might benefit more from non– vitamin K-dependent OAC therapy than aspirin. Fulfilling embolic stroke of unknown source criteria is an indication neither for empiric non– vitamin K-dependent OAC treatment nor for withholding prolonged ECG monitoring for AF. Clinically diagnosed AF after a stroke or a transient ischemic attack is associated with significantly increased risk of recurrent stroke or systemic embolism, in particular, with additional stroke risk factors, and requires OAC rather than antiplatelet therapy. The minimum subclinical AF duration required on ECG monitoring poststroke/transient ischemic attack to recommend OAC therapy is debated
OriginalsprogEngelsk
TidsskriftCirculation
Vol/bind140
Udgave nummer22
Sider (fra-til)1834-1850
ISSN0009-7322
DOI
StatusUdgivet - 26. nov. 2019

Fingeraftryk

Electrocardiography
Muscular Diseases
Transient Ischemic Attack
Physiologic Monitoring
Atrial Natriuretic Factor
Patient Selection
Health

Citer dette

Schnabel, R., Georg Häusler, K., Healey, J. S., Freedman, S. B., Boriani, G., Brachmann, J., ... Yan, B. (2019). Searching for Atrial Fibrillation Poststroke: A White Paper of the AF-SCREEN International Collaboration . Circulation, 140(22), 1834-1850. https://doi.org/10.1161/CIRCULATIONAHA.119.040267
Schnabel, Renate ; Georg Häusler, Karl ; Healey, Jeffrey S ; Freedman, S Ben ; Boriani, Giuseppe ; Brachmann, Johannes ; Brandes, Axel ; Bustamante, Alejandro ; Casadei, Barbara ; Crijns, Harry J G M ; Doehner, Wolfram ; Engström, Gunnar ; Fauchier, Laurent ; Friberg, Leif ; Gladstone, David J ; Glotzer, Taya V ; Goto, Shinya ; Hankey, Graeme J ; Harbison, Joseph A. ; Hobbs, F D Richard ; Johnson, Linda  S.B. ; Kamel, Hooman ; Kirchhof, Paulus ; Korompoki, Eleni ; Krieger, Derk Wolfgang ; Lip, Gregory Y H ; Lochen, M L ; Mairesse, Georges H ; Montaner, Joan ; Neubeck, Lis ; Ntaios, George ; Piccini, Jonathan P ; Potpara, Tatjana S ; Quinn, Terence J ; Reiffel, James ; Pinho Ribeiro, Antonio Luiz ; Rienstra, Michiel ; Rosenqvist, Mårten ; Themistoclakis, Sakis ; Sinner, Moritz F ; Svendsen, Jesper Hastrup ; Van Gelder, Isabelle C ; Wachter, Rolf ; Wijeratne, Tissa ; Yan, Bernard. / Searching for Atrial Fibrillation Poststroke : A White Paper of the AF-SCREEN International Collaboration . I: Circulation. 2019 ; Bind 140, Nr. 22. s. 1834-1850.
@article{8577ddca891b48a09b96097b75bfbd8c,
title = "Searching for Atrial Fibrillation Poststroke: A White Paper of the AF-SCREEN International Collaboration",
abstract = "Cardiac thromboembolism attributed to atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes. Stroke may be the first manifestation of previously undetected AF. Given the efficacy of oral anticoagulants in preventing AF-related ischemic strokes, strategies of searching for AF after a stroke using ECG monitoring followed by oral anticoagulation (OAC) treatment have been proposed to prevent recurrent cardioembolic strokes. This white paper by experts from the AF-SCREEN International Collaboration summarizes existing evidence and knowledge gaps on searching for AF after a stroke by using ECG monitoring. New AF can be detected by routine plus intensive ECG monitoring in approximately one-quarter of patients