Why did you (and your colleagues) write this paper? What was its main purpose?

ALKISTI KITSIOU

Me and my colleagues wrote this paper to present data of this unique cohort of patients with Embolic Stroke of Undetermined Source (ESUS) and prolonged cardiac monitoring. The main purpose was the detection of atrial fibrillation (AF) in this well defined and selected subpopulation of cryptogenic stroke. Furthermore,  the rate of recurrent strokes over a period of 3 years in the group of AF-patients, who received oral anticoagulation, was lower in comparison to the estimated stroke risk from their CHA2DS2-VASc score.

What are the main conclusions? 

ALKISTI KITSIOU

The main conclusion is that after a prolonged cardiac monitoring, 41.4% of the patients had indeed AF and for most of them the secondary stroke prevention was switched to oral anticoagulation. Importantly, in the other 60% of the patients, AF could not be detected, even though an intensified and prolonged monitoring with Event-Recorder for 3 years was applied. This finding highlights the large heterogeneity of the stroke etiology in ESUS-patients and calls for better definition of the concept.

What are the paper's implications? - to the public? -to medical professionals?

ALKISTI KITSIOU

The paper highlights the importance of continuous cardiac monitoring after a stroke for detection of atrial fibrillation for the medical professionals. As for the public, it can increase awareness, that stroke is a very serious medical condition with a broad spectrum of causes, which have to be immediately diagnosed and treated from doctors with high expertise in the stroke field.

Are the findings clinically significant? Should the findings change practice?

ALKISTI KITSIOU

The findings in this paper are significant and should encourage prolonged cardiac monitoring for detection of AF after a stroke, specifically ESUS. Once AF is detected as in our study, the secondary presention strategy should be switched to oral anticoagulation to prevent new strokes – a finding that needs to be confirmed in larger trials, such as the ongoing FIND-AF 2.