Cryptogenic stroke: atrial fibrillation under indictment

The stroke is the third cause of death and the main cause of disability in adults. 30% of ischaemic strokes are cryptogenic. Atrial Fibrillation (AF) is a common disease, mainly among older patients (pts) (9% of people over 80). AF is an indipendent risk factor for stroke, and 15% of ischaemic strokes are due to AF (25% in older people). The cardioembolic risk is determinated by duration of AF and comorbilities: high risk pts are identified by risk score scales, in order to define who needs anticoagulation. Identification of pts with AF, symptomatic or not, is mandatory to prevent thromboembolism. Thrombo embolic complications of asymptomatic AF (half of episodes are asymptomatic) are similar to symptomatic. Accuracy of methods for AF detection is higher if the monitored period is long, in particular for detection of asymptomatic AF. A careful identification of asymptomatic AF is mandatory to indicate the anticoagulation therapy in people with thromboembolic risk factor: in particular, pts with a previous stroke need to detect carefully potential arrhythmias in order to avoid relapses.