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Brain & Heart

REVIEW ARTICLE
Clinical predictive scores for detection of

sub-clinical atrial fibrillation after cryptogenic or
embolic stroke of undetermined source: A brief

systematic review

Luca Masotti*, and Elisa Grifoni
Internal Medicine II and Stroke Unit, San Giuseppe Hospital, Empoli, Italy

Abstract
Subclinical atrial fibrillation (SAF) is the primary underlying cause of cryptogenic
stroke (CS) or embolic stroke of undetermined source (ESUS), particularly in patients
over 65 years of age. Therefore, it is strongly recommended screening for SAF in
these patients. The development of tools designed to determine the priority of SAF
screening is essential for optimizing the diagnostic workup. The aim of our study was
to investigate the clinical predictive scores available for SAF detection in patients
with CS or ESUS. We gathered data from articles published on the PubMed database
from January 1, 2000, to January 31, 2023. Our search yielded eight scores for CS and
three for ESUS. SAF diagnosis was established using various methods: 12-lead ECG or
24-h ECG monitoring during 1-year follow-up in three scores; 72-h non-implantable
ECG monitoring in two scores; 2 or 3-week non-implantable ECG monitoring in three
*Corresponding author: scores; and implantable ECG monitoring in one score. In two scores, ECG monitoring
Luca Masotti (luca.masotti@tin.it) was performed using a non-implantable and/or implantable loop recorder. Overall,
Citation: Masotti L, Grifoni E, the rate of SAF detection was approximately 6% when using devices for monitoring
2023, Clinical predictive scores lasting no more than 72 h and increased to nearly 22% employing 2 or 3-week non-
for detection of sub-clinical atrial
fibrillation after cryptogenic or implantable or implantable devices. SAF was defined differently in various scores;
embolic stroke of undetermined five scores considered any episode, even if shorter than 30 s, while six scores required
source: A brief systematic review. episodes to last at least 30 s. Advanced age was included as a variable in 10 of 11
Brain & Heart, 1(2): 0955.
https://doi.org/10.36922/bh.0955 scores, whereas left atrial enlargement, premature atrial beats, and brain computed
tomography characteristics were features in four scores. The area under the curve
Received: May 16, 2023 values of these scores ranged from 0.72 to 0.94. In conclusion, it is still challenging
Accepted: September 12, 2023 to put the currently available clinical scores to use due to a lack of validation. To
Published Online: October 24, provide more comprehensive guidance, it is essential to conduct large prospective
2023 multicenter trials in the future.
Copyright: © 2023 Author(s).
This is an Open-Access article
distributed under the terms of the Keywords: Stroke; Atrial fibrillation; Score; Electrocardiographic monitoring; Age
Creative Commons Attribution
License, permitting distribution,
and reproduction in any medium,
provided the original work is
properly cited. 1. Introduction
Publisher’s Note: AccScience Cardioembolism stands as the primary pathogenetic mechanism of ischemic stroke, with
Publishing remains neutral with atrial fibrillation (AF) emerging as the major source of cardioembolism, particularly
regard to jurisdictional claims in
published maps and institutional in patients aged 65 years and older. AF accounts for one-third of all ischemic strokes.
affiliations. In approximately one-fourth of cases, referred to as cryptogenic strokes (CS), the

Volume 1 Issue 2 (2023) 1 https://doi.org/10.36922/bh.0955