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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Delayed Detection of Atrial Fibrillation After Cryptogenic Stroke and Risk of Recurrent Ischemic Stroke: A

Sadiq A Shah1, Taimoor Khan1, Khadija Syed2

  • 1Department of Neurology, Lady Reading Hospital, Peshawar, Pakistan.

Annals of Indian Academy of Neurology
|June 4, 2026
PubMed

Insights

Delayed diagnosis of atrial fibrillation (AF) in cryptogenic stroke (CS) patients significantly increases stroke recurrence risk. Early detection and treatment are crucial for better outcomes in CS patients.

Area of Science:

  • Cardiology
  • Neurology
  • Public Health

Background:

  • Cryptogenic stroke (CS) represents a significant portion of ischemic strokes.
  • Undetected atrial fibrillation (AF) is a primary cause of CS, with delayed diagnosis escalating recurrence risk.

Purpose of the Study:

  • To evaluate the timing of AF detection post-CS.
  • To assess the impact of AF detection timing on stroke recurrence and secondary prevention strategies.

Main Methods:

  • Retrospective observational analysis of 355 adult CS patients (Jan 2020 - June 2024).
  • Data collected included demographics, AF detection details, monitoring methods, anticoagulation status, and stroke recurrence.
  • Multivariable Cox regression identified predictors of recurrent stroke.

Main Results:

  • 115 (32.4%) CS patients diagnosed with AF; median detection time was 5.5 months.
  • Recurrent stroke occurred in 34 (29.6%) of AF patients, with only 12 (35.3%) on anticoagulation.
  • Predictors of recurrence: age >65, delayed AF diagnosis (>6 months), non-adherence to anticoagulation, and left atrial enlargement.

Conclusions:

  • Delayed AF diagnosis is common in CS and strongly associated with increased recurrent stroke risk.
  • Early and prolonged cardiac monitoring is essential for timely AF identification.
  • Initiating anticoagulation promptly after AF diagnosis is critical for improving outcomes in CS patients.
Abstract

Keywords:
Cryptogenic strokeanticoagulantsatrial fibrillationstroke recurrence

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