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Current Cardiology Reviews

Editor-in-Chief

ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

General Review Article

Cryptogenic Stroke and Embolic Stroke of Undetermined Source: Risk Factors and Approaches for Detection of Atrial Fibrillation

Author(s): Idaliya Rakhimova*, Yuliya Semenova, Talgat Khaibullin, Anargul Kuanysheva, Vitalii Kovalchuk and Ayan Abdrakhmanov

Volume 18, Issue 4, 2022

Published on: 01 March, 2022

Article ID: e211221199213 Pages: 14

DOI: 10.2174/1573403X18666211221145714

Price: $65

Abstract

Background: Stroke is a problem worldwide because of its high mortality and disability rates. Almost 90% of strokes are ischemic, and more than half of the deaths are caused by an ischemic stroke. Most risk factors for stroke are manageable so that it can be avoided with proper prevention. Despite the success in determining the causes of stroke in recent years, selectively, the “culprit” causing stroke remains unsolved. In such cases, a diagnosis of undetermined etiology (cryptogenic stroke) or embolic stroke of undetermined source (ESUS) is generated, resulting the prevention of a recurrent cerebrovascular occurrence impossible. Atrial fibrillation (AF) can be a cause of stroke by causing blood clots in the chambers of the heart.

Purpose: The aim was to determine the optimal method of heart rate monitoring in patients with ischemic stroke, as methods and approaches for detecting AF are very diverse, but there is still no single opinion, which would be universal.

Procedures: In our review, we consider epidemiology, risk factors for the stroke of undetermined etiology, as well as analytical methods for detecting heart rhythm disturbances in this category of patients.

Findings: Atrial fibrillation (AF) is detected by thorough monitoring of heart rate of patients with cryptogenic stroke and ESUS can be diagnosed in up to 46% of patients. .

Conclusion: After AF detection, consideration should be given to prescribing anticoagulants, instead of antiplatelet agents, for the secondary prevention of stroke.

Keywords: Stroke of undetermined etiology, cryptogenic stroke, embolic stroke of undetermined source, atrial fibrillation, heart rhythm monitoring, implantable loop recorder.

