Atrial fibrillation (AF) is undoubtedly one of the major hazards of contemporary medicine. Its prevalence is increasing, especially in the elderly, and AF-related cardioembolism is becoming the most frequent cause of stroke in this age group. This scenario is aggravated by the fact that cardioembolic stroke is frequently associated with a high morbimortality. AF also contributes to the vascular cognitive impairment, either through symptomatic acute ischemic cerebral infarcts, and/or through the multiple small, only apparently silent, cardioembolic ischemic lesions.
It is well settled that with appropriated treatment AF cardioembolic risk decreases significantly. Anticoagulation therapy is particularly effective in reducing the cardioembolic risk after a stroke and when administered to aged people. However, the ideal is to use it for preventing a first stroke, in primary prevention.
In order to deal with the burden of this enormous disease, each country warrants a multidisciplinary approach, involving correct identification of AF, even if paroxysmal, individual patient risk assessment, and an adequate stroke preventive treatment.
Fortunately, there have been important scientific breakthroughs on diagnosis and treatment of AF. Paroxysmal AF presents the same cardioembolic risk as the continuous AF, although it is often difficult to diagnose. Particularly in the case of a cryptogenic stroke with embolic characteristics, paroxysmal AF has to be exhaustively searched and might require long-term cardiac rhythm monitoring systems, which have been recently developed. Other new achievements are the therapeutic advances in oral anticoagulation treatment, allowing increased efficacy and safety, along with a better convenience to the patient.
All these new approaches are changing the paradigm of the acute stroke management, challenging the stroke unit neurologist.