ABC | Volume 111, Nº2, Agosto 2018

Minieditorial Henz e Leite Fibrilação atrial e eventos tromboembólicos criptogêncios Arq Bras Cardiol. 2018; 111(2):132-133 Apesar de a elevada frequência atrial com aumento de episódios embólicos estar bem documentada, a relação temporal e causal necessita maior elucidação. Subanálise do estudo TRENDS demonstrou a presença de taquiarritmias previamente ao evento embólico emapenas 50%dos pacientes; 73% deles não apresentaram taquiarritmias no período de 30 dias antecedendo o evento embólico. Ainda, o estudo ASSERT corroborou estes resultados, ao apresentar taxas de FA em 51% dos pacientes com tromboembolismo, mas somente 8% deles apresentaram FA no período de 30 dias pré-AVC. 15 A avaliação destes estudos nos sugerem que a presença de FA pode simplesmente ser um marcador de risco tromboemlólico e estar indiretamente ligado à ocorrência de tromboembolismos por mecanismomais complexo que o anteriormente esperado. 16 1. Ustrell X, Pelisé A. Cardiac workup of ischemic stroke. Curr Cardiol Rev. 2010;6(3):175–83. 2. Adams H, Bendixen BH, Kapelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Stroke. 1993;24(1):35–41 3. Hart RG, Diener HC, Coutts SB, Easton JD, Granger CB, O’Donel MJ, et al. Embolic strokes of undetermined source: The case for a new clinical construct. Lancet Neurol. 2014;13(4):429–38. 4. Li L, Yiin GS, Geraghty OS, Schulz UG, Kuker W, Mehta Z, et al. Incidence, outcome, risk factors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: A population-based study. Lancet Neurol. 2015;14(9):903–13. 5. Ntaios G, Vemmos K, Lijo GY, Koroboki E, Manios E, Vemmou A, et al. Risk Stratification for Recurrence and Mortality in Embolic Stroke of Undetermined Source. Stroke. 2016;47(9):2278–85. 6. Sanna T, Ziegler PD, Crea F. Detection andmanagement of atrial fibrillation after cryptogenic stroke or embolic stroke of undetermined source. Clin Cardiol. 2018;41(3):426–32. 7. KernanWN, Ovbiagele B, BlackHR, BravataDM, ChimowitzMI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American. Stroke Association. 2014;45(7):2160-236 8. Gladstone DJ. et al. Atrial Fibrillation in Patients with Cryptogenic Stroke. N Engl J Med. 2014;370(26):2467–77. 9. Sanna T, Dienner HC, Passman RS, Di Lazaro V, Bernstein RA, MorelloCA, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014; 370(26):2478–86. 10. Sampaio RF, Gomes IC, Sternick EB. Artigo Original AVC Isquêmico agudo criptogênico:avaliaçãododesempenhodeumnovosistemademonitorização contínua e prolongada. Arq Bras Cardiol. 2018; 111(2):122-131. 11. Glotzer TV, Hellkamps AB, Zimmerman J, Swoeney MO, Yee R, Marinchak R, et al. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: Report of the atrial diagnostics ancillary study of theMOde Selection Trial (MOST). Circulation. 2003;107(12):1614–19. 12. Glotzer TV, Daoud EG, Wyse DG, Singer DE, Ezekowitz MD, Hillker C, et al. The Relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk the trends study. Circ Arrhythm Electrophysiol. 2009;2(5):474–80. 13. Healey JS, Connolly SJ, Gold MR, Israel CW, Van Gelder IC, Capurci A, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012;366(2):120-9. 14. TomitaH,SasakiS,HagüJ,MetokiN.Covertatrialfibrillationandatrialhigh-rate episodesasapotentialcauseofembolicstrokesofundeterminedsource:Their detection and possiblemanagement strategy. J Cardiology. 2018;72(1):1–9. 15. Brambatti M, Connolly SJ, Gold MR, Morillo CA,Capucci A, Muto C, et al. Temporal relationship between subclinical atrial fibrillation and embolic events. Circulation. 2014;129(21):2094–99. 16. Van Gelder IC, Healy JS, Grijns HJ, Wang J, Hohnloser SH, Gold MR. Duration of device-detected subclinical atrial fibrillation and occurrence of stroke in ASSERT. Eur Heart J. 2017;38(17):1339–144. Referências Este é um artigo de acesso aberto distribuído sob os termos da licença de atribuição pelo Creative Commons 133