Graphical Abstract

[1]
Pistoia F, Sacco S, Tiseo C, Degan D, Ornello R, Carolei A. The epidemiology of atrial fibrillation and stroke. Cardiol Clin 2016; 34(2): 255-68.
[http://dx.doi.org/10.1016/j.ccl.2015.12.002] [PMID: 27150174]
[2]
Krishnamurthi RV, Moran AE, Feigin VL, et al. Stroke prevalence, mortality and disability-adjusted life years in adults aged 20-64 years in 1990-2013: Data from the global burden of disease 2013 study. Neuroepidemiology 2015; 45(3): 190-202.
[http://dx.doi.org/10.1159/000441098] [PMID: 26505983]
[3]
Chong JY, Sacco RL. Epidemiology of stroke in young adults: Race/ethnic differences. J Thromb Thrombolysis 2005; 20(2): 77-83.
[http://dx.doi.org/10.1007/s11239-005-3201-9] [PMID: 16205856]
[4]
Goeggel Simonetti B, Mono ML, Huynh-Do U, et al. Risk factors, aetiology and outcome of ischaemic stroke in young adults: The Swiss Young stroke study (SYSS). J Neurol 2015; 262(9): 2025-32.
[http://dx.doi.org/10.1007/s00415-015-7805-5] [PMID: 26067218]
[5]
Maaijwee NA, Rutten-Jacobs LC, Schaapsmeerders P, van Dijk EJ, de Leeuw FE. Ischaemic stroke in young adults: Risk factors and long-term consequences. Nat Rev Neurol 2014; 10(6): 315-25.
[http://dx.doi.org/10.1038/nrneurol.2014.72] [PMID: 24776923]
[6]
Rothwell PM, Coull AJ, Silver LE, et al. Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet 2005; 366(9499): 1773-83.
[http://dx.doi.org/10.1016/S0140-6736(05)67702-1] [PMID: 16298214]
[7]
Rojas JI, Zurrú MC, Romano M, Patrucco L, Cristiano E. Acute ischemic stroke and transient ischemic attack in the very old-risk factor profile and stroke subtype between patients older than 80 years and patients aged less than 80 years. Eur J Neurol 2007; 14(8): 895-9.
[http://dx.doi.org/10.1111/j.1468-1331.2007.01841.x] [PMID: 17662011]
[8]
Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: A review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003; 2(1): 43-53.
[http://dx.doi.org/10.1016/S1474-4422(03)00266-7] [PMID: 12849300]
[9]
Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics-2008 update: A report from the American heart association statistics committee and stroke statistics subcommittee. Circulation 2008; 117(4): e25-e146.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.107.187998] [PMID: 18086926]
[10]
Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 1993; 24(1): 35-41.
[http://dx.doi.org/10.1161/01.STR.24.1.35] [PMID: 7678184]
[11]
Fonseca AC, Ferro JM. Cryptogenic stroke. Eur J Neurol 2015; 22(4): 618-23.
[http://dx.doi.org/10.1111/ene.12673] [PMID: 25597418]
[12]
Yaghi S, Bernstein RA, Passman R, Okin PM, Furie KL. Cryptogenic stroke: Research and practice. Circ Res 2017; 120(3): 527-40.
[http://dx.doi.org/10.1161/CIRCRESAHA.116.308447] [PMID: 28154102]
[13]
Bulwa Z, Gupta A. Embolic stroke of undetermined source: The role of the nonstenotic carotid plaque. J Neurol Sci 2017; 382: 49-52.
[http://dx.doi.org/10.1016/j.jns.2017.09.027] [PMID: 29111018]
[14]
Di Tullio MR, Homma S. Mechanisms of cardioembolic stroke. Curr Cardiol Rep 2002; 4(2): 141-8.
[http://dx.doi.org/10.1007/s11886-002-0027-3] [PMID: 11827638]
[15]
Schmidt-Pogoda A, Minnerup J. [Rare causes of stroke-a frequent stroke etiology]. Nervenarzt 2019; 90(10): 1013-20.
[http://dx.doi.org/10.1007/s00115-019-00789-9] [PMID: 31471619]
[16]
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: The Framingham Study. Stroke 1991; 22(8): 983-8.
[http://dx.doi.org/10.1161/01.STR.22.8.983] [PMID: 1866765]
[17]
“Global Health Estimates 2016: Deaths by cause, age, sex, by country and by region, 2000-2016. Geneva, World Health Organization; 2018. Available from: https://www.who.int/healthinfo/global_burden_disease/estimates/en/ (Accessed on August 28, 2021).
[18]
Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017; 70(1): 1-25.
[http://dx.doi.org/10.1016/j.jacc.2017.04.052] [PMID: 28527533]
[19]
GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388(10053): 1459-544.
[http://dx.doi.org/10.1016/S0140-6736(16)31012-1] [PMID: 27733281]
[20]
