Glotzer Taya V, Ziegler Paul D
Hackensack University Medical Center, Hackensack, New Jersey,.
Cardiac Rhythm Disease Management Division, Medtronic Inc, Mounds View, Minnesota.
Heart Rhythm. 2015 Jan;12(1):234-41. doi: 10.1016/j.hrthm.2014.09.058. Epub 2014 Oct 5.
Stroke 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.
The purpose of this review is to examine "silent AF" as a potential cause of cryptogenic stroke.
METHODS/RESULTS: We 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.
Data 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.
病因不明的中风会让患者及其家属感到恐惧，也会让负责治疗的医生感到沮丧。大约30%植入心脏电子设备的患者有一些心房颤动（AF）的证据，而且其中大部分是隐匿性的：无症状且此前未被识别。
本综述的目的是探讨“隐匿性AF”作为隐源性中风潜在病因的情况。
方法/结果：我们首先回顾了已发表的关于在隐源性中风背景下使用不同监测技术筛查AF的大部分文献。我们展示了两项近期大型随机试验CRYSTAL AF和EMBRACE的结果，这两项试验分别将隐源性中风患者的标准护理监测与侵入性和非侵入性监测策略进行了比较。最后，我们回顾了隐匿性AF与植入心脏电子设备人群中风的关系。患者选择、监测持续时间、监测技术的敏感性和特异性、患者依从性以及其他几个因素会影响监测期间AF检测的阳性率。
数据表明，大约30%的隐源性中风患者可检测到隐匿性AF，这具有重要的治疗意义。检测到隐匿性AF时可能应给予口服抗凝治疗。
