Atrial Fibrillation Detected After Stroke and Increased Risk of Death

Globally, 8 million people experience an ischemic stroke (IS) each year,1 of whom 20% have prevalent atrial fibrillation (AF).2 Among the remining 80% without known AF (KAF), up to 24% can be newly diagnosed with AF after the application of prolonged ECG monitoring.2 Accordingly, the annual worldwide number of incident cases of AF detected after stroke (AFDAS) is estimated at 1.5 million. Although most cases remain undiagnosed because of insufficient monitoring, this estimate underscores the need for better understanding of the prognostic implications of AFDAS, a distinct clinical entity.3 AFDAS comprises 2 different types of AF. It has been hypothesized that neurogenic AFDAS is a relatively benign, low-burden AF caused by impairment of the central autonomic network and acute inflammation, whereas cardiogenic AFDAS is a more ominous preexistent arrhythmia that remains undetected until a stroke occurs.3 The mix of low- and high-risk AFDAS types would therefore result in an overall lower risk of cerebral and systemic embolism than KAF, which is essentially high risk.3,4

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