Erkebaeva SK, Nurguzhaev ES, Gafurov BG, Zharkinbekova NA, Abasova GB. Epidemiology and climate and geographic risk factors of stroke in the South Kazakhstan region. Zh Nevrol Psikhiatr Im S S Korsakova 2013; 113(3 Pt 2): 3-8.
[PMID: 23612391]
[21]
Asplund K, Karvanen J, Giampaoli S, et al. Relative risks for stroke by age, sex, and population based on follow-up of 18 European populations in the MORGAM Project. Stroke 2009; 40(7): 2319-26.
[http://dx.doi.org/10.1161/STROKEAHA.109.547869] [PMID: 19520994]
[22]
Redon J, Olsen MH, Cooper RS, et al. Stroke mortality and trends from 1990 to 2006 in 39 countries from Europe and Central Asia: Implications for control of high blood pressure. Eur Heart J 2011; 32(11): 1424-31.
[http://dx.doi.org/10.1093/eurheartj/ehr045] [PMID: 21487117]
[23]
Ji J, Sundquist J, Sundquist K. Risk of ischemic stroke varies by ethnicity in patients with atrial fibrillation: A Swedish national cohort study. Eur J Intern Med 2016; 36: e13-5.
[http://dx.doi.org/10.1016/j.ejim.2016.08.027] [PMID: 27594415]
[24]
Li C, Baek J, Sanchez BN, Morgenstern LB, Lisabeth LD. Temporal trends in age at ischemic stroke onset by ethnicity. Ann Epidemiol 2018; 28(10): 686-690.e2.
[http://dx.doi.org/10.1016/j.annepidem.2018.07.010] [PMID: 30087013]
[25]
Wu SH, Woo J, Zhang XH. Worldwide socioeconomic status and stroke mortality: An ecological study. Int J Equity Health 2013; 12: 42.
[http://dx.doi.org/10.1186/1475-9276-12-42] [PMID: 23767844]
[26]
Bettger JP, Zhao X, Bushnell C, et al. The association between socioeconomic status and disability after stroke: Findings from the adherence eValuation after ischemic stroke longitudinal (AVAIL) registry. BMC Public Health 2014; 14: 281.
[http://dx.doi.org/10.1186/1471-2458-14-281] [PMID: 24666657]
[27]
Venketasubramanian N, Yoon BW, Pandian J, Navarro JC. Stroke epidemiology in South, East, and South-East Asia: A Review. J Stroke 2017; 19(3): 286-94.
[http://dx.doi.org/10.5853/jos.2017.00234] [PMID: 29037005]
[28]
Marshall IJ, Wang Y, Crichton S, McKevitt C, Rudd AG, Wolfe CD. The effects of socioeconomic status on stroke risk and outcomes. Lancet Neurol 2015; 14(12): 1206-18.
[http://dx.doi.org/10.1016/S1474-4422(15)00200-8] [PMID: 26581971]
[29]
Emergency and comprehensive care for stroke needed. Lancet 2009; 373(9674): 1496.
[http://dx.doi.org/10.1016/S0140-6736(09)60833-3] [PMID: 19410695]
[30]
Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American heart association/American stroke association. Stroke 2013; 44(7): 2064-89.
[http://dx.doi.org/10.1161/STR.0b013e318296aeca] [PMID: 23652265]
[31]
Shuaib A, Hachinski VC. Mechanisms and management of stroke in the elderly. CMAJ 1991; 145(5): 433-43.
[PMID: 1878825]
[32]
Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med 2005; 352(17): 1791-8.
[http://dx.doi.org/10.1056/NEJMra042354] [PMID: 15858188]
[33]
Diener HC, Bernstein R, Hart R. Secondary stroke prevention in cryptogenic stroke and embolic stroke of undetermined source (ESUS). Curr Neurol Neurosci Rep 2017; 17(9): 64.
[http://dx.doi.org/10.1007/s11910-017-0775-5] [PMID: 28707135]
[34]
Ay H, Benner T, Arsava EM, et al. A computerized algorithm for etiologic classification of ischemic stroke: The Causative classification of stroke system. Stroke 2007; 38(11): 2979-84.
[http://dx.doi.org/10.1161/STROKEAHA.107.490896] [PMID: 17901381]
[35]
Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. New approach to stroke subtyping: The A-S-C-O (phenotypic) classification of stroke. Cerebrovasc Dis 2009; 27(5): 502-8.
[http://dx.doi.org/10.1159/000210433] [PMID: 19342826]
[36]
Gökçal E, Niftaliyev E, Asil T. Etiological classification of ischemic stroke in young patients: A comparative study of TOAST, CCS, and ASCO. Acta Neurol Belg 2017; 117(3): 643-8.
[http://dx.doi.org/10.1007/s13760-017-0813-8] [PMID: 28689236]
[37]
Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: The case for a new clinical construct. Lancet Neurol 2014; 13(4): 429-38.
[http://dx.doi.org/10.1016/S1474-4422(13)70310-7] [PMID: 24646875]
[38]
