• George Ntaios, Vasileios Papavasileiou, Gregory Y H Lip, Haralampos Milionis, Konstantinos Makaritsis, Anastasia Vemmou, Eleni Koroboki, Efstathios Manios, Konstantinos Spengos, Patrik Michel, and Konstantinos Vemmos.
• Department of Medicine, Larissa University Hospital, School of Medicine, University of Thessaly, Larissa, Greece. Electronic address: gntaios@med.uth.gr.
• J Stroke Cerebrovasc Dis. 2016 Dec 1; 25 (12): 2975-2980.

BackgroundThere is increasing debate whether atrial fibrillation (AF) episodes during follow-up in patients with embolic stroke of undetermined source (ESUS) are causally associated with the event. AF-related strokes are more severe than strokes of other etiologies. In this context, we aimed to compare stroke severity between ESUS patients diagnosed with AF during follow-up and those who were not. We hypothesized that, if AF episodes detected during follow-up are indeed causally associated with the index event, stroke severity in the AF group should be higher than the non-AF group.MethodsDataset was derived from the Athens Stroke Registry. ESUS was defined by the Cryptogenic Stroke/ESUS International-Working-Group criteria. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) score. Cumulative probabilities of recurrent stroke or peripheral embolism in the AF and non-AF ESUS groups were estimated by Kaplan-Meier analyses.ResultsAmong 275 ESUS patients, AF was detected during follow-up in 80 (29.1%), either during repeated electrocardiogram monitoring (18.2%) or during hospitalization for stroke recurrence (10.9%). NIHSS score was similar between the two groups (5 [2-13] versus 5 [2-14], P = .998). More recurrent strokes or peripheral embolisms occurred in the AF group compared with the non-AF group (42.5% versus 13.3%, P = .001).ConclusionsStroke severity is similar between ESUS patients who were diagnosed with AF during follow-up and those who were not. Given that AF-related strokes are more severe than strokes of other etiologies, this finding challenges the assumption that the association between ESUS and AF detected during follow-up is as frequently causal as regarded.Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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