Atrial Fibrillation and Cryptogenic Thromboembolic Events

Detection of subclinical atrial fibrillation in cryptogenic and embolic stroke of undetermined source

The use of long-term monitoring dramatically improved the ability to detect short, rare, and asymptomatic AF periods in stroke patients. The EMBRACE study evaluated 572 patients with ischemic stroke in the last 6 months, with no AF diagnosis, with randomization for 30-day continuous monitoring (287 patients) vs. 24-hour Holter (285 patients).

The AF detection rates (> 30 seconds) were 16.1% in the long-term monitoring group vs. 3.2% in the Holter group. Similarly, when Implantable Monitors (IM) were used, as in the CRYSTAL-AF (Cryptogenic Stroke and underlying Atrial Fibrillation) study, AF detection rates using IM were higher than the standard detection rates during a long-term follow-up: 8.9%, 12.4% and 30% vs. 1.4%, 2.0% and 3% in the period of 6, 12 and 36 months.

[…]