Böttger P, Grond M, Lemm H, Buerke M. 10 Kernaussagen zum embolic stroke of undetermined source und Kryptogenen Schlaganfall Ten key messages regarding embolic stroke of undetermined source and cryptogenic stroke. Med Klin Intensivmed Notfmed 2018; 113(8): 664-71.
[http://dx.doi.org/10.1007/s00063-018-0470-6]
[39]
Ntaios G. Embolic stroke of undetermined source: JACC review topic of the week. J Am Coll Cardiol 2020; 75(3): 333-40.
[http://dx.doi.org/10.1016/j.jacc.2019.11.024] [PMID: 31976872]
[40]
Geisler T, Mengel A, Ziemann U, Poli S. Management of embolic stroke of undetermined source (ESUS). Drugs 2018; 78(8): 823-31.
[http://dx.doi.org/10.1007/s40265-018-0912-8] [PMID: 29737498]
[41]
Arauz A, Arteaga C, Zapata-Gómez C, et al. Embolic stroke of undetermined source: Beyond atrial fibrillation. Neurologia 2019; S0213-4853(19): 30056-8.
[http://dx.doi.org/10.1016/j.nrl.2019.03.008]
[42]
Maier IL, Schregel K, Karch A, et al. Association between embolic stroke patterns, ESUS etiology, and new diagnosis of atrial fibrillation: A secondary data analysis of the Find-AF Trial. Stroke Res Treat 2017; 2017: 1391843.
[http://dx.doi.org/10.1155/2017/1391843] [PMID: 28536667]
[43]
Arboix A, Alió J. Cardioembolic stroke: Clinical features, specific cardiac disorders and prognosis. Curr Cardiol Rev 2010; 6(3): 150-61.
[http://dx.doi.org/10.2174/157340310791658730] [PMID: 21804774]
[44]
Diener HC, Sacco RL, Easton JD, et al. Dabigatran for prevention of stroke after embolic stroke of undetermined source. N Engl J Med 2019; 380(20): 1906-17.
[http://dx.doi.org/10.1056/NEJMoa1813959] [PMID: 31091372]
[45]
Diener HC, Sacco RL, Easton JD, et al. Antithrombotic treatment of embolic stroke of undetermined source: RE-SPECT ESUS elderly and renally impaired subgroups. Stroke 2020; 51(6): 1758-65.
[http://dx.doi.org/10.1161/STROKEAHA.119.028643] [PMID: 32404035]
[46]
Ntaios G, Perlepe K, Lambrou D, et al. Prevalence and overlap of potential embolic sources in patients with embolic stroke of undetermined source. J Am Heart Assoc 2019; 8(15): e012858.
[http://dx.doi.org/10.1161/JAHA.119.012858] [PMID: 31364451]
[47]
Ntaios G, Pearce LA, Veltkamp R, et al. Potential embolic sources and outcomes in embolic stroke of undetermined source in the NAVIGATE-ESUS trial. Stroke 2020; 51(6): 1797-804.
[http://dx.doi.org/10.1161/STROKEAHA.119.028669] [PMID: 32295509]
[48]
Tsivgoulis G, Katsanos AH, Köhrmann M, et al. Embolic strokes of undetermined source: Theoretical construct or useful clinical tool? Ther Adv Neurol Disord 2019; 12: 1756286419851381.
[http://dx.doi.org/10.1177/1756286419851381] [PMID: 31205494]
[49]
Sacchetti DC, Furie KL, Yaghi S. Cardioembolic stroke: Mechanisms and therapeutics. Semin Neurol 2017; 37(3): 326-38.
[http://dx.doi.org/10.1055/s-0037-1603465] [PMID: 28759914]
[50]
Marks SJ, Khera S. Cryptogenic stroke: Making the management less cryptic. Cardiol Rev 2016; 24(4): 153-7.
[http://dx.doi.org/10.1097/CRD.0000000000000073] [PMID: 25867760]
[51]
Watson T, Shantsila E, Lip GY. Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited. Lancet 2009; 373(9658): 155-66.
[http://dx.doi.org/10.1016/S0140-6736(09)60040-4] [PMID: 19135613]
[52]
Shafqat S, Kelly PJ, Furie KL. Holter monitoring in the diagnosis of stroke mechanism. Intern Med J 2004; 34(6): 305-9.
[http://dx.doi.org/10.1111/j.1444-0903.2004.00589.x] [PMID: 15228390]
[53]
Schaer B, Sticherling C, Lyrer P, Osswald S. Cardiological diagnostic work-up in stroke patients-a comprehensive study of test results and therapeutic implications. Eur J Neurol 2009; 16(2): 268-73.
[http://dx.doi.org/10.1111/j.1468-1331.2008.02413.x] [PMID: 19146645]
[54]
Koudstaal PJ, van Gijn J, Klootwijk AP, van der Meche FG, Kappelle LJ. Holter monitoring in patients with transient and focal ischemic attacks of the brain. Stroke 1986; 17(2): 192-5.
[http://dx.doi.org/10.1161/01.STR.17.2.192] [PMID: 2938308]
[55]
Schuchert A, Behrens G, Meinertz T. Impact of long-term ECG recording on the detection of paroxysmal atrial fibrillation in patients after an acute ischemic stroke. Pacing Clin Electrophysiol 1999; 22(7): 1082-4.
[http://dx.doi.org/10.1111/j.1540-8159.1999.tb00574.x] [PMID: 10456638]
