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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Identification of Covert Atrial Fibrillation in Cryptogenic Ischemic Stroke: Current Clinical Practice in Japan
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Identification of Covert Atrial Fibrillation in Cryptogenic Ischemic Stroke: Current Clinical Practice in Japan

机译：隐源性缺血性卒中隐性房颤的鉴定：日本目前的临床实践

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Background and aim: A new insertable cardiac monitor, Reveal LINQ (Medtronic, Dublin, Ireland), was approved for clinical use in Japan in March 2016 for detecting atrial fibrillation in patients who develop ischemic stroke with no clearly definable etiology even after extensive workup, so-called cryptogenic ischemic stroke. Cooperation between a specialist of the Japan Stroke Society and a trained cardiologist or cardiac surgeon is needed both for appropriate patient selection and appropriate management of the device. In this paper, the clinical significance of and diagnostic methods for cryptogenic stroke and covert atrial fibrillation are explained, along with our proposal for the clinical indications for this new device. Methods, results, and conclusion: The majority of cryptogenic ischemic strokes are considered to be embolic. In particular, covert atrial fibrillation is drawing attention as the causal emboligenic disease, and it was identified in 30% of patients with long-term observation using an insertable cardiac monitor. Should atrial fibrillation be present, there is a high risk of recurrent stroke, and the cardioembolic stroke that appears is generally severe. The ability to identify atrial fibrillation would be beneficial for preventing stroke recurrence, as anticoagulants can then be used as an established method of secondary prevention. Because the use of insertable cardiac monitors is somewhat invasive, and long-term care systems are also needed, patients suitable for examination using the new device would need to be identified on the basis of detailed diagnostics in accordance with current medical practice in Japan.
机译：背景与目的：2016年3月，一种新型的可插入式心脏监护仪Reveal LINQ（Medtronic，爱尔兰都柏林）被批准在日本用于临床，用于检测发生缺血性卒中且病因尚无明确定义的患者的房颤，所谓的隐源性缺血性中风。日本中风学会的专家与受过训练的心脏病专家或心脏外科医生之间需要进行合作，以进行适当的患者选择和设备的适当管理。在本文中，解释了隐源性中风和隐性房颤的临床意义和诊断方法，以及我们对这种新设备的临床适应症的建议。方法，结果和结论：大多数隐源性缺血性中风被认为是栓塞性的。特别是隐性房颤作为引起栓塞的病因引起了人们的注意，并且在30％的使用可插入式心脏监护仪进行长期观察的患者中发现了这种情况。如果存在房颤，则存在复发性中风的高风险，并且出现的心脏栓塞性中风通常很严重。识别心房颤动的能力将有助于预防中风复发，因为抗凝剂可以用作已建立的二级预防方法。由于插入式心脏监护仪的使用具有侵入性，并且还需要长期护理系统，因此需要根据日本目前的医疗习惯，在详细诊断的基础上确定适合使用新设备进行检查的患者。

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