Early recurrence in paroxysmal versus sustained atrial fibrillation in patients with acute ischaemic stroke
Authors: Paciaroni Maurizio , Angelini Filippo , Agnelli Giancarlo , Tsivgoulis Georgios , Furie Karen L , Tadi Prasanna , Becattini Cecilia , Falocci Nicola , Zedde Marialuisa , Abdul-Rahim Azmil H , Lees Kennedy R , Alberti Andrea , Venti Michele , Acciarresi Monica , Altavilla Riccardo , D’Amore Cataldo , Mosconi Maria G , Cimini Ludovica A , Bovi Paolo , Carletti Monica , Rigatelli Alberto , Cappellari Manuel , Putaala Jukka , Tomppo Liisa , Tatlisumak Turgut , Bandini Fabio , Marcheselli Simona , Pezzini Alessandro , Poli Loris , Padovani Alessandro , Masotti Luca , Vannucchi Vieri , Sohn Sung-Il , Lorenzini Gianni , Tassi Rossana , Guideri Francesca , Acampa Maurizio , Martini Giuseppe , Ntaios George , Karagkiozi Efstathia , Athanasakis George , Makaritsis Kostantinos , Vadikolias Kostantinos , Liantinioti Chrysoula , Chondrogianni Maria , Mumoli Nicola , Consoli Domenico , Galati Franco , Sacco Simona , Carolei Antonio , Tiseo Cindy , Corea Francesco , Ageno Walter , Bellesini Marta , Silvestrelli Giorgio , Ciccone Alfonso , Scoditti Umberto , Denti Licia , Mancuso Michelangelo , Maccarrone Miriam , Orlandi Giovanni , Giannini Nicola , Gialdini Gino , Tassinari Tiziana , Lodovici Maria Luisa De , Bono Giorgio , Rueckert Christina , Baldi Antonio , Toni Danilo , Letteri Federica , Giuntini Martina , Lotti Enrico M , Flomin Yuriy , Pieroni Alessio , Kargiotis Odysseas , Karapanayiotides Theodore , Monaco Serena , Baronello Mario M , Csiba Laszló , Szabó Lilla , Chiti Alberto , Giorli Elisa , Sette Massimo Del , Imberti Davide , Zabzuni Dorjan , Doronin Boris , Volodina Vera , Michel Pd-Mer Patrik , Vanacker Peter , Barlinn Kristian , Pallesen Lars P , Kepplinger Jessica , Deleu Dirk , Melikyan Gayane , Ibrahim Faisal , Akhtar Naveed , Gourbali Vanessa , Yaghi Shadi , Caso Valeria 
Published: July 2018

Background

The relationship between different patterns of atrial fibrillation and early recurrence after an acute ischaemic stroke is unclear.

Purpose

In a prospective cohort study, we evaluated the rates of early ischaemic recurrence after an acute ischaemic stroke in patients with paroxysmal atrial fibrillation or sustained atrial fibrillation which included persistent and permanent atrial fibrillation.

Methods

In patients with acute ischaemic stroke, atrial fibrillation was categorised as paroxysmal atrial fibrillation or sustained atrial fibrillation. Ischaemic recurrences were the composite of ischaemic stroke, transient ischaemic attack and symptomatic systemic embolism occurring within 90 days from acute index stroke.

Results

A total of 2150 patients (1155 females, 53.7%) were enrolled: 930 (43.3%) had paroxysmal atrial fibrillation and 1220 (56.7%) sustained atrial fibrillation. During the 90-day follow-up, 111 ischaemic recurrences were observed in 107 patients: 31 in patients with paroxysmal atrial fibrillation (3.3%) and 76 with sustained atrial fibrillation (6.2%) (hazard ratio (HR) 1.86 (95% CI 1.24–2.81)). Patients with sustained atrial fibrillation were on average older, more likely to have diabetes mellitus, hypertension, history of stroke/ transient ischaemic attack, congestive heart failure, atrial enlargement, high baseline NIHSS-score and implanted pacemaker. After adjustment by Cox proportional hazard model, sustained atrial fibrillation was not associated with early ischaemic recurrences (adjusted HR 1.23 (95% CI 0.74–2.04)).

Conclusions

After acute ischaemic stroke, patients with sustained atrial fibrillation had a higher rate of early ischaemic recurrence than patients with paroxysmal atrial fibrillation. After adjustment for relevant risk factors, sustained atrial fibrillation was not associated with a significantly higher risk of recurrence, thus suggesting that the risk profile associated with atrial fibrillation, rather than its pattern, is determinant for recurrence.