The complexity of atrial fibrillation newly diagnosed after ischemic stroke and transient ischemic attack: advances and uncertainties

Abstract

Purpose of reviewAtrial fibrillation is being increasingly diagnosed after ischemic stroke and transient ischemic attack (TIA). Patient characteristics, frequency and duration of paroxysms, and the risk of recurrent ischemic stroke associated with atrial fibrillation detected after stroke and TIA (AFDAS) may differ from atrial fibrillation already known before stroke occurrence. We aim to summarize major recent advances in the field, in the context of prior evidence, and to identify areas of uncertainty to be addressed in future research.Recent findingsHalf of all atrial fibrillations in ischemic stroke and TIA patients are AFDAS, and most of them are asymptomatic. Over 50% of AFDAS paroxysms last less than 30 s. The rapid initiation of cardiac monitoring and its duration are crucial for its timely and effective detection. AFDAS comprises a heterogeneous mix of atrial fibrillation, possibly including cardiogenic and neurogenic types, and a mix of both. Over 25 single markers and at least 10 scores have been proposed as predictors of AFDAS. However, there are considerable inconsistencies across studies. The role of AFDAS burden and its associated risk of stroke recurrence have not yet been investigated.SummaryAFDAS may differ from atrial fibrillation known before stroke in several clinical dimensions, which are important for optimal patient care strategies. Many questions remain unanswered. Neurogenic and cardiogenic AFDAS need to be characterized, as it may be possible to avoid some neurogenic cases by initiating timely preventive treatments. AFDAS burden may differ in ischemic stroke and TIA patients, with distinctive diagnostic and treatment implications. The prognosis of AFDAS and its risk of recurrent stroke are still unknown; therefore, it is uncertain whether AFDAS patients should be treated with oral anticoagulants.

Biomarkers Associated with Atrial Fibrillation in Patients with Ischemic Stroke: A Pilot Study from the NOR-FIB Study

“…In line with previous studies [6,15], the results of the present study support the hypothesis that a variety of molecular biomarkers can potentially be used as indicators of underlying AF in CS patients. In earlier studies, the relationship between AF and biomarker levels were mostly investigated by testing individual biomarkers [8,22] or a specific biomarker selection based on their functional similarities [15]. To our knowledge, this is the first study using a multiple-biomarker approach in patients with stroke of different etiologies.…”

Atrial fibrillation and stroke: a practical guide

“…This ‘neurogenic’ AF could be a transient phenomenon and not require long-term anticoagulation, unlike ‘cardiogenic’ AF due to structural heart disease 53. Although there is insufficient supporting evidence to change clinical practice, a recent report suggested that recurrent ischaemic stroke risk in patients diagnosed with AF after stroke is low compared with that of patients known to have AF before the stroke, and similar to that in patients in sinus rhythm 54.…”

A Web Based Dynamic MANA Nomogram for Predicting the Malignant Cerebral Edema in patients with large hemispheric infarction

“…Currently, the KAF is considered as the cardiogenic AF, which was mainly caused by cardiac remodeling, while AF detected after stroke (AFDAS) may composed of multiple types of AF, including the preexisting but newly diagnosed atrial brillation (cardiogenic AF) and newly emerged atrial brillation (neurogenic AF) (24). The neurogenic AF is the main type of AFDAS, which may be caused by in ammatory response and dysfunction of the autonomic regulation of cardiac rhythm (24,25). Based on this difference between mechanisms of KAF and AFDAS, the effect of AFDAS on stroke severity may also vary from that of KAF.…”