with ischemic stroke. It may be causal, a bystander, or neurogenically induced by the stroke. AF after a stroke is a risk factor for thromboembolism and a strong marker for atrial myopathy. After acute ischemic stroke, patients should undergo 72 hours of electrocardiographic monitoring to detect AF. The diagnosis requires an ECG of sufficient quality for confirmation by a health professional with ECG rhythm expertise. AF detection rate is a function of monitoring duration and quality of analysis, AF episode definition, interval from stroke to monitoring commencement, and patient characteristics including old age, certain ECG alterations, and stroke type. Markers of atrial myopathy (eg, imaging, atrial ectopy, natriuretic peptides) may increase AF yield from monitoring and could be used to guide patient selection for more intensive/prolonged poststroke ECG monitoring. Atrial myopathy without detected AF is not currently sufficient to initiate OAC. The concept of embolic stroke of unknown source is not proven to identify patients who have had a stroke benefitting from empiric OAC treatment. However, some embolic stroke of unknown source subgroups (eg, advanced age, atrial enlargement) might benefit more from non– vitamin K-dependent OAC therapy than aspirin. Fulfilling embolic stroke of unknown source criteria is an indication neither for empiric non– vitamin K-dependent OAC treatment nor for withholding prolonged ECG monitoring for AF. Clinically diagnosed AF after a stroke or a transient ischemic attack is associated with significantly increased risk of recurrent stroke or systemic embolism, in particular, with additional stroke risk factors, and requires OAC rather than antiplatelet therapy. The minimum subclinical AF duration required on ECG monitoring poststroke/transient ischemic attack to recommend OAC therapy is debated",
keywords = "anticoagulants, atrial fibrillation, cardiomyopathies, electrocardiography, stroke",
author = "Renate Schnabel and {Georg H{\"a}usler}, Karl and Healey, {Jeffrey S} and Freedman, {S Ben} and Giuseppe Boriani and Johannes Brachmann and Axel Brandes and Alejandro Bustamante and Barbara Casadei and Crijns, {Harry J G M} and Wolfram Doehner and Gunnar Engstr{\"o}m and Laurent Fauchier and Leif Friberg and Gladstone, {David J} and Glotzer, {Taya V} and Shinya Goto and Hankey, {Graeme J} and Harbison, {Joseph A.} and Hobbs, {F D Richard} and Johnson, {Linda  S.B.} and Hooman Kamel and Paulus Kirchhof and Eleni Korompoki and Krieger, {Derk Wolfgang} and Lip, {Gregory Y H} and Lochen, {M L} and Mairesse, {Georges H} and Joan Montaner and Lis Neubeck and George Ntaios and Piccini, {Jonathan P} and Potpara, {Tatjana S} and Quinn, {Terence J} and James Reiffel and {Pinho Ribeiro}, {Antonio Luiz} and Michiel Rienstra and M{\aa}rten Rosenqvist and Sakis Themistoclakis and Sinner, {Moritz F} and Svendsen, {Jesper Hastrup} and {Van Gelder}, {Isabelle C} and Rolf Wachter and Tissa Wijeratne and Bernard Yan",
year = "2019",
month = "11",
day = "26",
doi = "10.1161/CIRCULATIONAHA.119.040267",
language = "English",
volume = "140",
pages = "1834--1850",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams & Wilkins",
number = "22",

