Short-duration atrial fibrillation in ischemic stroke: high risk despite subclinical burden-a prospective cohort study
Abstract Background and purpose Atrial fibrillation (AF) episodes ≥ 30 s are currently considered clinically relevant in stroke diagnostics. However, shorter AF episodes may signal a significant embolic risk, especially in patients with embolic stroke of undetermined source (ESUS). This study invest...
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BMC
2025-08-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-025-05080-1 |
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| author | Priyanka Boettger Karolis Macius Jamschid Sedighi Henning Lemm Kerstin Piayda Bernhard Unsoeld Samuel Sossalla Omar Alhaj Omar Martin Juenemann Michael Buerke |
| author_facet | Priyanka Boettger Karolis Macius Jamschid Sedighi Henning Lemm Kerstin Piayda Bernhard Unsoeld Samuel Sossalla Omar Alhaj Omar Martin Juenemann Michael Buerke |
| author_sort | Priyanka Boettger |
| collection | DOAJ |
| description | Abstract Background and purpose Atrial fibrillation (AF) episodes ≥ 30 s are currently considered clinically relevant in stroke diagnostics. However, shorter AF episodes may signal a significant embolic risk, especially in patients with embolic stroke of undetermined source (ESUS). This study investigates the prevalence, risk profile, and stroke severity associated with short-duration AF (SDAF < 30 s) across ischemic stroke subtypes. Methods We prospectively enrolled 714 consecutive patients with ischemic stroke or Transient ischemic attacks who underwent ≥ 48-hour ECG monitoring. AF episodes were classified as 0–14 s, 15–29 s, or ≥ 30 s. Stroke subtypes were defined using TOAST and ESUS criteria. Risk profiles, NIH Stroke Scale scores, and CHA₂DS₂-VASc scores were analyzed by AF duration. Results AF of any duration was detected in 53.8% of patients; 22.8% had episodes ≥ 30 s and 29.9% had SDAF. Among ESUS patients, 35.7% exhibited SDAF, and 80.2% of these had CHA₂DS₂-VASc scores ≥ 2. Stroke severity and risk scores were significantly higher in patients with SDAF than those without AF. SDAF was more prevalent in women (37.0%) and in individuals aged > 65 years (89.4%). Conclusions SDAF is common across stroke subtypes—particularly ESUS—and is associated with elevated thromboembolic risk despite falling below current diagnostic thresholds. These findings highlight a diagnostic blind spot in stroke workup and support reevaluation of duration-based criteria for post-stroke AF detection and risk profiling. |
| format | Article |
| id | doaj-art-3e9446b8f7bc4e398aecdaab3b0a1e40 |
| institution | Kabale University |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-3e9446b8f7bc4e398aecdaab3b0a1e402025-08-24T11:06:42ZengBMCBMC Cardiovascular Disorders1471-22612025-08-0125111310.1186/s12872-025-05080-1Short-duration atrial fibrillation in ischemic stroke: high risk despite subclinical burden-a prospective cohort studyPriyanka Boettger0Karolis Macius1Jamschid Sedighi2Henning Lemm3Kerstin Piayda4Bernhard Unsoeld5Samuel Sossalla6Omar Alhaj Omar7Martin Juenemann8Michael Buerke9Department of Internal Medicine I, Cardiology, Angiology and Intensive Care, Justus-Liebig University HospitalDepartment of Internal Medicine I, Cardiology, Angiology and Intensive Care, Justus-Liebig University HospitalDepartment of Internal Medicine I, Cardiology, Angiology and Intensive Care, Justus-Liebig University HospitalDepartment of Internal Medicine II, Cardiology, Angiology and Intensive Care Medicine, Heart-Center-SüdwestfalenDepartment of Internal Medicine I, Cardiology, Angiology and Intensive Care, Justus-Liebig University HospitalDepartment of Internal Medicine I, Cardiology, Angiology and Intensive Care, Justus-Liebig University HospitalDepartment of Internal Medicine I, Cardiology, Angiology and Intensive Care, Justus-Liebig University HospitalDepartment of Neurology, Justus-Liebig UniversityDepartment of Neurology, Justus-Liebig UniversityDepartment of Internal Medicine II, Cardiology, Angiology and Intensive Care Medicine, Heart-Center-SüdwestfalenAbstract Background and purpose Atrial fibrillation (AF) episodes ≥ 30 s are currently considered clinically relevant in stroke diagnostics. However, shorter AF episodes may signal a significant embolic risk, especially in patients with embolic stroke of undetermined source (ESUS). This study investigates the prevalence, risk profile, and stroke severity associated with short-duration AF (SDAF < 30 s) across ischemic stroke subtypes. Methods We prospectively enrolled 714 consecutive patients with ischemic stroke or Transient ischemic attacks who underwent ≥ 48-hour ECG monitoring. AF episodes were classified as 0–14 s, 15–29 s, or ≥ 30 s. Stroke subtypes were defined using TOAST and ESUS criteria. Risk profiles, NIH Stroke Scale scores, and CHA₂DS₂-VASc scores were analyzed by AF duration. Results AF of any duration was detected in 53.8% of patients; 22.8% had episodes ≥ 30 s and 29.9% had SDAF. Among ESUS patients, 35.7% exhibited SDAF, and 80.2% of these had CHA₂DS₂-VASc scores ≥ 2. Stroke severity and risk scores were significantly higher in patients with SDAF than those without AF. SDAF was more prevalent in women (37.0%) and in individuals aged > 65 years (89.4%). Conclusions SDAF is common across stroke subtypes—particularly ESUS—and is associated with elevated thromboembolic risk despite falling below current diagnostic thresholds. These findings highlight a diagnostic blind spot in stroke workup and support reevaluation of duration-based criteria for post-stroke AF detection and risk profiling.https://doi.org/10.1186/s12872-025-05080-1Atrial fibrillationElectrocardiographyStroke/etiologyRisk assessmentIschemic strokeProspective studies |
| spellingShingle | Priyanka Boettger Karolis Macius Jamschid Sedighi Henning Lemm Kerstin Piayda Bernhard Unsoeld Samuel Sossalla Omar Alhaj Omar Martin Juenemann Michael Buerke Short-duration atrial fibrillation in ischemic stroke: high risk despite subclinical burden-a prospective cohort study BMC Cardiovascular Disorders Atrial fibrillation Electrocardiography Stroke/etiology Risk assessment Ischemic stroke Prospective studies |
| title | Short-duration atrial fibrillation in ischemic stroke: high risk despite subclinical burden-a prospective cohort study |
| title_full | Short-duration atrial fibrillation in ischemic stroke: high risk despite subclinical burden-a prospective cohort study |
| title_fullStr | Short-duration atrial fibrillation in ischemic stroke: high risk despite subclinical burden-a prospective cohort study |
| title_full_unstemmed | Short-duration atrial fibrillation in ischemic stroke: high risk despite subclinical burden-a prospective cohort study |
| title_short | Short-duration atrial fibrillation in ischemic stroke: high risk despite subclinical burden-a prospective cohort study |
| title_sort | short duration atrial fibrillation in ischemic stroke high risk despite subclinical burden a prospective cohort study |
| topic | Atrial fibrillation Electrocardiography Stroke/etiology Risk assessment Ischemic stroke Prospective studies |
| url | https://doi.org/10.1186/s12872-025-05080-1 |
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