Background: Cryptogenic stroke (CS) represents 25% of ischemic strokes. Especially
after CS, the detection of atrial fibrillation (AF) is important because it provides clues to the
mechanism of stroke. However, the relationship between AF and stroke appears more complex than
a simple cause-effect mechanism, suggesting that the association between AF and stroke may be
due to other systemic and atrial factors including systemic inflammation that may lead to atrial
remodeling and subsequent atrial cardiopathy.
Objective: The aim of this study was to evaluate the relationship among different electrocardiographic
parameters, inflammatory markers and in-hospital AF occurrence after acute CS.
Methods: 222 patients with CS underwent 12-lead resting ECG at admission and 7-day in-hospital
ECG monitoring. The following indices were evaluated: P-wave dispersion (PWD), P-wave index,
P-wave axis, atrial size and high-sensitivity-C reactive protein (CRP).
Results: AF was detected in 44 patients. AF-group had significantly higher PWD, P-wave index,
PR interval, CRP and greater frequency of abnormal P-wave axis in comparison with no-AF group.
There was a significant correlation between CRP and PWD (r=0.28). By using the mediation
analysis, performed according to the “bootstrapping” method, we found that PWD is a significant
mediator variable of the relationship between CRP and AF occurrence, accounting for 40% of the
Conclusions: In cryptogenic stroke, high PWD is partly due to systemic inflammation that
increases AF risk possibly via atrial electric remodeling. These findings could also suggest
inflammation as a possible therapeutic target in order to prevent atrial electrical alterations and
finally AF occurrence in CS.