%0 Journal Article
%T Detection of Paroxysmal Atrial Fibrillation in Stroke/Tia Patients
%A Muhib Khan
%A Daniel J. Miller
%J Stroke Research and Treatment
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/840265
%X One-third of stroke and transient ischemic attack (TIA) are cryptogenic, and paroxysmal atrial fibrillation (PAF) has been suggested as a possible cause for these cryptogenic strokes. Multiple studies have recently evaluated long-term cardiac rhythm monitoring with good yield for PAF. The duration of monitoring varies between studies as well as the qualifying event definition. Moreover, the clinical significance of very brief atrial fibrillation events is unclear in the literature. This paper provides an overview of current advances in the detection of paroxysmal atrial fibrillation, the clinical and genetic factors predictive of arrhythmia detection, and the therapeutic dilemma concerning this approach. 1. Introduction One-third of stroke and transient ischemic attack (TIA) are cryptogenic requiring additional investigation and intervention [1]. Occult paroxysmal atrial fibrillation (PAF) has been suggested as a possible cause for these cryptogenic strokes [2]. Atrial fibrillation has been long associated with high risk of stroke, but most of this knowledge is derived from patient data from chronic atrial fibrillation. It has been suggested that PAF is more prevalent than persistent atrial fibrillation in stroke and TIA patients [3]. Anticoagulation therapy initiated after detection of atrial fibrillation (AF) provides an additional 40% risk reduction of stroke as compared to antiplatelet therapy alone [4]. Therefore, it is important to diagnose AF after an ischemic stroke to provide maximal stroke prevention therapy. Current standard of care dictates an admission electrocardiogram (ECG) and at least 24£¿h of continuous telemetry monitoring [5]. However, brief asymptomatic paroxysmal atrial fibrillation events may remain undetected by traditional methods of screening. Recent technological advances have made it possible to perform long-term cardiac rhythm monitoring up to months or even years after a stroke. 2. Definition Paroxysmal atrial fibrillation is not clearly defined in the literature. There is controversy over the duration and morphology of the ECG data in defining an event qualifying for atrial fibrillation. Studies evaluating the incidence of PAF in stroke and TIA patient populations have used different definitions adding confusion about the true incidence. In our paper, we have highlighted the need for a rigorous definition of paroxysmal atrial fibrillation especially in the light of widely used advanced rhythm monitoring devices. 3. Epidemiology Atrial fibrillation prevalence is associated with age with 0.5% at 50¨C59 years of age increasing
%U http://www.hindawi.com/journals/srt/2013/840265/