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Early recurrence in paroxysmal versus sustained atrial fibrillation in patients with acute ischaemic stroke.

Journal article
Authors Maurizio Paciaroni
Filippo Angelini
Giancarlo Agnelli
Georgios Tsivgoulis
Karen L Furie
Prasanna Tadi
Cecilia Becattini
Nicola Falocci
Marialuisa Zedde
Azmil H Abdul-Rahim
Kennedy R Lees
Andrea Alberti
Michele Venti
Monica Acciarresi
Riccardo Altavilla
Cataldo D'Amore
Maria G Mosconi
Ludovica A Cimini
Paolo Bovi
Monica Carletti
Alberto Rigatelli
Manuel Cappellari
Jukka Putaala
Liisa Tomppo
Turgut Tatlisumak
Fabio Bandini
Simona Marcheselli
Alessandro Pezzini
Loris Poli
Alessandro Padovani
Luca Masotti
Vieri Vannucchi
Sung-Il Sohn
Gianni Lorenzini
Rossana Tassi
Francesca Guideri
Maurizio Acampa
Giuseppe Martini
George Ntaios
Efstathia Karagkiozi
George Athanasakis
Kostantinos Makaritsis
Kostantinos Vadikolias
Chrysoula Liantinioti
Maria Chondrogianni
Nicola Mumoli
Domenico Consoli
Franco Galati
Simona Sacco
Antonio Carolei
Cindy Tiseo
Francesco Corea
Walter Ageno
Marta Bellesini
Giorgio Silvestrelli
Alfonso Ciccone
Umberto Scoditti
Licia Denti
Michelangelo Mancuso
Miriam Maccarrone
Giovanni Orlandi
Nicola Giannini
Gino Gialdini
Tiziana Tassinari
Maria Luisa De Lodovici
Giorgio Bono
Christina Rueckert
Antonio Baldi
Danilo Toni
Federica Letteri
Martina Giuntini
Enrico M Lotti
Yuriy Flomin
Alessio Pieroni
Odysseas Kargiotis
Theodore Karapanayiotides
Serena Monaco
Mario M Baronello
Laszló Csiba
Lilla Szabó
Alberto Chiti
Elisa Giorli
Massimo Del Sette
Davide Imberti
Dorjan Zabzuni
Boris Doronin
Vera Volodina
Patrik Michel Pd-Mer
Peter Vanacker
Kristian Barlinn
Lars P Pallesen
Jessica Kepplinger
Dirk Deleu
Gayane Melikyan
Faisal Ibrahim
Naveed Akhtar
Vanessa Gourbali
Shadi Yaghi
Valeria Caso
Published in European stroke journal
Volume 4
Issue 1
Pages 55-64
ISSN 2396-9881
Publication year 2019
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Pages 55-64
Language en
Links dx.doi.org/10.1177/2396987318785853
www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords Stroke, anticoagulation, atrial fibrillation, paroxysmal atrial fibrillation, stroke recurrence, sustained atrial fibrillation
Subject categories Neurology

Abstract

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

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