A score for paroxysmal atrial fibrillation in acute ischemic stroke

Aim Many patients with ischemic stroke have paroxysmal atrial fibrillation that may be difficult to detect. We sought to identify markers of paroxysmal atrial fibrillation and construct a score that may help the clinician to select patients for anticoagulation even if investigations do not disclose atrial fibrillation. Methods A group of patients with acute ischemic stroke and TIA and documented paroxysmal atrial fibrillation was compared to a group of patients with ischemic stroke and TIA and no known paroxysmal atrial fibrillation and sinus rhythm on Holter monitoring. Clinical features, blood tests, ECG, and MRI findings were compared. Sensitivity and specificity of significant markers for paroxysmal atrial fibrillation were calculated. A simple score based on independent markers for paroxysmal atrial fibrillation was constructed. Results Out of 3480 patients with TIA or ischemic stroke, 237 (19%) had paroxysmal atrial fibrillation and 1002 (81%) had sinus rhythm. On univariate analyses, significant markers for paroxysmal atrial fibrillation included increasing age, females, prior ischemic stroke, myocardial infarction, other heart diseases, pathologic troponin, embolic stroke and stroke in different arterial territories (all P < .01). A score including age dichotomized at 75 years, cardiac disease and troponin was constructed. Conclusion We identified many markers for paroxysmal atrial fibrillation and constructed a score that may help the clinician to select patients for anticoagulation even if investigations do not disclose paroxysmal atrial fibrillation.