Comment Authors: Madalena Rosário and Diana Aguiar de Sousa, Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal
Original Article: Paciaroni M, Angelini F, Agnelli G et al. 2018.
Early recurrence in paroxysmal versus sustained atrial fibrillation in patients with acute ischaemic stroke.
European Stroke Journal. doi: 10.1177/2396987318785853
Atrial fibrillation (AF) is a recognised risk factor for stroke and thromboembolic events and the number of persons at risk is expected to grow in the next years, together with the current demographic evolution. This arrhythmia can be categorised as paroxysmal, persistent or permanent, depending on the duration of episodes and/or response to treatment. Previous studies focusing on the association between the AF pattern and the risk of stroke have produced conflicting results.
Using data from multicentre prospective observational databases, Paciaroni et al tried to understand if specific AF patterns were associated to different recurrence rates and, ultimately, should benefit from different treatment approaches. They studied the rates of ischaemic recurrences within 90 days after an acute ischaemic stroke among patients with paroxysmal AF and sustained AF (including persistent and permanent AF).
2150 patients were enrolled (43% with paroxysmal AF and 57% with sustained AF), the majority of which was receiving anticoagulant therapy. Patients with sustained AF were older and had more cardiovascular risk factors. During the follow-up period, 111 ischaemic recurrences were recorded. Patients with recurrence were also older, with more cardiovascular risk factors, and more frequently had sustained AF. Importantly, 9% of patients who did not start anticoagulation had a recurrent event. However, when adjusting for cardiovascular risk factors, lesion size and type of anticoagulant, neither AF pattern was associated with a higher risk of ischaemic recurrence.
The data now published seem to discard the hypothetical higher risk of AIS in patients with sustained AF and the authors conclude that the AF pattern should not influence the decision to start anticoagulation. One should stress that the majority of patients were anticoagulated, which might offset the natural history of ischaemic recurrence in different AF patterns. In fact, the higher rates of recurrence may be related to other etiologic factors, as reflected by the patients’ cardiovascular profiles, and not just the arrhythmia itself.
The original article “Early recurrence in paroxysmal versus sustained atrial fibrillation in patients with acute ischaemic stroke” is available in the Online First section of the European Stroke Journal.
- Paciaroni M, Angelini F, Agnelli G et al. Early recurrence in paroxysmal versus sustained atrial fibrillation in patients with acute ischaemic stroke. European Stroke Journal. 2018; online first