ArticleAnnals of Indian Academy of Neurology2026
Delayed Detection of Atrial Fibrillation After Cryptogenic Stroke and Risk of Recurrent Ischemic Stroke: A Retrospective Cohort Study.
Article in Annals of Indian Academy of Neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectivesCryptogenic stroke (CS) accounts for a significant percentage of ischemic strokes. Undetected atrial fibrillation (AF) is a major underlying cause, and delayed identification increases recurrence risk. This study evaluated the timing of AF detection after CS and its impact on stroke recurrence and secondary prevention in a tertiary care setting.
methodsThis retrospective observational analysis comprised 355 adult patients with CS hospitalized from January 2020 to June 2024. Demographic data, AF detection, timing, monitoring options, anticoagulation status, and stroke recurrence were all recorded. A multivariable Cox regression analysis identified predictors of recurrent stroke. SPSS version 23.0 was used for analysis.
resultsAmong 355 CS patients, 115 (32.4%) were diagnosed with AF during the follow-up period. The median time to AF detection was 5.5 months. Modalities for detection included Holter monitoring 55 (47.8%), electrocardiography 48 (41.7%), and implantable loop recorders 12 (10.4%). Among those with AF, 34 (29.6%) suffered a recurrent stroke; only 12 (35.3%) were on anticoagulation at the time of recurrence. Independent predictors of recurrence included age >65 years (hazard ratio [HR] 2.29; P = 0.012), delayed AF diagnosis >6 months (HR 2.51; P = 0.003), non-adherence to anticoagulation (HR 3.59, P = 0.002), and left atrial enlargement (HR 2.31, P = 0.017).
conclusionsDelayed AF diagnosis in CS is prevalent and has been linked to a significantly greater risk of recurrent stroke. Early and extended cardiac monitoring, combined with early anticoagulation, is critical for improving patient outcomes in CS.
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