Rhythm Control of AF in Patients With Acute Stroke

Study Overview
=================
Brief Summary
-----------------
Prospective randomized (rhythm control or rate control) Objective of study To analyze long term outcome of patients with acute stroke with atrial fibrillation according to the rhythm control To analyze recurrence rate of atrial fibrillation or recurrence stroke in patients with acute stroke according to the rhythm control (by antiarrhythmic drug, cardioversion, catheter ablation)

Conditions
-----------------
Atrial Fibrillation

Intervention / Treatment
-----------------
* Procedure: Rhythm control
* Procedure: Rate control


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients with Atrial fibrillation (20 80 years old) patients with Acute stroke within 7 days LA diameter < 55mm patients possible to anticoagulation and anti arrhythmic drug NIHSS score ≤12 Exclusion Criteria: Hemorrhagic transformation Large cerebral lesion or cerebellar lesion (more than 1/3 of MCA area and 1/2 of ACA area, 1/2 of PCA area, 1/2 of cerebellar area) active internal bleeding Impossible to anticoagulation or anti arrhythmic drug Valvular AF (MA> GII, Mechanical valve, Mitral valve replacement) LV ejection fraction < 30% Structural cardiac disease Catheter ablation history for AF, Cardiac surgery Already prescribed anti arrhythmic drugs With severe medical disease Expected survival < 1year Severe alcoholics, drug addiction 14. Contraindication to MRI 15. Pregnancy

Ages Eligible for Study
-----------------
Minimum Age: 19 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Rhythm control group<br>Start AAD right after evaluating for LA size, EF, LA thrombus, and presence of CAD during anticoagulation Cardioversion after 1 month Rhythm FU schedule (2012 ACC/AHA/ESC guidelines) If AF recur, RFCA | Procedure: Rhythm control<br>* Start AAD right after evaluating for LA size, EF, LA thrombus, and presence of CAD during anticoagulation Cardioversion after 1 month Rhythm FU schedule (2012 ACC/AHA/ESC guidelines) If AF recur, RFCA<br>|
| Active Comparator: Rate control group<br>No AAD, just anticoagulation HR control between 60 110bpm (with beta blocker, calcium channel blocker, digoxin) Without the treatment about antiarrhythmia and rhythm control, deification of rate control, the subject will be drop out for study. | Procedure: Rate control<br>* No AAD, just anticoagulation HR control between 60 110bpm (with beta blocker, calcium channel blocker, digoxin) Without the treatment about antiarrhythmia and rhythm control, deification of rate control, the subject will be drop out for study.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| acute stroke with AF | Long term outcome of rhythm control in patients with acute stroke with AF related to all cause morality, hospital admission, recurrence rate of stroke, major adverse cardiac events | 1 year | 
| recurrence of silence stroke | Adverse events after anticoagulation or anti arrhythmic drug, recurrence rate after RFCA on AF in patients with stroke, adverse events after RFCA, recurrence rate of silence stroke or clinical stroke | 1 year | 
| recurrence of AF after rhythm control | Adverse events after anticoagulation or anti arrhythmic drug, recurrence rate after RFCA on AF in patients with stroke, adverse events after RFCA, recurrence rate of silence stroke or clinical stroke | 1 year |