Pezawas Thomas
Department of Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
J Cardiovasc Dev Dis. 2023 Jul 18;10(7):306. doi: 10.3390/jcdd10070306.
Up to 20% of patients with ischemic stroke or transient ischemic attack have a prior history of known atrial fibrillation (AF). Additionally, unknown AF can be detected by different monitoring strategies in up to 23% of patients with cryptogenic or non-cardioembolic stroke. However, most studies had substantial gaps in monitoring time, especially early after the index event. Following this, AF rates would be higher if patients underwent continuous monitoring early after stroke, avoiding any gaps in monitoring. The few existing randomized studies focused on patients with cryptogenic stroke but did not focus otherwise specifically on prevention strategies in patients at high risk for AF (patients at higher age or with high CHA2DS2-VASC scores). Besides invasive implantable loop recorders (ILRs), external loop recorders (ELRs) and mobile cardiac outpatient telemetry (MCOT) are non-invasive tools that are commonly used for long-term ECG monitoring in cryptogenic-stroke patients in the ambulatory setting. The role of MCOT and hand-held devices within ECG smart monitoring in the detection of AF for the prevention of and after cryptogenic stroke is currently unclear. This intense review provides an overview of current evidence, techniques, and gaps in knowledge and aims to advise which patients benefit most from the current available devices.
高达20%的缺血性中风或短暂性脑缺血发作患者有已知心房颤动（AF）病史。此外，在高达23%的隐源性或非心源性栓塞性中风患者中，通过不同的监测策略可检测到隐匿性AF。然而，大多数研究在监测时间上存在很大差距，尤其是在索引事件后的早期。在此之后，如果患者在中风后早期接受连续监测，避免监测出现任何间隙，AF发生率会更高。现有的少数随机研究聚焦于隐源性中风患者，但未特别关注AF高危患者（年龄较大或CHA2DS2-VASC评分较高的患者）的预防策略。除了侵入性植入式循环记录仪（ILR）外，外部循环记录仪（ELR）和移动心脏门诊遥测（MCOT）是非侵入性工具，常用于门诊环境中对隐源性中风患者进行长期心电图监测。目前尚不清楚MCOT和手持设备在心电图智能监测中对预防和发生隐源性中风后检测AF的作用。本深入综述概述了当前的证据、技术和知识空白，旨在就哪些患者从现有可用设备中获益最大提供建议。
