Strokes after cardioversion of atrial fibrillation — The FibStroke study

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• 作者：Antti Palom&auml ; ki^a ; ^{ajpalo@utu.fi" class="auth_mail" title="E-mail the corresponding author} ; Pirjo Mustonen^b ; ^{pirjo.mustonen@ksshp.fi" class="auth_mail" title="E-mail the corresponding author} ; Juha E.K. Hartikainen^c ; ^{juha.hartikainen@kuh.fi" class="auth_mail" title="E-mail the corresponding author} ; Ilpo Nuotio^d ; ^{ilpo.nuotio@tyks.fi" class="auth_mail" title="E-mail the corresponding author} ; Tuomas Kiviniemi^a ; ^{tuoski@utu.fi" class="auth_mail" title="E-mail the corresponding author} ; Antti Ylitalo^e ; ^{antti.ylitalo@dnainternet.net" class="auth_mail" title="E-mail the corresponding author} ; P&auml ; ivi Hartikainen^f ; ^{paivi.hartikainen@kuh.fi" class="auth_mail" title="E-mail the corresponding author} ; Heidi Lehtola^b ; ^{heidi.lehtola@ksshp.fi" class="auth_mail" title="E-mail the corresponding author} ; Riho Luite^c ; ^{riho.luite@kuh.fi" class="auth_mail" title="E-mail the corresponding author} ; K.E. Juhani Airaksinen^a ; ^{juhani.airaksinen@tyks.fi" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AF ; atrial fibrillation ; CHA2DS2-VASc ; congestive heart failure ; hypertension ; age  ; &ge ;   ; 75 (doubled) ; diabetes mellitus ; and prior Stroke ; transient ischemic attack or thromboembolism (doubled) ; vascular disease ; Age 65 to 74 ; sex category (female ; unless < ;   ; 65  ; years and no other risk factors) ; INR ; international normalized ratio ; IQR ; inter-quartile range ; TIA ; transient ischemic attack
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 January 2016
• 年：2016
• 卷：203
• 期：Complete
• 页码：269-273
• 全文大小：220 K

文摘

Cardioversion of atrial fibrillation (AF) is associated with an increased risk for stroke. We identified all cardioversions during the 30 days preceding stroke or transient ischemic attack (TIA) in patients with a previously diagnosed AF, and sought to assess the characteristics of cardioversions leading to stroke or TIA.

Methods

FibStroke is a cross-sectional observational multicenter registry that included AF patients with an ischemic stroke or intracranial bleed identified from a discharge registry of four Finnish hospitals. In total 3677 consecutive AF patients suffered 3252 strokes and 956 TIA episodes during 2003–2012. This pre-specified analysis focused on the 1644 events that occurred to patients with paroxysmal or persistent AF at the time of stroke/TIA.

Results

A total of 78 strokes and 22 TIA episodes were preceded by a cardioversion. Post-cardioversion strokes accounted for 6.4% of strokes in patients with paroxysmal/persistent AF. Of the 100 cardioversions leading to an ischemic event, 77 were acute and 23 were elective, 63 events occurred in patients not using anticoagulation, and 5 patients had periprocedural INR < 2. Importantly, 21 patients were in low risk of stroke, i.e. CHA₂DS₂-VASc score < 2. The median delay from cardioversion to event was 2 days. All nine patients who after an unsuccessful cardioversion developed a stroke had a spontaneous cardioversion prior to stroke.

Conclusions

Every sixteenth stroke of patients with paroxysmal/persistent AF is preceded by a cardioversion. Most post-cardioversion strokes occur in patients not using oral anticoagulation before cardioversion of acute AF.