Letter by Haft Regarding Article, “High Prevalence of Atrial Fibrillation Among Patients With Ischemic Stroke”

Friberg et al 1 using Swedish national registry data, have demonstrated that the incidence of atrial fibrillation in patients with ischemic stroke is much higher than the 15% to 19% previously considered.Diagnosis of atrial fibrillation (AF) is often difficult because it is frequently intermittent, transient, and asymptomatic in the individual patient with stroke.We have found similar incidences of AF in patients with ischemic stroke (31.3% in the total ischemic stroke population, 2,3 61.9% in patients with congestive heart failure, 4 and 71.1% in patients with implanted pacemakers or defibrillators), 5 using the computerized multiyear ECG database that is available in most hospitals.This database includes all the ECGs of each patient with stroke recorded in the medical center during any previous admission, or emergency department, clinic, or laboratory visit.Many patients with stroke who were found to have had AF in this readily available database did not have the diagnosis of AF in their clinical record.Although serendipitous, and related to the number of ECGs performed per patient, diagnosis of AF from this frequently overlooked resource can provide documentation for anticoagulation to prevent a repeat stroke without the need for prospective long-term monitoring in many patients with ischemic stroke.