In most strokes, the blood flow in an artery is interrupted. However, the exact cause is unclear in up to 20 percent of all strokes. Medical experts call this an embolic stroke of undetermined cause, or ESUS. If the cause of the stroke is unclear, the suspicion often falls on atrial fibrillation - one of the most common cardiac arrhythmias.
To identify patients at exceptionally high risk for atrial fibrillation and thus for another stroke, scientists at LMU Hospital Munich have tested a risk score: The risk score is determined by ECG. If it is high, the patient's heart rhythm can be monitored more intensively - whether as an inpatient in the stroke unit or as an outpatient in cardiological aftercare.
Risk score can be determined non-invasively by ECG in all stroke patients
The result of the study by the Departments of Cardiology and Neurology at LMU Klinikum was published in the journal Annals of Neurology. DZHK scientist PD Dr. Moritz Sinner from the Hospital of the Ludwig-Maximilians-University Munich explains what follows from the individual risk assessment for atrial fibrillation in ESUS patients: "For example, some patients may require more intensive monitoring with repeated long-term ECGs or even implantable event recorders, whereas this does not seem necessary in low-risk patients. A major advantage of our new ECG-based risk score is that it is non-invasive, making it particularly easy to apply to all stroke patients. Because if atrial fibrillation is detected, we can effectively protect our ESUS patients from another stroke with appropriate medication."
The observational study analyzed nearly 300 patients who had an embolic stroke of unexplained cause and were treated at LMU Klinikum between 2018 and 2019. Prof. Dr. Lars Kellert, the senior physician at the Department of Neurology, says, "The so-called Rhythm Irregularity Burden, which records the irregularity of the heartbeat, plays an important role." It enables patients with very high and shallow risks of atrial fibrillation to be accurately distinguished. "If the system reports an increased risk of atrial fibrillation, we can detect atrial fibrillation in about 25 percent of these patients over the next 15 months," Kellert says.
Atrial Fibrillation Risk Assessment after Embolic Stroke of Undetermined Source
Aenne S von Falkenhausen, Katharina Feil, Moritz F Sinner, Sonja Schönecker, Johanna Müller, Johannes Wischmann, Elodie Eiffener, Sebastian Clauss, Sven Poli, Khouloud Poli, Christine S Zuern, Ulf Ziemann, Jörg Berrouschot, Alkisti Kitsiou, Wolf-Rüdiger Schäbitz, Marianne Dieterich, Steffen Massberg, Stefan Kääb, Lars Kellert. Annals of Neurology. 2022 Nov 13. DOI: https://doi.org/10.1002/ana.26545
Scientific contact person: Prof. Dr. med. Lars Kellert, Neurologische Klinik und Poliklinik, LMU Klinikum München, lars.kellert(at)med.uni-muenchen.de
PD Dr. med. Moritz Sinner, MPH, Leitung Rhythmologie, Standort Großhadern, Medizinische Klinik und Poliklinik I, LMU Klinikum München, moritz.sinner(at)med.uni-muenchen.de