[56]
Hornig CR, Haberbosch W, Lammers C, Waldecker B, Dorndorf W. Specific cardiological evaluation after focal cerebral ischemia. Acta Neurol Scand 1996; 93(4): 297-302.
[http://dx.doi.org/10.1111/j.1600-0404.1996.tb00524.x] [PMID: 8739442]
[57]
Jabaudon D, Sztajzel J, Sievert K, Landis T, Sztajzel R. Usefulness of ambulatory 7-day ECG monitoring for the detection of atrial fibrillation and flutter after acute stroke and transient ischemic attack. Stroke 2004; 35(7): 1647-51.
[http://dx.doi.org/10.1161/01.STR.0000131269.69502.d9] [PMID: 15155965]
[58]
Wachter R, Gröschel K, Gelbrich G, et al. Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (Find-AFRANDOMISED): An open-label randomised controlled trial. Lancet Neurol 2017; 16(4): 282-90.
[http://dx.doi.org/10.1016/S1474-4422(17)30002-9] [PMID: 28187920]
[59]
Grond M, Jauss M, Hamann G, et al. Improved detection of silent atrial fibrillation using 72-hour Holter ECG in patients with ischemic stroke: A prospective multicenter cohort study. Stroke 2013; 44(12): 3357-64.
[http://dx.doi.org/10.1161/STROKEAHA.113.001884] [PMID: 24130137]
[60]
Stahrenberg R, Weber-Krüger M, Seegers J, et al. Enhanced detection of paroxysmal atrial fibrillation by early and prolonged continuous holter monitoring in patients with cerebral ischemia presenting in sinus rhythm. Stroke 2010; 41(12): 2884-8.
[http://dx.doi.org/10.1161/STROKEAHA.110.591958] [PMID: 20966415]
[61]
Higgins P, MacFarlane PW, Dawson J, McInnes GT, Langhorne P, Lees KR. Noninvasive cardiac event monitoring to detect atrial fibrillation after ischemic stroke: A randomized, controlled trial. Stroke 2013; 44(9): 2525-31.
[http://dx.doi.org/10.1161/STROKEAHA.113.001927] [PMID: 23899913]
[62]
Gladstone DJ, Spring M, Dorian P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med 2014; 370(26): 2467-77.
[http://dx.doi.org/10.1056/NEJMoa1311376] [PMID: 24963566]
[63]
Plas GJ, Bos J, Velthuis BO, Scholten MF, den Hertog HM, Brouwers PJ. Diagnostic yield of external loop recording in patients with acute ischemic stroke or TIA. J Neurol 2015; 262(3): 682-8.
[http://dx.doi.org/10.1007/s00415-014-7621-3] [PMID: 25557280]
[64]
Sejr MH, May O, Damgaard D, Sandal BF, Nielsen JC. External continuous ECG versus loop recording for atrial fibrillation detection in patients who had a stroke. Heart 2019; 105(11): 848-54.
[http://dx.doi.org/10.1136/heartjnl-2018-314186] [PMID: 30898849]
[65]
Sejr MH, Nielsen JC, Damgaard D, Sandal BF, May O. Atrial fibrillation detected by external loop recording for seven days or two-day simultaneous Holter recording: A comparison in patients with ischemic stroke or transient ischemic attack. J Electrocardiol 2017; 50(3): 287-93.
[http://dx.doi.org/10.1016/j.jelectrocard.2017.01.009] [PMID: 28118928]
[66]
Koh KT, Law WC, Zaw WM, et al. Smartphone electrocardiogram for detecting atrial fibrillation after a cerebral ischaemic event: A multicentre randomized controlled trial. Europace 2021; 23(7)
[http://dx.doi.org/10.1093/europace/euab036] [PMID: 33782701]
[67]
Yan B, Tu H, Lam C, et al. Nurse led smartphone electrographic monitoring for atrial fibrillation after ischemic stroke: SPOT-AF. J Stroke 2020; 22(3): 387-95.
[http://dx.doi.org/10.5853/jos.2020.00689] [PMID: 33053954]
[68]
Kallmünzer B, Breuer L, Hering C, et al. A structured reading algorithm improves telemetric detection of atrial fibrillation after acute ischemic stroke. Stroke 2012; 43(4): 994-9.
[http://dx.doi.org/10.1161/STROKEAHA.111.642199] [PMID: 22308240]
[69]
Rizos T, Güntner J, Jenetzky E, et al. Continuous stroke unit electrocardiographic monitoring versus 24-hour Holter electrocardiography for detection of paroxysmal atrial fibrillation after stroke. Stroke 2012; 43(10): 2689-94.
[http://dx.doi.org/10.1161/STROKEAHA.112.654954] [PMID: 22871678]
[70]
Kamel H, Navi BB, Elijovich L, et al. Pilot randomized trial of outpatient cardiac monitoring after cryptogenic stroke. Stroke 2013; 44(2): 528-30.
[http://dx.doi.org/10.1161/STROKEAHA.112.679100] [PMID: 23192756]
[71]
