Cryptogenic Stroke: Cardiac Rhythm Monitoring as An Indispensable Screening Modality
Keywords:
cryptogenic stroke, atrial fibrillation, ECG, digital health tools
Abstract
The prevalence of stroke in Indonesia increased overtime. CS ranges from 15 to 40% from all ischemic strokes. Finding the etiology of ischemic stroke is important to prevent recurrence. AF is predicted as the etiology behind CS. The current recommendation only supports short period of ECG monitoring. However, studies have shown that a higher detection rate can be achieved with longer duration of monitoring. ICM, a diagnostic tool with the highest detection rate, is still considered cost-effective when the calculation takes into account the QALY gained. Digital health tools such as handheld devices and smartwatch ECG have revolutionized the screening of AF however it is still considered as pre-diagnostic and verification is needed to confirm the rhythm generated.
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References
1. Dangayach NS, Kane K, Moonis M. Paroxysmal atrial fibrillation in cryptogenic stroke. Ther Clin Risk Manag. 2011;7:33-37.
2. Carmona-Puerta R, Castro-Torres Y. Atrial fibrillation and cryptogenic stroke. What is the current evidence? role of electrocardiographic monitoring. J Arrhythmia. 2018;34:1-3.
3. Rajsic S, Gothe H, Borba HH, Sroczynski G, Vujicic J, Toell T, Siebert U. Economic burden of stroke: a systematic review on post-stroke care. Eur J Heal Econ. 2019;20:107-134.
4. Fadhilah H, Permanasari VY. Economic Burden Bore by Patients and Families because of stroke: Policy Assessment. J Indones Heal Policy Adm. 2020;5:91-95.
5. McMahon NE, Bangee M, Benedetto V, Bray EP, Georgiou RF, Gibson JME, Lane DA, Al-Khalidi AH, Chatterjee K, Chauhan U, Clegg AJ, Lightbody CE, Lip GYH, Sekhar A, Watkins CL. Etiologic Workup in Cases of Cryptogenic Stroke: A Systematic Review of International Clinical Practice Guidelines. Stroke. 2020:1419-1427.
6. Edwards JD, Kapral MK, Fang J, Saposnik G, Gladstone DJ. Underutilization of Ambulatory ECG Monitoring after Stroke and Transient Ischemic Attack: Missed Opportunities for Atrial Fibrillation Detection. Stroke. 2016;47:1982-1989.
7. Gladstone DJ, Spring M, Dorian P, Panzov V, Thorpe KE, Hall J, et al. Atrial Fibrillation in Patients with Cryptogenic Stroke. N Engl J Med. 2014;370:2467-2477.
8. Raharjo SB. SPAF in Developing Country. In: SPAF in Developing Country. Bangkok: 12th Asia Pacific Heart Rhythm Society Scientific Session; 2019.
9. Sanna T, Diener H-C, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, Rymer MM, Thijs V, Rogers T, Beckers F, Lindborg K, Brachmann J. Cryptogenic Stroke and Underlying Atrial Fibrillation. N Engl J Med. 2014;370:2478-2486.
10. Schnabel RB, Haeusler KG, Healey JS, Freedman B, Boriani G, Brachmann J, et al. Searching for Atrial Fibrillation Poststroke: A White Paper of the AF-SCREEN International Collaboration. Circulation. 2019;140:1834-1850.
11. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42:373-498.
12. Richardson E, Hall A, Mitchell ARJ. Screening for Atrial Fibrillation and the Role of Digital Health Technologies. Epidemiol Treat Atr Fibrillation. 2020:137-144.
13. Varma N, Cygankiewicz I, Turakhia MP, Heidbuchel H, Hu Y-F, Chen LY, et al. 2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals. Circ Arrhythmia Electrophysiol. February 2021.
14. Perez M V., Mahaffey KW, Hedlin H, Rumsfeld JS, Garcia A, Ferris T, et al. Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation. N Engl J Med. 2019;381:1909-1917.
