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