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Silent Atrial Fibrillation and Cryptogenic Strokes
James E Dalen1, Joseph S Alpert1
1Department of Medicine, University of Arizona, Tucson.
The American Journal of Medicine
|October 21, 2016
Summary
Silent atrial fibrillation, often asymptomatic, is frequently detected in stroke patients and those with pacemakers. Early detection in stroke patients warrants anticoagulation, while monitoring is recommended for others.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Cryptic strokes are increasingly linked to silent atrial fibrillation.
- Implanted cardiac devices enable continuous rhythm monitoring, revealing frequent, asymptomatic atrial fibrillation episodes.
Purpose of the Study:
- To investigate the prevalence and implications of silent atrial fibrillation in stroke patients and individuals with pacemakers.
- To inform clinical management strategies for silent atrial fibrillation.
Main Methods:
- Meta-analysis of 50 studies (over 10,000 stroke patients) to assess atrial fibrillation diagnosis post-stroke.
- Pooled analysis of 3 studies (over 10,000 pacemaker patients) to evaluate atrial fibrillation frequency and duration.
- Review of diagnostic criteria and treatment recommendations.
Main Results:
- 23.7% of recent stroke patients were diagnosed with silent atrial fibrillation after hospital admission.
- In pacemaker patients without recent stroke, 43% experienced atrial fibrillation >5 minutes daily, and 10% had episodes >12 hours over 24 months.
- Annual stroke incidence in pacemaker patients with silent atrial fibrillation was low (0.23%).
Conclusions:
- Silent atrial fibrillation is a common finding in stroke patients and pacemaker recipients.
- Anticoagulation is indicated for silent atrial fibrillation in patients with recent cryptogenic stroke.
- In patients without stroke, silent atrial fibrillation warrants further monitoring rather than immediate anticoagulation.
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