15. Diamantopoulos A, Sawyer LM, Lip GYH, Witte KK, Reynolds MR, Fauchier L, Thijs V, Brown B, Angulo MEQ, Diener HC. Cost-effectiveness of an insertable cardiac monitor to detect atrial fibrillation in patients with cryptogenic stroke. Int J Stroke. 2016;11:302-312.
2. Carmona-Puerta R, Castro-Torres Y. Atrial fibrillation and cryptogenic stroke. What is the current evidence? role of electrocardiographic monitoring. J Arrhythmia. 2018;34:1-3.
3. Rajsic S, Gothe H, Borba HH, Sroczynski G, Vujicic J, Toell T, Siebert U. Economic burden of stroke: a systematic review on post-stroke care. Eur J Heal Econ. 2019;20:107-134.
4. Fadhilah H, Permanasari VY. Economic Burden Bore by Patients and Families because of stroke: Policy Assessment. J Indones Heal Policy Adm. 2020;5:91-95.
5. McMahon NE, Bangee M, Benedetto V, Bray EP, Georgiou RF, Gibson JME, Lane DA, Al-Khalidi AH, Chatterjee K, Chauhan U, Clegg AJ, Lightbody CE, Lip GYH, Sekhar A, Watkins CL. Etiologic Workup in Cases of Cryptogenic Stroke: A Systematic Review of International Clinical Practice Guidelines. Stroke. 2020:1419-1427.
6. Edwards JD, Kapral MK, Fang J, Saposnik G, Gladstone DJ. Underutilization of Ambulatory ECG Monitoring after Stroke and Transient Ischemic Attack: Missed Opportunities for Atrial Fibrillation Detection. Stroke. 2016;47:1982-1989.
7. Gladstone DJ, Spring M, Dorian P, Panzov V, Thorpe KE, Hall J, et al. Atrial Fibrillation in Patients with Cryptogenic Stroke. N Engl J Med. 2014;370:2467-2477.
8. Raharjo SB. SPAF in Developing Country. In: SPAF in Developing Country. Bangkok: 12th Asia Pacific Heart Rhythm Society Scientific Session; 2019.
9. Sanna T, Diener H-C, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, Rymer MM, Thijs V, Rogers T, Beckers F, Lindborg K, Brachmann J. Cryptogenic Stroke and Underlying Atrial Fibrillation. N Engl J Med. 2014;370:2478-2486.
10. Schnabel RB, Haeusler KG, Healey JS, Freedman B, Boriani G, Brachmann J, et al. Searching for Atrial Fibrillation Poststroke: A White Paper of the AF-SCREEN International Collaboration. Circulation. 2019;140:1834-1850.
11. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42:373-498.
12. Richardson E, Hall A, Mitchell ARJ. Screening for Atrial Fibrillation and the Role of Digital Health Technologies. Epidemiol Treat Atr Fibrillation. 2020:137-144.
13. Varma N, Cygankiewicz I, Turakhia MP, Heidbuchel H, Hu Y-F, Chen LY, et al. 2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals. Circ Arrhythmia Electrophysiol. February 2021.
14. Perez M V., Mahaffey KW, Hedlin H, Rumsfeld JS, Garcia A, Ferris T, et al. Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation. N Engl J Med. 2019;381:1909-1917.
15. Diamantopoulos A, Sawyer LM, Lip GYH, Witte KK, Reynolds MR, Fauchier L, Thijs V, Brown B, Angulo MEQ, Diener HC. Cost-effectiveness of an insertable cardiac monitor to detect atrial fibrillation in patients with cryptogenic stroke. Int J Stroke. 2016;11:302-312.
Published
2021-09-16
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How to Cite
Raharjo, S., Humaira, S., & Liastuti, L. (2021). Cryptogenic Stroke: Cardiac Rhythm Monitoring as An Indispensable Screening Modality. Indonesian Journal of Cardiology, 42(3). https://doi.org/10.30701/ijc.1143
Section
Review Article
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