Table 1 Summary of relevant guidelines for AF screening after ischemic stroke or TIA, in force at the time of the survey (November 2021)
Recommendation | COR | LOE |
|---|---|---|
2020 ESC Guidelines for the diagnosis and management of atrial fibrillation [13] | ||
In patients with acute ischaemic stroke or TIA and without previously known AF, […] short-term ECG recording for at least the first 24 h, followed by continuous ECG monitoring for at least 72 h whenever possible [is recommended] | 1 | B |
In selected stroke patients without previously known AF, additional ECG monitoring using long-term non-invasive ECG monitors or insertable cardiac monitors should be considered, to detect AF | 2a | B |
AHA/ASA Guideline 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack [14] | ||
In patients suspected of having a stroke or TIA, an ECG is recommended to screen for AF and atrial flutter and to assess for other concomitant cardiac conditions | 1 | B-R |
In patients with cryptogenic stroke who do not have a contraindication to anticoagulation, long-term rhythm monitoring with mobile cardiac outpatient telemetry, ILR, or other approach is reasonable to detect intermittent AF | 2a | B-R |
Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals [19] | ||
Cardiac monitoring is recommended to screen for AF and other potentially serious arrhythmias that would necessitate emergency cardiac interventions. Cardiac monitoring should be performed for at least the first 24 h | 1 | B-NR |
The effectiveness of prolonged cardiac monitoring during hospitalization after acute ischemic stroke to guide treatment selection for prevention of recurrent stroke is uncertain | 2b | C-LD |
Guideline: Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11–13 November 2018[20] What is good clinical practice in work up for suspected cardio-embolic cases? | ||
[…] 24-h 12-lead ECG | A | |
Continuous monitoring of heart rhythm up to 30 days is reasonable in patients with embolic stroke of undetermined aetiology despite recommended diagnostic work up to increase covert AF detection | A | |
It remains to be firmly established that the increased detection of brief episodes of AF will lead to a reduction in stroke recurrence after adequate treatment | C | |