ONE THIRD OF CRYPTOGENIC STROKES ARE UNEXPLAINED1-7
Each year, at least 200,000 cryptogenic strokes occur in the United States.7
Cryptogenic stroke accounts for approximately one-third of ischemic strokes in the modern stroke registries and databases.1-6
Cryptogenic stroke is as prevalent as large vessel stroke.
Atrial Fibrillation Detection and Treatment Matters
HOW DO YOU MONITOR FOR AF IN YOUR CRYPTOGENIC STROKE PATIENTS?
Conventional, external monitoring modalities share important limitations that impact the practical duration of monitoring11-13
- Many cryptogenic stroke patients with AF may remain undiagnosed
- Interference with rehabilitation and daily activities
- Wide range of patient compliance
AF detection and monitoring modality selection matters for cryptogenic stroke patients
- The ability to identify AF in patients with cryptogenic stroke has profound implications for long-term medical management19
- Recurrence was more frequent and functional deficits were more likely to be severe among survivors of AF-related ischemic stroke9
- Guidelines recommend anticoagulant therapy for stroke prevention in most patients with AF20
- Sacco RL, Ellenberg JH, Mohr JP, et al. Infarcts of undetermined cause: the NINCDS Stroke Data Bank. Ann Neurol.April 1989;25(4):382-390.
- Petty GW, Brown RD Jr, Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke. December 1999;30(12):2513-2516.
- Kolominsky-Rabas PL, Weber M, Gefeller O, Neundoerfer B, Heuschmann PU. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. December 1, 2001;32(12):2735-2740.
- Schulz UG, Rothwell PM. Differences in vascular risk factors between etiological subtypes of ischemic stroke: importance of population-based studies. Stroke. August 2003;34(8):2050-2059.
- Schneider AT, Kissela B, Woo D, et al. Ischemic stroke subtypes: a population-based study of incidence rates among blacks and whites. Stroke. July 2004;35(7):1552-1556.
- Lee BI, Nam HS, Heo JH, Kim DI, Yonsei Stroke Team. Yonsei Stroke Registry. Analysis of 1,000 patients with acute cerebral infarctions. Cerebrovasc Dis. 2001;12(3):145-151.
- American Heart Association. Heart Disease and Stroke Statistics, 2015 Update. Available at: http://www.heart.org/HEARTORG/General/Heart-and-Stroke-Association-Statistics_UCM_319064_SubHomePage.jsp. Accessed April 12, 2015.
- Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. September 1987;147(9):1561-1564.
- Lin HJ, Kelly-Hayes M, Beiser AS, et al. Stroke Severity in Atrial Fibrillation: The Framingham Study. Stroke. 1996; 27: 1760-1764.
- Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation. August 1991;84(2):527-539.
- Strickberger SA, Ip J, Saksena S, Curry K, Bahnson TD, Ziegler PD. Relationship between atrial tachyarrhythmias and symptoms. Heart Rhythm. February 2005;2(2):125-131.
- Glotzer TV, Ziegler PD. Cryptogenic stroke: Is silent atrial fibrillation the culprit? Heart Rhythm. January 2015;12(1):234-241.
- Sanna T, Diener HC, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. June 26, 2014;370(26):2478-2486.
- Vasamreddy CR, Dalal D, Dong J, et al. Symptomatic and asymptomatic atrial fibrillation in patients undergoing radio frequency catheter ablation. J Cardiovasc Electrophysiol. February 2006;17(2):134-139.
- Gladstone DJ, Spring M, Dorian P, et al. Atrial Fibrillation in Patients with Cryptogenic Stroke. N Engl J Med. June 2014;370(26):2467-2477.
- Rosenberg MA, Samuel M, Thosani A, Zimetbaum PJ. Use of a noninvasive continuous monitoring device in the management of atrial fibrillation: a pilot study. Pacing Clin Electrophysiol. March 2013;36(3):328-333.
- Kamel H, Navi BB, Elijovich L, et al. Pilot randomized trial of outpatient cardiac monitoring after cryptogenic stroke. Stroke. February 2013;44(2):528-530.
- Shinbane JS, Merkert M, Fogoros R, Mehta V, Cao M, Saxon LA. Wearable Wireless Arrhythmia Detection Patches: Diagnostic Arrhythmia Yield, Time to First Arrhythmia, and Patient Compliance. Heart Rhythm Society 2013 34th Annual Scientific Sessions, Volume 10, Issue 5S, 2013.
- Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. July 2014;45(7):2160-2236.
- January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.
J Am Coll Cardiol. December 2, 2014;64(21):e1-76.