Miller DJ, Khan MA, Schultz LR, et al. Outpatient cardiac telemetry detects a high rate of atrial fibrillation in cryptogenic stroke. J Neurol Sci 2013; 324(1-2): 57-61.
[http://dx.doi.org/10.1016/j.jns.2012.10.001] [PMID: 23102659]
[72]
Israel C, Kitsiou A, Kalyani M, et al. Detection of atrial fibrillation in patients with embolic stroke of undetermined source by prolonged monitoring with implantable loop recorders. Thromb Haemost 2017; 117(10): 1962-9.
[http://dx.doi.org/10.1160/TH17-02-0072] [PMID: 28862284]
[73]
Pecha S, Wilke I, Yildirim Y, Reichenspurner H, Aydin MA. Implantable loop recorder monitoring in patients with cryptogenic stroke - detection and treatment of different clinically relevant arrhythmias. J Electrocardiol 2020; 60: 102-6.
[http://dx.doi.org/10.1016/j.jelectrocard.2020.04.007] [PMID: 32339814]
[74]
Poli S, Diedler J, Härtig F, et al. Insertable cardiac monitors after cryptogenic stroke-a risk factor based approach to enhance the detection rate for paroxysmal atrial fibrillation. Eur J Neurol 2016; 23(2): 375-81.
[http://dx.doi.org/10.1111/ene.12843] [PMID: 26470854]
[75]
Sanna T, Diener HC, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014; 370(26): 2478-86.
[http://dx.doi.org/10.1056/NEJMoa1313600] [PMID: 24963567]
[76]
Rojo-Martinez E, Sandín-Fuentes M, Calleja-Sanz AI, et al. [High performance of an implantable Holter monitor in the detection of concealed paroxysmal atrial fibrillation in patients with cryptogenic stroke and a suspected embolic mechanism]. Rev Neurol 2013; 57(6): 251-7.
[PMID: 24008935]
[77]
Cotter PE, Martin PJ, Ring L, Warburton EA, Belham M, Pugh PJ. Incidence of atrial fibrillation detected by implantable loop recorders in unexplained stroke. Neurology 2013; 80(17): 1546-50.
[http://dx.doi.org/10.1212/WNL.0b013e31828f1828] [PMID: 23535493]
[78]
Víctor CU, Carolina PE, Jorge TR, et al. Incidence and predictive factors of hidden atrial fibrillation detected by implantable loop recorder after an embolic stroke of undetermined source. J Atr Fibrillation 2018; 11(3): 2078.
[http://dx.doi.org/10.4022/jafib.2078] [PMID: 31139276]
[79]
Christensen LM, Krieger DW, Højberg S, et al. Paroxysmal atrial fibrillation occurs often in cryptogenic ischaemic stroke. Final results from the SURPRISE study. Eur J Neurol 2014; 21(6): 884-9.
[http://dx.doi.org/10.1111/ene.12400] [PMID: 24628954]
[80]
Bettin M, Dechering D, Kochhäuser S, et al. Extended ECG monitoring with an implantable loop recorder in patients with cryptogenic stroke: time schedule, reasons for explantation and incidental findings (results from the TRACK-AF trial). Clin Res Cardiol 2019; 108(3): 309-14.
[http://dx.doi.org/10.1007/s00392-018-1358-4] [PMID: 30167809]
[81]
Carrazco C, Golyan D, Kahen M, Black K, Libman RB, Katz JM. Prevalence and risk factors for paroxysmal atrial fibrillation and flutter detection after cryptogenic ischemic stroke. J Stroke Cerebrovasc Dis 2018; 27(1): 203-9.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.08.022] [PMID: 29032886]
[82]
Seow SC, How AK, Chan SP, et al. High incidence of occult atrial fibrillation in Asian patients with cryptogenic stroke. J Stroke Cerebrovasc Dis 2018; 27(8): 2182-6.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.03.019] [PMID: 29678635]
[83]
Jorfida M, Antolini M, Cerrato E, et al. Cryptogenic ischemic stroke and prevalence of asymptomatic atrial fibrillation: A prospective study. J Cardiovasc Med (Hagerstown) 2016; 17(12): 863-9.
[http://dx.doi.org/10.2459/JCM.0000000000000181] [PMID: 25379716]
[84]
Iwata T, Todo K, Yamagami H, et al. High detection rate of atrial fibrillation with insertable cardiac monitor implantation in patients with cryptogenic stroke diagnosed by magnetic resonance imaging. J Stroke Cerebrovasc Dis 2019; 28(9): 2569-73.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.05.023] [PMID: 31230824]
[85]
Ritter MA, Kochhäuser S, Duning T, et al. Occult atrial fibrillation in cryptogenic stroke: Detection by 7-day electrocardiogram versus implantable cardiac monitors. Stroke 2013; 44(5): 1449-52.
[http://dx.doi.org/10.1161/STROKEAHA.111.676189] [PMID: 23449264]
[86]
