Identification of Covert Atrial Fibrillation in Cryptogenic Ischemic Stroke: Current Clinical Practice in Japan

Kazunori Toyoda, Ken Okumura, Yoichiro Hashimoto, Takanori Ikeda, Takashi Komatsu, Teruyuki Hirano, Haruhisa Fukuda, Kazuo Matsumoto, Masahiro Yasaka

研究成果: Contribution to journalReview article査読

14 被引用数 (Scopus)

抄録

Background and aim A new insertable cardiac monitor, Reveal LINQ (Medtronic, Dublin, Ireland), was approved for clinical use in Japan in March 2016 for detecting atrial fibrillation in patients who develop ischemic stroke with no clearly definable etiology even after extensive workup, so-called cryptogenic ischemic stroke. Cooperation between a specialist of the Japan Stroke Society and a trained cardiologist or cardiac surgeon is needed both for appropriate patient selection and appropriate management of the device. In this paper, the clinical significance of and diagnostic methods for cryptogenic stroke and covert atrial fibrillation are explained, along with our proposal for the clinical indications for this new device. Methods, results, and conclusion The majority of cryptogenic ischemic strokes are considered to be embolic. In particular, covert atrial fibrillation is drawing attention as the causal emboligenic disease, and it was identified in 30% of patients with long-term observation using an insertable cardiac monitor. Should atrial fibrillation be present, there is a high risk of recurrent stroke, and the cardioembolic stroke that appears is generally severe. The ability to identify atrial fibrillation would be beneficial for preventing stroke recurrence, as anticoagulants can then be used as an established method of secondary prevention. Because the use of insertable cardiac monitors is somewhat invasive, and long-term care systems are also needed, patients suitable for examination using the new device would need to be identified on the basis of detailed diagnostics in accordance withcurrent medical practice in Japan.

本文言語英語
ページ(範囲)1829-1837
ページ数9
ジャーナルJournal of Stroke and Cerebrovascular Diseases
25
8
DOI
出版ステータス出版済み - 8 1 2016

All Science Journal Classification (ASJC) codes

  • 外科
  • リハビリテーション
  • 臨床神経学
  • 循環器および心血管医学

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