Atrial Fibrillation in Young Ischemic Stroke Patients: An Underestimated Cause?

Abstract

Background: Undetected atrial fibrillation (AF) is often suspected as the possible cause in patients with cryptogenic ischemic stroke (IS), especially in elderly population. In young IS patients, the prevalence of AF, particularly paroxysmal form, remains still not enough established. Our aim was to assess the presence of AF in young patients using a long-term electrocardiography (ECG) Holter monitoring. Methods: The study set consisted of acute IS patients ≤50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study (NCT01541163). In all patients, admission ECG, serum cardiac markers, transesophageal echocardiography, 24-h and 3-week ECG Holter monitoring were performed. Results: Out of 634 enrolled patients in the HISTORY study, 98 were ≤50 years (56 males, mean age 39.7 ± 8.4). In total, AF was detected in 10.2% of patients and 70% of them had a paroxysmal form of AF. The elevated serum cardiac markers were present in 70% of patients with detected AF (p = 0.0001). Conclusion: AF was detected in 10.2% of young stroke patients and paroxysmal form of AF prevailed. Using of long-term ECG Holter monitoring improved the detection of AF. Patients with presence of AF had more frequently elevated serum specific cardiac markers.

Atrial Fibrillation as an Ischemic Stroke Clinical and Economic Burden Modifier: A 15-Year Nationwide Study

“…Patients younger than 50 years represented 4.4% (n ¼ 12,177) of the IS hospitalizations. From that age group, only 3% had a diagnosis of AF, a similar prevalence when comparing with the 3.3% reported by Pan et al [13], but quite different from the 10.2% and 8.9% described by Šanˇák et al [45] and Prefasi et al [46], respectively. This might suggest the hypothesis that this group of patients is at particular risk of underdiagnosis, but could also result from intrinsic differences among the populations, namely, as far as risk factors for AF are concerned.…”

Resting 12-lead electrocardiogram reveals high-risk sources of cardioembolism in young adult ischemic stroke

“…In another study with older stroke patients, 60% had an abnormal ECG, although that analysis was also based on the ECG obtained on admission [17]. Notably, based on recent studies, paroxysmal AF might be underdiagnosed in our cohort, since ambulatory ECG was not widely used during the inclusion period [18,19].…”

Cardiac Blood-Based Biomarkers of Myocardial Stress as Predictors of Atrial Fibrillation Development in Patients With Embolic Stroke of Undetermined Source/Cryptogenic Stroke: A Systematic Review and Meta-Analysis

“…This review analyzed 14 27 28 29 30 31 32 33 34 35 36 37 38 39 40 studies that investigated the association between NT-proBNP and AF diagnosis in patients with ESUS/CS, encompassing 3,420 individuals of whom 593 were subsequently diagnosed with AF. Nine of the studies were prospective and ten involved a single center, while the others were retrospective and involved multiple centers.…”