Macfarlane PW, Mason JW, Kligfield P, et al. Debatable issues in automated ECG reporting. J Electrocardiol 2017; 50(6): 833-40.
[http://dx.doi.org/10.1016/j.jelectrocard.2017.08.027] [PMID: 28985886]
[87]
Roten L, Schilling M, Häberlin A, et al. Is 7-day event triggered ECG recording equivalent to 7-day Holter ECG recording for atrial fibrillation screening? Heart 2012; 98(8): 645-9.
[http://dx.doi.org/10.1136/heartjnl-2011-301455] [PMID: 22397942]
[88]
Suissa L, Lachaud S, Mahagne MH. Continuous ECG monitoring for tracking down atrial fibrillation after stroke: Holter or automated analysis strategy? Eur Neurol 2014; 72(1-2): 7-12.
[http://dx.doi.org/10.1159/000358053] [PMID: 24777038]
[89]
Srinivasulu A, Sriraam N. An engineering perspective of external cardiac loop recorder: A systematic review. J Med Eng 2016; 2016: 6931347.
[http://dx.doi.org/10.1155/2016/6931347] [PMID: 27872843]
[90]
Lee R, Mittal S. Utility and limitations of long-term monitoring of atrial fibrillation using an implantable loop recorder. Heart Rhythm 2018; 15(2): 287-95.
[http://dx.doi.org/10.1016/j.hrthm.2017.09.009] [PMID: 28919290]
[91]
Nölker G, Mayer J, Boldt LH, et al. Performance of an implantable cardiac monitor to detect atrial fibrillation: Results of the DETECT AF study. J Cardiovasc Electrophysiol 2016; 27(12): 1403-10.
[http://dx.doi.org/10.1111/jce.13089] [PMID: 27565119]
[92]
Ciconte G, Saviano M, Giannelli L, et al. Atrial fibrillation detection using a novel three-vector cardiac implantable monitor: The atrial fibrillation detect study. Europace 2017; 19(7): 1101-8.
[http://dx.doi.org/10.1093/europace/euw181] [PMID: 27702865]
[93]
Keogh C, Wallace E, Dillon C, Dimitrov BD, Fahey T. Validation of the CHADS2 clinical prediction rule to predict ischaemic stroke. A systematic review and meta-analysis. Thromb Haemost 2011; 106(3): 528-38.
[http://dx.doi.org/10.1160/TH11-02-0061] [PMID: 21800003]
[94]
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European association for cardio-thoracic surgery (EACTS): The task force for the diagnosis and management of atrial fibrillation of the European society of cardiology (ESC) developed with the special contribution of the European heart rhythm association (EHRA) of the ESC. Eur Heart J 2021; 42(5): 373-498.
[http://dx.doi.org/10.1093/eurheartj/ehaa612] [PMID: 32860505]
[95]
January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: Executive summary: A report of the American college of cardiology/American heart association task force on practice guidelines and the heart rhythm society. Circulation 2014; 130(23): 2071-104.
[http://dx.doi.org/10.1161/CIR.0000000000000040] [PMID: 24682348]
[96]
Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37(38): 2893-962.
[http://dx.doi.org/10.1093/eurheartj/ehw210] [PMID: 27567408]
[97]
López-López JA, Sterne JAC, Thom HHZ, et al. Oral anticoagulants for prevention of stroke in atrial fibrillation: Systematic review, network meta-analysis, and cost effectiveness analysis. BMJ 2017; 359: j5058.
[http://dx.doi.org/10.1136/bmj.j5058] [PMID: 29183961]
[98]
Steffel J, Verhamme P, Potpara TS, et al. The 2018 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J 2018; 39(16): 1330-93.
[http://dx.doi.org/10.1093/eurheartj/ehy136] [PMID: 29562325]
[99]
Verheugt FW, Granger CB. Oral anticoagulants for stroke prevention in atrial fibrillation: Current status, special situations, and unmet needs. Lancet 2015; 386(9990): 303-10.
[http://dx.doi.org/10.1016/S0140-6736(15)60245-8] [PMID: 25777666]
[100]
Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: The Euro heart survey. Chest 2010; 138(5): 1093-100.
[http://dx.doi.org/10.1378/chest.10-0134] [PMID: 20299623]
[101]
Zhu W, He W, Guo L, Wang X, Hong K. The HAS-BLED score for predicting major bleeding risk in anticoagulated patients with atrial fibrillation: A systematic review and meta-analysis. Clin Cardiol 2015; 38(9): 555-61.
[http://dx.doi.org/10.1002/clc.22435] [PMID: 26418409]
[102]
