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Updated: May 2, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Poststroke atrial fibrillation: cause or consequence? Critical review of current views

Luciano A Sposato1, Patricia M Riccio, Vladimir Hachinski

  • 1From the Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Canada.

Neurology
|March 4, 2014
PubMed

Insights

Poststroke atrial fibrillation (AF) may be a temporary consequence of stroke, not a persistent condition. Stroke-induced autonomic imbalance and inflammation could trigger AF, questioning its causal role.

Area of Science:

  • Neurology
  • Cardiology
  • Pathophysiology

Background:

  • Atrial fibrillation (AF) is diagnosed in up to 25% of acute ischemic stroke patients.
  • Current guidelines mandate oral anticoagulation for all diagnosed poststroke AF.
  • Short-lasting AF after stroke may be a transient epiphenomenon, not a persistent condition.

Purpose of the Study:

  • To investigate the potential mechanisms linking acute ischemic stroke to atrial fibrillation.
  • To explore whether poststroke AF is a cause or a consequence of the stroke event.

Main Methods:

  • Review of autonomic nervous system regulation of cardiac rhythm.
  • Analysis of the role of cerebral cortex, particularly the insula, in cardiac autonomic control.
  • Examination of the impact of stroke-induced autonomic imbalance and inflammation on AF genesis.

Main Results:

  • Insular infarctions can disrupt cerebral control of cardiac rhythm, leading to autonomic imbalance.
  • Inflammation following stroke may directly stimulate the cardiac autonomic system and damage atrial tissue.
  • The precise causal relationship between stroke and AF remains undetermined.

Conclusions:

  • Poststroke AF may arise from stroke-induced autonomic dysregulation and inflammation.
  • The insula plays a critical role in the central control of cardiac autonomic function.
  • Further research is needed to elucidate the cause-and-effect relationship between stroke and AF.

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