Brief Summary:

This study aimed to investigate the risk and factors that predict recurrent stroke in patients who initially had a stroke with no clear cause (called cryptogenic stroke) and were later found to have atrial fibrillation (AF), an irregular heart rhythm that can increase stroke risk. The study was conducted at Lady Reading Hospital in Peshawar, Pakistan, over five years from 2018 to 2023.

Stroke is a leading cause of death and disability worldwide. In many cases, the cause of stroke is unclear, which makes it difficult to prevent it from happening again. Atrial fibrillation is a common hidden cause of such strokes but is often hard to detect because it can occur intermittently without symptoms. Detecting AF early is important because patients with AF benefit greatly from blood-thinning medicines (anticoagulants) that reduce the risk of another stroke.

In this study, medical records of patients diagnosed with cryptogenic stroke were reviewed. Patients who were later diagnosed with atrial fibrillation within 12 months of their stroke were included. The researchers collected information about their age, gender, heart examinations, how and when AF was diagnosed, use of blood-thinning medicines, and if they had another stroke during follow-up.

The study highlights the importance of early and prolonged heart rhythm monitoring in patients with cryptogenic stroke to detect atrial fibrillation. It also stresses the need for better access to and adherence to anticoagulant therapy in resource-limited settings like Pakistan to reduce the risk of recurrent stroke and improve patient outcomes.

Inclusion Criteria:

• Adults aged 18 years or older.
• Patients initially diagnosed with cryptogenic ischemic stroke confirmed by neuroimaging and standard diagnostic evaluation.
• Patients subsequently diagnosed with atrial fibrillation within 12 months of index stroke, confirmed by ECG, 24-hour Holter monitoring, or implantable loop recorder.
• Availability of complete clinical and follow-up data.

Exclusion Criteria:

• Known history of atrial fibrillation or atrial flutter prior to the index stroke.
• Presence of structural heart diseases, valvular abnormalities, or congenital cardiac anomalies.
• Incomplete clinical or follow-up data.

This study includes adult patients admitted to Lady Reading Hospital with cryptogenic ischemic stroke who were later diagnosed with atrial fibrillation within 12 months. The cohort was followed for recurrent stroke and clinical outcomes over a median of 13.8 months.