Skanes AC, Healey JS, Cairns JA, et al. Focused 2012 update of the Canadian cardiovascular society atrial fibrillation guidelines: Recommendations for stroke prevention and rate/rhythm control. Can J Cardiol 2012; 28(2): 125-36.
[http://dx.doi.org/10.1016/j.cjca.2012.01.021] [PMID: 22433576]
[103]
Hijazi Z, Oldgren J, Lindbäck J, et al. The novel biomarker-based ABC (age, biomarkers, clinical history)-bleeding risk score for patients with atrial fibrillation: A derivation and validation study. Lancet 2016; 387(10035): 2302-11.
[http://dx.doi.org/10.1016/S0140-6736(16)00741-8] [PMID: 27056738]
[104]
O’Brien EC, Simon DN, Thomas LE, et al. The ORBIT bleeding score: A simple bedside score to assess bleeding risk in atrial fibrillation. Eur Heart J 2015; 36(46): 3258-64.
[http://dx.doi.org/10.1093/eurheartj/ehv476] [PMID: 26424865]
[105]
Koscielny J, Rosenthal C, von Heymann C. Blutungsmanagement unter direkten oralen Antikoagulanzien (DOAK). (Bleeding Management under Direct Oral Anticoagulants (DOAC)). Dtsch Med Wochenschr 2018; 143(24): 1734-8.
[http://dx.doi.org/10.1055/a-0585-8166]
[106]
Merkler AE, Diaz I, Wu X, et al. Duration of heightened ischemic stroke risk after acute myocardial infarction. J Am Heart Assoc 2018; 7(22): e010782.
[http://dx.doi.org/10.1161/JAHA.118.010782] [PMID: 30571491]
[107]
Gensini GF, Rostagno C. La terapia anticoagulante nel paziente con miocardiopatia dilatativa [Anticoagulant therapy in patients with dilated cardiomyopathy]. Ann Ital Med Int 1998; 13(4): 227-32.
[PMID: 10349204]
[108]
Seckeler MD, Hoke TR. The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clin Epidemiol 2011; 3: 67-84.
[http://dx.doi.org/10.2147/CLEP.S12977] [PMID: 21386976]
[109]
Sun JC, Davidson MJ, Lamy A, Eikelboom JW. Antithrombotic management of patients with prosthetic heart valves: Current evidence and future trends. Lancet 2009; 374(9689): 565-76.
[http://dx.doi.org/10.1016/S0140-6736(09)60780-7] [PMID: 19683642]
[110]
Poli D, Antonucci E, Pengo V, et al. Mechanical prosthetic heart valves: Quality of anticoagulation and thromboembolic risk. The observational multicenter PLECTRUM study. Int J Cardiol 2018; 267: 68-73.
[http://dx.doi.org/10.1016/j.ijcard.2018.04.042] [PMID: 29957264]
[111]
Cigarroa R, Elmariah S. Anticoagulation management after transcatheter and surgical valve replacement. Curr Treat Options Cardiovasc Med 2018; 20(5): 42.
[http://dx.doi.org/10.1007/s11936-018-0629-8] [PMID: 29637470]
[112]
Geva T, Martins JD, Wald RM. Atrial septal defects. Lancet 2014; 383(9932): 1921-32.
[http://dx.doi.org/10.1016/S0140-6736(13)62145-5] [PMID: 24725467]
[113]
Rana BS, Shapiro LM, McCarthy KP, Ho SY. Three-dimensional imaging of the atrial septum and patent foramen ovale anatomy: Defining the morphological phenotypes of patent foramen ovale. Eur J Echocardiogr 2010; 11(10): i19-25.
[http://dx.doi.org/10.1093/ejechocard/jeq122] [PMID: 21078835]
[114]
Saver JL, Mattle HP, Thaler D. Patent foramen ovale closure versus medical therapy for cryptogenic ischemic stroke: A topical review. Stroke 2018; 49(6): 1541-8.
[http://dx.doi.org/10.1161/STROKEAHA.117.018153] [PMID: 29760277]
[115]
Uemura J, Kimura K, Sibazaki K, Inoue T, Iguchi Y, Yamashita S. Acute stroke patients have occult malignancy more often than expected. Eur Neurol 2010; 64(3): 140-4.
[http://dx.doi.org/10.1159/000316764] [PMID: 20668384]
[116]
Grisold W, Oberndorfer S, Struhal W. Stroke and cancer: A review. Acta Neurol Scand 2009; 119(1): 1-16.
[http://dx.doi.org/10.1111/j.1600-0404.2008.01059.x] [PMID: 18616624]
[117]
Dearborn JL, Urrutia VC, Zeiler SR. Stroke and cancer- a complicated relationship. J Neurol Transl Neurosci 2014; 2(1): 1039.
[PMID: 26322334]
[118]
Navi BB, Singer S, Merkler AE, et al. Cryptogenic subtype predicts reduced survival among cancer patients with ischemic stroke. Stroke 2014; 45(8): 2292-7.
[http://dx.doi.org/10.1161/STROKEAHA.114.005784] [PMID: 24994717]
[119]
Sun B, Fan S, Li Z, et al. Clinical and neuroimaging features of acute ischemic stroke in cancer patients. Eur Neurol 2016; 75(5-6): 292-9.
[http://dx.doi.org/10.1159/000447126] [PMID: 27300135]

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