Searching for atrial fibrillation post-stroke with prolonged monitoring: Do it early, but should we be looking for something else?

摘要

Performing extended monitoring for atrial fibrillation (AF) in a general, untargeted population, is widely contentious, as the cases of subclinical AF identified in this manner generally have low stroke risk, and as such is not recommended in guidelines [1]. Extended monitoring following stroke, particularly cryptogenic (CS) or embolic stroke of unknown source (ESUS), is less con- tentious as these subclinical AF cases have a much higher stroke recurrence rate so treatment with oral anticoagulants (OAC) would be recommended. The highest yield of AF occurs when monitoring is performed very early after stroke, i.e., during the stroke admis- sion or soon after discharge. Most stroke management guidelines recommend early monitoring for AF and a 24-hour Holter monitor, though more recently Holter monitoring of at least 72-hours has been recommended [1,2].