}

Schnabel, R, Georg Häusler, K, Healey, JS, Freedman, SB, Boriani, G, Brachmann, J, Brandes, A, Bustamante, A, Casadei, B, Crijns, HJGM, Doehner, W, Engström, G, Fauchier, L, Friberg, L, Gladstone, DJ, Glotzer, TV, Goto, S, Hankey, GJ, Harbison, JA, Hobbs, FDR, Johnson, LSB, Kamel, H, Kirchhof, P, Korompoki, E, Krieger, DW, Lip, GYH, Lochen, ML, Mairesse, GH, Montaner, J, Neubeck, L, Ntaios, G, Piccini, JP, Potpara, TS, Quinn, TJ, Reiffel, J, Pinho Ribeiro, AL, Rienstra, M, Rosenqvist, M, Themistoclakis, S, Sinner, MF, Svendsen, JH, Van Gelder, IC, Wachter, R, Wijeratne, T & Yan, B 2019, 'Searching for Atrial Fibrillation Poststroke: A White Paper of the AF-SCREEN International Collaboration ', Circulation, bind 140, nr. 22, s. 1834-1850. https://doi.org/10.1161/CIRCULATIONAHA.119.040267

Searching for Atrial Fibrillation Poststroke : A White Paper of the AF-SCREEN International Collaboration . / Schnabel, Renate; Georg Häusler, Karl; Healey, Jeffrey S; Freedman, S Ben; Boriani, Giuseppe; Brachmann, Johannes; Brandes, Axel; Bustamante, Alejandro; Casadei, Barbara; Crijns, Harry J G M; Doehner, Wolfram; Engström, Gunnar; Fauchier, Laurent; Friberg, Leif; Gladstone, David J; Glotzer, Taya V; Goto, Shinya; Hankey, Graeme J; Harbison, Joseph A. ; Hobbs, F D Richard; Johnson, Linda  S.B. ; Kamel, Hooman; Kirchhof, Paulus; Korompoki, Eleni ; Krieger, Derk Wolfgang; Lip, Gregory Y H; Lochen, M L; Mairesse, Georges H; Montaner, Joan; Neubeck, Lis; Ntaios, George; Piccini, Jonathan P; Potpara, Tatjana S; Quinn, Terence J; Reiffel, James; Pinho Ribeiro, Antonio Luiz ; Rienstra, Michiel; Rosenqvist, Mårten; Themistoclakis, Sakis; Sinner, Moritz F; Svendsen, Jesper Hastrup; Van Gelder, Isabelle C; Wachter, Rolf; Wijeratne, Tissa ; Yan, Bernard.

I: Circulation, Bind 140, Nr. 22, 26.11.2019, s. 1834-1850.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Searching for Atrial Fibrillation Poststroke

T2 - A White Paper of the AF-SCREEN International Collaboration

AU - Schnabel, Renate

AU - Georg Häusler, Karl

AU - Healey, Jeffrey S

AU - Freedman, S Ben

AU - Boriani, Giuseppe

AU - Brachmann, Johannes

AU - Brandes, Axel

AU - Bustamante, Alejandro

AU - Casadei, Barbara

AU - Crijns, Harry J G M

AU - Doehner, Wolfram

AU - Engström, Gunnar

AU - Fauchier, Laurent

AU - Friberg, Leif

AU - Gladstone, David J

AU - Glotzer, Taya V

AU - Goto, Shinya

AU - Hankey, Graeme J

AU - Harbison, Joseph A.

AU - Hobbs, F D Richard

AU - Johnson, Linda  S.B.

