Prevalence and Factors Associated With Atrial Fibrillation Among Young Patients With Ischemic Stroke

Atrial fibrillation (AF) is an important risk factor for stroke with increasing prevalence and incidence, especially in older people. However, prevalence and risk factors of AF in young patients with stroke remain unclear. The aim of this study was to determine the prevalence and factors associated with AF in young patients with stroke.

We included patients with first-ever ischemic stroke (18-49 years) with imaging-confirmed ischemia from the ODYSSEY (Observational Dutch Young Symptomatic Stroke) study. All patients underwent cardiac evaluation, including ECG, cardiac rhythm monitoring, and echocardiography.

Of 1259 patients (mean age 41.8 years, SD 7.5, 47.3% female), 13 patients (1%) had a known history of AF. Additionally, AF was found in 19 patients (1.5%), predominantly detected during telemetric observation within first 24 hours. Patients with AF had higher National Institutes of Health Stroke Scale scores at admission (adjusted odds ratio [aOR], 1.1 [95% CI, 1.0-1.2]) and more frequent history of cardiac pathology (aOR, 5.0 [95% CI, 2.2-10.9]). The most important factors associated with AF were history of heart valve abnormalities (OR, 6.5 [95% CI, 2.1-16.7]) and hypertension (aOR, 2.5 [95% CI, 1.1-6.1]). Recurrence of ischemic stroke occurred more frequently in patients with AF (aOR, 2.5 [95% CI, 1.0-5.9], adjusted hazard ratio, 2.2 [95% CI, 1.0-4.7]) compared with those without AF.

Approximately 2.5% of young patients with stroke have AF, with about half previously known and half detected through rhythm observation, all within 24 hours. Furthermore, most patients with AF had structural cardiac pathology, especially heart valve abnormalities, suggesting an increased risk of developing AF. Patients with AF had more severe strokes and higher recurrence of vascular events.