New-Onset Paroxysmal Atrial Fibrillation Diagnosis in Ischemic Stroke Patients

The aims of this study are to describe the incidence of paroxysmal atrial fibrillation (pAF) in patients with ischemic stroke (IS) or transient ischemic attack (TIA), and to create a risk prediction model, using immediately available clinical data associated with new pAF diagnosis.

We analyzed data from the BASICMAR stroke register, with 5 inclusion criteria: (1) diagnosis of IS/TIA; (2) no history of AF or structural cardiopathy; (3) stroke unit (SU) monitoring after normal electrocardiogram in the emergency room; (4) complete etiologic study; and (5) 3-month follow-up. We investigated clinical predictors of pAF detection; we analyzed newly diagnosed pAF according to 4 cardiac monitoring screening methods and created a pAF-risk prediction model.

The final cohort included 1,240 patients. pAF was diagnosed in 139 patients (11.2%), the majority at the SU (54.7%). Multivariate predictors of new-pAF diagnosis during 3-month follow-up after ischemic event were age 75 years, female gender, history of congestive heart failure, and initial National Institute of Health Stroke Scale 15, with a predicted AF risk of 64%.

This risk prediction model can be helpful to estimate the risk of an underlying pAF within 3 months after suffering an IS/TIA, contributing to increased AF detection efforts, thereby starting the correct secondary prevention treatment.