Cryptogenic Stroke and Underlying Atrial Fibrillation

In patients with cryptogenic stroke, undetected paroxysmal atrial fibrillation may be a cause of the stroke. In this randomized trial, an insertable cardiac monitor was superior to conventional cardiac monitoring for detecting atrial fibrillation in patients with cryptogenic stroke. Ischemic stroke is among the leading causes of death and disability. 1 The cause remains unexplained after routine evaluation in 20 to 40% of cases, resulting in the classification, by exclusion, of cryptogenic stroke. 2 – 6 Atrial fibrillation is a well-recognized cause of ischemic stroke, 7 though the risk is markedly reduced by anticoagulation 7 , 8 Documentation of atrial fibrillation is required to initiate anticoagulant therapy after ischemic stroke. 8 In the absence of documented atrial fibrillation, antiplatelet agents are recommended. 7 Given the often paroxysmal and asymptomatic nature of atrial fibrillation, it may not be detected with the use of traditional monitoring techniques. 9 – 12 Strategies . . .