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

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Searching for Atrial Fibrillation Poststroke : A White Paper of the AF-SCREEN International Collaboration. / Schnabel, Renate B.; Haeusler, Karl Georg; Healey, Jeffrey S.; Freedman, 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 W.; Lip, Gregory Y.H.; Løchen, Maja Lisa; Mairesse, Georges H.; Montaner, Joan; Neubeck, Lis; Ntaios, George; Piccini, Jonathan P.; Potpara, Tatjana S.; Quinn, Terence J.; Reiffel, James A.; Ribeiro, Antonio Luiz Pinho; Rienstra, Michiel; Rosenqvist, Mårten; Sakis, Themistoclakis; Sinner, Moritz F.; Svendsen, Jesper Hastrup; Van Gelder, Isabelle C.; Wachter, Rolf; Wijeratne, Tissa; Yan, Bernard.

In: Circulation, Vol. 140, No. 22, 2019, p. 1834-1850.

Research output: Contribution to journalArticle

Harvard

Schnabel, RB, Haeusler, KG, Healey, JS, Freedman, B, 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, Løchen, ML, Mairesse, GH, Montaner, J, Neubeck, L, Ntaios, G, Piccini, JP, Potpara, TS, Quinn, TJ, Reiffel, JA, Ribeiro, ALP, Rienstra, M, Rosenqvist, M, Sakis, T, 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, vol. 140, no. 22, pp. 1834-1850. https://doi.org/10.1161/CIRCULATIONAHA.119.040267

APA

Schnabel, R. B., Haeusler, K. G., Healey, J. S., Freedman, 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

CBE

Schnabel RB, Haeusler KG, Healey JS, Freedman B, 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, Løchen ML, Mairesse GH, Montaner J, Neubeck L, Ntaios G, Piccini JP, Potpara TS, Quinn TJ, Reiffel JA, Ribeiro ALP, Rienstra M, Rosenqvist M, Sakis T, 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. 140(22):1834-1850. https://doi.org/10.1161/CIRCULATIONAHA.119.040267

MLA

Vancouver

Author

Schnabel, Renate B. ; Haeusler, Karl Georg ; Healey, Jeffrey S. ; Freedman, 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 W. ; Lip, Gregory Y.H. ; Løchen, Maja Lisa ; Mairesse, Georges H. ; Montaner, Joan ; Neubeck, Lis ; Ntaios, George ; Piccini, Jonathan P. ; Potpara, Tatjana S. ; Quinn, Terence J. ; Reiffel, James A. ; Ribeiro, Antonio Luiz Pinho ; Rienstra, Michiel ; Rosenqvist, Mårten ; Sakis, Themistoclakis ; 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. In: Circulation. 2019 ; Vol. 140, No. 22. pp. 1834-1850.

RIS

TY - JOUR

T1 - Searching for Atrial Fibrillation Poststroke

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

AU - Schnabel, Renate B.

AU - Haeusler, Karl Georg

AU - Healey, Jeffrey S.

AU - Freedman, 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 W.

AU - Lip, Gregory Y.H.

AU - Løchen, Maja Lisa

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 A.

AU - Ribeiro, Antonio Luiz Pinho

AU - Rienstra, Michiel

AU - Rosenqvist, Mårten

AU - Sakis, Themistoclakis

AU - Sinner, Moritz F.

AU - Svendsen, Jesper Hastrup

AU - Van Gelder, Isabelle C.

AU - Wachter, Rolf

AU - Wijeratne, Tissa

AU - Yan, Bernard

PY - 2019

Y1 - 2019

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 - Article

VL - 140

SP - 1834

EP - 1850

JO - Circulation

JF - Circulation

SN - 1524-4539

IS - 22

ER -