ABSTRACT NUMBER: ESOC2026A1909 ATRIAL FIBRILLATION DETECTED AFTER STROKE: COMPARING ECG-DETECTED, MONITORING-DETECTED, AND KNOWN ATRIAL FIBRILLATION

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Abstract Background and aims Atrial fibrillation (AF) detected after ischemic stroke (AFDAS) is heterogenous. We hypothesized that AFDAS identified on admission ECG (ECG-AFDAS) represents an intermediate stage on the AF disease continuum between AFDAS detected only during prolonged cardiac monitoring on stroke unit (PCM-AFDAS) and AF known before the stroke (KAF). Methods We compared clinical, electrophysiological and neuroimaging features of consecutive patients with AF and MRI-confirmed ischemic stroke admitted to a comprehensive stroke center (10/2020–01/2023). AF subtype was treated as an ordered factor reflecting the suspected AF disease progression (PCM-AFDAS Results Among 409 ischemic stroke patients with AF (median age 81 years, 272 had KAF (66.5%), 56 ECG-AFDAS (13.7%), and 81 PCM-AFDAS (19.8%). Monotonic increases (i.e., lowest in PCM-AFDAS and highest in KAF) were observed for rate of diabetes and prior stroke, CHA₂DS₂-VASc score and AF burden. Monotonic decreases (i.e., highest in PCM-AFDAS and lowest in KAF) were observed for stroke lesion volume, rate of insular involvement, heart rate during AF, and LDL cholesterol (all P for trend <0.05). Across these variables, ECG-AFDAS consistently maintained an intermediate position relative to PCM-AFDAS and KAF. Conclusions Across many domains, ECG-AFDAS represents an intermediate AF phenotype between PCM-AFDAS and KAF. These findings support a continuum model of AFDAS and could inform future risk stratification strategies. Conflict of interest Markus G. Klammer, MD: nothing to disclose; Laura Reimann: nothing to disclose; Simone Lieschke, MD: nothing to disclose; Helena Stengl, MD: nothing to disclose; Maximilian Schoels, MD: nothing to disclose; Alexander Nelde, MSc: nothing to disclose; Kersten Villringer, MD: nothing to disclose; Christian Meisel, MD: nothing to disclose; Matthias Endres, MD: nothing to disclose; Jan F. Scheitz, MD: nothing to disclose

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