AU - Kamel, Hooman

AU - Kirchhof, Paulus

AU - Korompoki, Eleni

AU - Krieger, Derk Wolfgang

AU - Lip, Gregory Y H

AU - Lochen, M L

AU - Mairesse, Georges H

AU - Montaner, Joan

AU - Neubeck, Lis

AU - Ntaios, George

AU - Piccini, Jonathan P

AU - Potpara, Tatjana S

AU - Quinn, Terence J

AU - Reiffel, James

AU - Pinho Ribeiro, Antonio Luiz

AU - Rienstra, Michiel

AU - Rosenqvist, Mårten

AU - Themistoclakis, Sakis

AU - Sinner, Moritz F

AU - Svendsen, Jesper Hastrup

AU - Van Gelder, Isabelle C

AU - Wachter, Rolf

AU - Wijeratne, Tissa

AU - Yan, Bernard

PY - 2019/11/26

Y1 - 2019/11/26

N2 - Cardiac thromboembolism attributed to atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes. Stroke may be the first manifestation of previously undetected AF. Given the efficacy of oral anticoagulants in preventing AF-related ischemic strokes, strategies of searching for AF after a stroke using ECG monitoring followed by oral anticoagulation (OAC) treatment have been proposed to prevent recurrent cardioembolic strokes. This white paper by experts from the AF-SCREEN International Collaboration summarizes existing evidence and knowledge gaps on searching for AF after a stroke by using ECG monitoring. New AF can be detected by routine plus intensive ECG monitoring in approximately one-quarter of patients with ischemic stroke. It may be causal, a bystander, or neurogenically induced by the stroke. AF after a stroke is a risk factor for thromboembolism and a strong marker for atrial myopathy. After acute ischemic stroke, patients should undergo 72 hours of electrocardiographic monitoring to detect AF. The diagnosis requires an ECG of sufficient quality for confirmation by a health professional with ECG rhythm expertise. AF detection rate is a function of monitoring duration and quality of analysis, AF episode definition, interval from stroke to monitoring commencement, and patient characteristics including old age, certain ECG alterations, and stroke type. Markers of atrial myopathy (eg, imaging, atrial ectopy, natriuretic peptides) may increase AF yield from monitoring and could be used to guide patient selection for more intensive/prolonged poststroke ECG monitoring. Atrial myopathy without detected AF is not currently sufficient to initiate OAC. The concept of embolic stroke of unknown source is not proven to identify patients who have had a stroke benefitting from empiric OAC treatment. However, some embolic stroke of unknown source subgroups (eg, advanced age, atrial enlargement) might benefit more from non– vitamin K-dependent OAC therapy than aspirin. Fulfilling embolic stroke of unknown source criteria is an indication neither for empiric non– vitamin K-dependent OAC treatment nor for withholding prolonged ECG monitoring for AF. Clinically diagnosed AF after a stroke or a transient ischemic attack is associated with significantly increased risk of recurrent stroke or systemic embolism, in particular, with additional stroke risk factors, and requires OAC rather than antiplatelet therapy. The minimum subclinical AF duration required on ECG monitoring poststroke/transient ischemic attack to recommend OAC therapy is debated

AB - Cardiac thromboembolism attributed to atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes. Stroke may be the first manifestation of previously undetected AF. Given the efficacy of oral anticoagulants in preventing AF-related ischemic strokes, strategies of searching for AF after a stroke using ECG monitoring followed by oral anticoagulation (OAC) treatment have been proposed to prevent recurrent cardioembolic strokes. This white paper by experts from the AF-SCREEN International Collaboration summarizes existing evidence and knowledge gaps on searching for AF after a stroke by using ECG monitoring. New AF can be detected by routine plus intensive ECG monitoring in approximately one-quarter of patients with ischemic stroke. It may be causal, a bystander, or neurogenically induced by the stroke. AF after a stroke is a risk factor for thromboembolism and a strong marker for atrial myopathy. After acute ischemic stroke, patients should undergo 72 hours of electrocardiographic monitoring to detect AF. The diagnosis requires an ECG of sufficient quality for confirmation by a health professional with ECG rhythm expertise. AF detection rate is a function of monitoring duration and quality of analysis, AF episode definition, interval from stroke to monitoring commencement, and patient characteristics including old age, certain ECG alterations, and stroke type. Markers of atrial myopathy (eg, imaging, atrial ectopy, natriuretic peptides) may increase AF yield from monitoring and could be used to guide patient selection for more intensive/prolonged poststroke ECG monitoring. Atrial myopathy without detected AF is not currently sufficient to initiate OAC. The concept of embolic stroke of unknown source is not proven to identify patients who have had a stroke benefitting from empiric OAC treatment. However, some embolic stroke of unknown source subgroups (eg, advanced age, atrial enlargement) might benefit more from non– vitamin K-dependent OAC therapy than aspirin. Fulfilling embolic stroke of unknown source criteria is an indication neither for empiric non– vitamin K-dependent OAC treatment nor for withholding prolonged ECG monitoring for AF. Clinically diagnosed AF after a stroke or a transient ischemic attack is associated with significantly increased risk of recurrent stroke or systemic embolism, in particular, with additional stroke risk factors, and requires OAC rather than antiplatelet therapy. The minimum subclinical AF duration required on ECG monitoring poststroke/transient ischemic attack to recommend OAC therapy is debated

KW - anticoagulants

KW - atrial fibrillation

KW - cardiomyopathies

KW - electrocardiography

KW - stroke

U2 - 10.1161/CIRCULATIONAHA.119.040267

DO - 10.1161/CIRCULATIONAHA.119.040267

M3 - Journal article

C2 - 31765261

VL - 140

SP - 1834

EP - 1850

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 22

ER -

Schnabel R, Georg Häusler K, Healey JS, Freedman SB, Boriani G, Brachmann J et al. Searching for Atrial Fibrillation Poststroke: A White Paper of the AF-SCREEN International Collaboration . Circulation. 2019 nov 26;140(22):1834-1850. https://doi.org/10.1161/CIRCULATIONAHA.119.040267