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Abstract

Approximately one out of five strokes is associated with atrial fibrillation (AF). AF is often intermittent and asymptomatic. Detection of AF after cryptogenic stroke will change therapy from antiplatelet to oral anti-coagulation agents for secondary stroke prevention. A critical step is to convert "covert" AF into ECG documented AF. External rhythm recording devices have registered a high incidence of AF to occur after a cryptogenic stroke, but are limited by short duration of continuous recordings. Invasive cardiac monitoring using insertable leadless cardiac monitors (ICMs) are sensitive means to identify subclinical AF (SCAF) after cryptogenic stroke, and AF has been reported to occur in up to 30% of these patients. It will be even more attractive to identify SCAF before a stroke occurs. Recent series in pacemaker and implantable cardioverter defibrillator showed that short episodes of SCAF increased stroke risk, with odds ratio ~2.2-3.1 compared to those without SCAF recorded. However, temporal sequence of recorded SCAF and stroke occurrence was uncertain, and the overall stroke risk was lower compared with patients with clinical AF at similar risk scores. This article reviews the incidence and clinical role of using implanted devices to detect SCAF and discuss the implication of SCAF so detected in primary and secondary stroke prevention.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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