Atrial Fibrillation Detection and Load: Knowledge Gaps Related to Stroke Prevention

Eric E. Smith, Shadi Yaghi, Luciano A. Sposato, Marc Fisher, Joseph Broderick, Alvin S. Das, Mitchell S.V. Elkind, Larry B. Goldstein, M. Edip Gurol, Hooman Kamel, John R. Morgan, Bruce Ovbiagele, Sean Savitz, Magdy Selim, Manish Wadhwa

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Atrial fibrillation is a major cause of ischemic stroke. Technological advances now support prolonged cardiac rhythm monitoring using either surface electrodes or insertable cardiac monitors. Four major randomized controlled trials show that prolonged cardiac monitoring detects subclinical paroxysmal atrial fibrillation in 9% to 16% of patients with ischemic stroke, including in patients with potential alternative causes such as large artery disease or small vessel occlusion; however, the optimal monitoring strategy, including the target patient population and the monitoring device (whether to use an event monitor, insertable cardiac monitor, or stepped approach) has not been well defined. Furthermore, the clinical significance of very short duration paroxysmal atrial fibrillation remains controversial. The relevance of the duration of monitoring, burden of device-detected atrial fibrillation, and its proximity to the acute ischemic stroke will require more research to define the most effective methods for stroke prevention in this patient population.

Original languageEnglish
Pages (from-to)205-213
Number of pages9
Issue number1
StatePublished - Jan 1 2024

Bibliographical note

Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.


  • anticoagulation
  • atrial fibrillation
  • left atrial appendage closure
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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