We want to report a case of a young woman who in 2007, when she was 47 years old, developing syncopal and pre-syncopal episodes. Only after several registration of Holter ECG she had the documentation of short (a few minutes) paroxysmal of atrial fibrillation. She was classified in class 1 for the CHA?DS?Vasc score and she was treated with aspirin. In November 2010 the patient developed a contemporary heart attack with ST inferior elevation (STEMI) with atrial fibrillation and an acute ischaemic stroke with right hemiplegia with aphasia. In the emergency room the echocardiogram revealed inferior akinesia and absence of left atrial or ventricular thrombosis. CT scan excluded an aortic dissection and intracranial haemorrhage . She was admitted and in the stroke unit and she was treated with IV tPA (the procedure was started between 6 - 12 h after symptom onset) with improvement of neurological and ischaemic framework. The acute cerebral ischemia was located in the area of circulation of the left cerebral artery. Atrial fibrillation continued. A CT scan of the head post thrombolysis did not show any hemorrhagic transformation. She showed a total recovery in motor function and language. After 1 week with Low Molecular Weight Heparin patient started the anticoagulant therapy with dabigatran etexilate (150 mg BID) for stroke prevention in atrial fibrillation with a good safety and efficacy profile. She remained in permanent atrial fibrillation and she is still treated with beta blockers and dabigatran. Subsequent investigations have ruled out the presence of foramen ovale and tests for thrombophilia were negative. The left ventricular function has regained normality. Our interpretation is that short episodes of paroxysmal atrial fibrillation have a potential risk even in a CHA?DS?Vasc 1 score for thrombosis and embolic events: in our case with contemporary embolization in a coronary and cerebral circulation. Thrombolysis has solved both thrombotic occlusion situations. Our patient, in permanent atrial fibrillation, remains free of ischaemic recurrences without any bleeding complications at more than 4 years follow up.