Atrial fibrillation (AF) is the most potent predictive factor for risk of stroke. The good news is that stroke risk in AF patients can be reduced by more than two-thirds with use of currently available antithrombotic medications, while incurring only a minor risk (< 1.0%/yr) of central nervous system bleed.
I guess the reason we use the words “idiopathic” and “cryptogenic” is because it is difficult for us to say “We just don’t know.” But package the answer in whichever jargon you like, cryptogenic stroke is an important public health issue, since approximately 25% of ischemic strokes are ultimately so-classified.
Before labeling a stroke cryptogenic, an evaluation for underlying pathology is generally performed, which includes scrutiny for AF, since that is so frequently a culprit and so importantly remedied. If AF was not detected in the proximate temporal vicinity of the stroke, can an “innocent” verdict be rendered as far as AF is concerned?
Sometimes, apparently not. Gladstone et al report on the results from cryptogenic stroke/TIA patients (n = 572), half of whom were randomized to 30-day post-event cardiac rhythm monitoring. AF of at least 30 seconds duration was identified in 16.1% of the patients who were monitored.
AF is responsible for a significant number of stroke patients who would not otherwise enjoy the benefits of anticoagulation. More routine inclusion of longer monitoring will help to identify these patients.
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