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Letter to the Editor| Volume 89, P135-136, July 2021

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Validation of the AF-ESUS score to identify patients with embolic stroke of undetermined source and low risk of device-detected atrial fibrillation

Published:May 02, 2021DOI:https://doi.org/10.1016/j.ejim.2021.04.003
Validation of the AF-ESUS score to identify patients with embolic stroke of undetermined source and low risk of device-detected atrial fibrillation
Previous ArticleDirect oral anticoagulants versus enoxaparin in patients with atrial fibrillation and active cancer
      During the recent years, the term ESUS (embolic stroke of undetermined source) is used to describe patients with ischemic stroke for whom the source of embolism remains undetected despite recommended investigation [
      • Hart R.G.
      • Diener H.C.
      • Coutts S.B.
      • et al.
      Embolic strokes of undetermined source: the case for a new clinical construct.
      Lancet Neurol. 2014; 13: 429-438
      ] Although ESUS patients represent a very heterogeneous population in terms of the underlying stroke mechanism, atrial fibrillation (AF) is frequently detected and therefore, prolonged cardiac rhythm monitoring is recommended [
      • Hart R.G.
      • Diener H.C.
      • Coutts S.B.
      • et al.
      Embolic strokes of undetermined source: the case for a new clinical construct.
      Lancet Neurol. 2014; 13: 429-438
      ,
      • Ntaios G.
      Embolic stroke of undetermined source: JACC review topic of the week.
      J Am Coll Cardiol. 2020; 75: 333-340
      ,
      • Ntaios G.
      • Perlepe K.
      • Lambrou D.
      • et al.
      Prevalence and overlap of potential embolic sources in patients with embolic stroke of undetermined source.
      J Am Heart Assoc. 2019; 8e012858
      ] However, only a minority of ESUS patients receive prolonged cardiac monitoring, mainly due to limited availability of technical and human resources, and the considerable cost of some of the available monitoring options [
      • Schnabel R.B.
      • Haeusler K.G.
      • Healey J.S.
      • et al.
      Searching for atrial fibrillation poststroke: a white paper of the AF-SCREEN international collaboration.
      Circulation. 2019; 140: 1834-1850
      ]. Therefore, tools to identify better candidates for prolonged cardiac monitoring are welcome, as they could increase the diagnostic yield [
      • Schnabel R.B.
      • Haeusler K.G.
      • Healey J.S.
      • et al.
      Searching for atrial fibrillation poststroke: a white paper of the AF-SCREEN international collaboration.
      Circulation. 2019; 140: 1834-1850
      ].

      Keywords

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      References

        • Hart R.G.
        • Diener H.C.
        • Coutts S.B.
        • et al.
        Embolic strokes of undetermined source: the case for a new clinical construct.
        Lancet Neurol. 2014; 13: 429-438
        View in Article
        • Ntaios G.
        Embolic stroke of undetermined source: JACC review topic of the week.
        J Am Coll Cardiol. 2020; 75: 333-340
        View in Article
        • Ntaios G.
        • Perlepe K.
        • Lambrou D.
        • et al.
        Prevalence and overlap of potential embolic sources in patients with embolic stroke of undetermined source.
        J Am Heart Assoc. 2019; 8e012858
        View in Article
        • Schnabel R.B.
        • Haeusler K.G.
        • Healey J.S.
        • et al.
        Searching for atrial fibrillation poststroke: a white paper of the AF-SCREEN international collaboration.
        Circulation. 2019; 140: 1834-1850
        View in Article
        • Ntaios G.
        • Perlepe K.
        • Lambrou D.
        • et al.
        Identification of patients with embolic stroke of undetermined source and low risk of new incident atrial fibrillation: the AF-ESUS score.
        Int J Stroke. 2020; 1747493020925281
        View in Article
        • Israel C.
        • Kitsiou A.
        • Kalyani M.
        • et al.
        Detection of atrial fibrillation in patients with embolic stroke of undetermined source by prolonged monitoring with implantable loop recorders.
        Thromb Haemost. 2017; 117: 1962-1969
        View in Article

      Article info

      Publication history

      Published online: May 02, 2021
      Accepted: April 7, 2021
      Received in revised form: April 1, 2021
      Received: March 1, 2021

      Identification

      DOI: https://doi.org/10.1016/j.ejim.2021.04.003

      Copyright

      © 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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