https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Gießen und Marburg GmbH Medizinische Klinik I - Innere Medizin, Kardiologie und Angiologie Gießen, Deutschland; 2Universitätsklinikum Gießen und Marburg GmbH Medizinische Klinik I - Kardiologie und Angiologie Gießen, Deutschland; 3St. Marien Krankenhaus Siegen gGmbH Med. Klinik II, Kardiologie, Angiologie, Intern. Intensivmed. Siegen, Deutschland; 4Universitätsklinikum Gießen und Marburg GmbH Gießen, Deutschland
Background – Stroke is one of the most common causes for disability and death in the world. Atrial fibrillation (AF) of more than 30 sec is considered a cause for cardioembolic stroke. Nevertheless, shorter periods of AF might also be a possible risk factor.
Methods - Patients presenting with ischemic stroke and transient ischemic attacks (TIA) to the stroke unit/emergency room within 6 months were prospectively analyzed. Periods of AF were classified in three categories; 0-14 s, 15-30 s and > 30 s All stroke patients received electrocardiogram (ECG) monitoring over a minimum time period of 24h and were characterized for three different, aforementioned AF periods and by etiological stroke entity.
Results – Within 6 months, 714 patients were hospitalized with stroke. Among them 163 (30.8%) had a cryptogenic stroke, including 98 (19%) patients with embolic stroke of undetermined source (ESUS). Furthermore, 185 (26%) TIA, 209 (39%) cardioembolic, 110 (21%) atherosclerotic, 40 (8%) lacunar and 7 (1%) other specific strokes were registered. Short-term AF (<30s) is predominant in all stroke entities, being most prevalent in cardioembolic strokes. Manifest atrial fibrillation (>30s) was observed in 23% of our stroke population. Whereas 15% had an AF episode of 15-29 s and 16% presented AF episode of 0-14 s. Among cardioembolic infarctions, 45% had manifest atrial fibrillation (>30 s), 20% had an atrial fibrillation episode of 15-29s, and 22% showed an atrial fibrillation episode of 0-14s. In summary, more than 90% of cardioembolic infarcts had an atrial fibrillation episode during the monitoring period. In more than 30% of ESUS and cryptogenic stroke patients, short-term AF could be detected during hospitalization. Similar, 22% of the TIA patients presented with manifest atrial fibrillation and 7% of TIA patients showed short term AF of 15-29 s and 10% an episode of 0-14 s. All short-term AF subgroups had a CHA2DS2-VASc Score of ≥2 points, and a moderate stroke severity (NIHSS 1-14). Elderly patients and women seem to be at higher risk for presenting with short-term AF and developing manifest AF in the future.
Conclusion – Short term AF is observed in all stroke entities. Short term AF may be a risk factor for stroke and might implicate future risk of AF development or threat of recurrent stroke. Short term AF might be especially relevant in the subgroup of ESUS or cryptogenic strokes which potentially benefit from oral anticoagulation (OAC). Whether short term AF patients in general might benefit from OAC has to be determined.