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The complexity of atrial fibrillation newly diagnosed after ischemic stroke and
transient ischemic attack: advances and uncertainties
#MMPMID27984303
Cerasuolo JO
; Cipriano LE
; Sposato LA
Curr Opin Neurol
2017[Feb]; 30
(1
): 28-37
PMID27984303
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PURPOSE OF REVIEW: Atrial fibrillation is being increasingly diagnosed after
ischemic stroke and transient ischemic attack (TIA). Patient characteristics,
frequency and duration of paroxysms, and the risk of recurrent ischemic stroke
associated with atrial fibrillation detected after stroke and TIA (AFDAS) may
differ from atrial fibrillation already known before stroke occurrence. We aim to
summarize major recent advances in the field, in the context of prior evidence,
and to identify areas of uncertainty to be addressed in future research. RECENT
FINDINGS: Half of all atrial fibrillations in ischemic stroke and TIA patients
are AFDAS, and most of them are asymptomatic. Over 50% of AFDAS paroxysms last
less than 30?s. The rapid initiation of cardiac monitoring and its duration are
crucial for its timely and effective detection. AFDAS comprises a heterogeneous
mix of atrial fibrillation, possibly including cardiogenic and neurogenic types,
and a mix of both. Over 25 single markers and at least 10 scores have been
proposed as predictors of AFDAS. However, there are considerable inconsistencies
across studies. The role of AFDAS burden and its associated risk of stroke
recurrence have not yet been investigated. SUMMARY: AFDAS may differ from atrial
fibrillation known before stroke in several clinical dimensions, which are
important for optimal patient care strategies. Many questions remain unanswered.
Neurogenic and cardiogenic AFDAS need to be characterized, as it may be possible
to avoid some neurogenic cases by initiating timely preventive treatments. AFDAS
burden may differ in ischemic stroke and TIA patients, with distinctive
diagnostic and treatment implications. The prognosis of AFDAS and its risk of
recurrent stroke are still unknown; therefore, it is uncertain whether AFDAS
patients should be treated with oral anticoagulants.
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