Aktuelle Diagnostik auf der Stroke Unit

Zusammenfassung

Um Schlaganfall-Patienten eine effiziente Sekundärprophylaxe anbieten zu können, ist eine strukturierte Diagnostik hinsichtlich der vermuteten Schlaganfallätiologie auf einer Stroke Unit unabdingbar. Bei den ätiologisch „kryptogenen” Schlaganfällen wird zunehmend ein paroxysmales Vorhofflimmern (pVHF) als mögliche auslösende Ursache gefunden. Lässt sich das permanente Vorhofflimmern (VHF) einfach durch ein 12-Kanal-EKG detektieren, kann das häufig klinisch asymptomatisch und in Clustern auftretende pVHF diagnostische Schwierigkeiten bereiten. Aktuelle Studien konnten belegen, dass ein prolongiertes EKG-Monitoring über die derzeit empfohlenen 24 Stunden hinweg häufiger zur Detektion von pVHF führt. Dies hat direkte sekundärprophylaktische Konsequenzen, da in den meisten Fällen dann eine orale Antikoagulation indiziert ist. Sowohl permanentes als auch pVHF sind mit einem erhöhten Re-Schlaganfallrisiko vergesellschaftet. Insbesondere vor dem Hintergrund der Effektivität direkter oraler Antikoagulantien, kommt damit der Diagnostik von pVHF eine besondere Bedeutung zu. In der vorliegenden Übersicht werden die Möglichkeiten einer optimierten pVHF Diagnostik diskutiert.

Summary

A structured diagnostic work-up to clarify the etiology of ischaemic stroke is one of the main aims of stroke unit treatment. With an improved detection of stroke etiology we can offer patients a more efficient and personalized secondary prophylaxis. Particularly in case of “cryptogenic” stroke, in which the etiology of cerebral ischaemia remains unspecified/undiscovered, recent studies demonstrate atrial fibrillation as a potential underlying cause. Permanent as well as paroxysmal atrial fibrillation (pAF) is associated with a high risk of recurrent ischaemic stroke. Whereas permanent atrial fibrillation is easily discovered by conventional electrocardiogram-recording, the detection of pAF is associated with a greater diagnostic complexity, as it occurs in clusters and is often clinically asymptomatic. In principle, the detection of pAF increases with the duration of electrocardiogram-recording and consequently influences the medical secondary prophylaxis since oral anticoagulation is indicated in most cases of atrial fibrillation. Especially considering the availability of new oral anticoagulants we have to focus on pAF in stroke unit diagnostics. In this review article, current options in stroke unit diagnostics with a focus on the detection of paroxysmal atrial fibrillation are discussed.

Schlüsselwörter

Paroxysmales Vorhofflimmern - Diagnostik - Stroke Unit - ESUS

Keywords

Paroxysmal atrial fibrillation - diagnostic - Stroke Unit - ESUS

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