Despite the recently described new syndromes, about a third of ischemic stroke (aic) in young adults remains unexplained. The role of atrial vulnerability (va), was suggested as substratum of paroxysmal atrial fibrillation (paf); we studied prospectively in 121 young patients with ischemic stroke.

The aims of this study is to search recurrence of stroke for patients with atrial vulnerabilities requiring direct oral anticoagulant therapy for prevention vs patients without atrial vulnerabilities.

Patients 17 to 55 victims admitted for ischemic stroke. An electrophysiological study was performed in case of unknown etiology, within 90 days after ischemic stroke. In addition to the usual parameters were measured conduction time intra atrial refractory periods, latent vulnerability index, prior to the completion of atrial stimulation Programmed. A total of 53 patients with VA+ and, two groups of patients were formed: the first group (27 patients) VA+ was treated with DOA (rivaroxaban), and (26 patients) VA+ were not treated and followed for 06 months.

A total of 121 patients, mean age 40.89 years, sex ratio 1.63: 53 (43.8%) had a positive atrial vulnerability. There is no evidence of significant difference in the type and location of the AIC, with a significant difference against tobacco (risk=2.4), birth control pills (risk=3.6), the presence>70 esa on holter ECG (risk=3.7) and septal defects (pfo and/or asia with a risk=2.89). On a mean follow up of 06 months, 04 (17%) patients presented with cerebral embolic recurrence in the group without DOA, and 00 patients in the VA+ group with DOA.

With a sensitivity of 83% and a specificity of 61% and a negative predictive value of 97%; The presence of atrial vulnerability with a pathological ECG Holter (esa) exposed to a high risk of recurrence and embolic requiring antiarrhythmic therapy and discussion of anticoagulant treatment, specially with DOA.