Dem kryptogenen Stroke auf der Spur: neue Möglichkeiten des Event-Recordings

Zusammenfassung

Ein Viertel der neu aufgetretenen Schlaganfälle wird weiterhin als kryptogen klassifiziert. Das Rezidivrisiko ist vergleichbar hoch wie bei sonstigen Schlaganfällen, und ein Teil dieser Schlaganfälle ist mit pAF assoziiert. Zahlreiche Studien zur kontinuierlichen Herzrhythmusüberwachung nach CS zeigten eine hohe Rate an neu diagnostiziertem AF, wobei die Rate in Abhängigkeit der Registrierungsdauer steigt. Die höchste „diagnostische Ausbeute“ ist mit kardialen Ereignisrekordern erzielbar, die binnen 12 Monaten nach CS bei ca. 20 % der Patienten AF detektieren können. Der zeitliche Zusammenhang zwischen Auftreten des Vorhofflimmerns und des Schlaganfalls scheint gering zu sein. Die AHA-Leitlinie von 2014 empfiehlt nach kryptogenem Schlaganfall eine 30-tägige Herzrhythmusüberwachung und im Falle der Detektion von Vorhofflimmern die Rezidivprophylaxe des Apoplex mit Vitamin-K-Antagonisten, Apixaban, Dabigatran oder Rivaroxaban. Wichtige offene Fragen sind die klinische Relevanz sehr kurzer AF-Episoden und Kriterien für die Selektion von Patienten zur ICM-Implantation.

Abstract

About 25 % of newly detected strokes remain to be classified as CS and they carry a relevant risk of recurrence. Current studies have found a high detection yield of newly diagnosed AF by prolonged continuous heart rhythm monitoring after CS. Detection rates increase by the duration of monitoring and the highest yield is obtained using ICMs, which will detect AF in about 20 % of CS patients after 12 months. The association of atrial tachyarrhythmia and stroke seems to be weak. Recent AHA-Guidelines recommend a prolonged rhythm monitoring of about 30 days in CS patients. In patients achieving the diagnosis of AF, oral anticoagulation using vitamin K antagonists, apixaban, dabigatran or rivaroxaban is recommended. Important questions remain in the discussion of the problem of AF: the clinical relevance of brief episodes of pAF and the properties of monitoring those patients.

Schlüsselwörter

kryptogener Schlaganfall - Vorhofflimmern - Ereignisrekorder - Langzeit-Monitoring

Key words

cryptogenic stroke - atrial fibrillation - event recorder - long-term monitoring

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