Aim and objective:
Atrial fibrillation (AF) occupies an important place among the etiological agents in ischemic cerebrovascular disease. Smoking is thought to be a predisposing factor for AF. The probable relation between smoking and AF can be explained in terms of oxidant mechanisms and inflammation. This study investigated the probable link between smoking and AF against a background of stroke.

Methods:
Three centers were included in the study. Cases diagnosed with stroke and transient ischemic attack (TIA) arriving at these centers were evaluated in terms of demographic, clinical, and radiological characteristics. The Modified Rankin Score (MRS) and National Institutes of Health Stroke Scale (NIHSS) scores were used to assess severity of stroke.

Results:
Three hundred forty-one patients with a mean age of 73.73±11.40 were enrolled; 282 were evaluated as ischemic stroke, 50 as hemorrhagic stroke, and 9 as TIA. Mean MRS was 2.92±1.63, and mean NIHSS was 10.12±8.01. Of the study group, 65.7% had never smoked, 23.2% were active smokers, and 11% had quit. The relation between etiological factors and smoking was investigated based on the TOAST classification in the ischemic subgroup. Stroke associated with large or small vessel disease and the AF-related stroke group were compared in terms of smoking status, and smoking status was significantly higher in the AF group (p=0,04). A significant difference was observed in mean EF values at echocardiography performed on patients in the ischemic subgroup between the smoking and non-smoking groups (57.71±14.37, and 60.83±8.92, respectively, p=0,002).

Conclusions:
Our study determined no relation between smoking and stroke subtypes, severity, or other risk factors, while smoking emerged as a risk factor in AF-related stroke. This once again shows that smoking, in other words nicotine, lays the foundation for AF through inflammation, catecholamine-mediated effects, and oxidative stress, constitutes a risk factor for stroke, together with advanced age.