title: Incidence of Stroke or Systemic Embolism in Paroxysmal Versus Sustained Atrial Fibrillation: The Fushimi Atrial Fibrillation Registry.
abstract: OBJECTIVE
  There is controversy on the relationship of the type of atrial fibrillation (AF) to stroke. Although several studies show that patients with paroxysmal AF (PAF) have a stroke risk similar to those with persistent or permanent AF, recent studies suggest that PAF is associated with a lower rate of stroke. Limited data on stroke risk associated with PAF are evident in Asian populations.
  
  
  METHODS
  The Registry Study of Atrial Fibrillation Patients in Fushimi-ku (Fushimi AF Registry) is a community-based survey of patients with AF in Fushimi-ku, Kyoto, Japan. Patients were categorized into 2 types of AF: PAF or sustained (persistent or permanent) AF. We compared clinical events between PAF (n=1588) and sustained AF (n=1716).
  
  
  RESULTS
  Patients with PAF were younger, had less comorbidities, and received oral anticoagulants (OAC) less commonly. A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed (non-OAC users: hazard ratio, 0.45; 95% confidence intervals, 0.27-0.75; P<0.01 and OAC users: hazard ratio, 0.59; 95% confidence interval, 0.35-0.93; P=0.03). The composite end point of stroke/systemic embolism/all-cause mortality was also lower in PAF, whether among OAC users (hazard ratio, 0.77; 95% confidence interval, 0.59-0.99; P=0.046) or non-OAC users (hazard ratio, 0.59; 95% confidence interval, 0.46-0.75; P<0.01). On multivariate analysis, PAF was an independent predictor of lower stroke/systemic embolism risk.
  
  
  CONCLUSIONS
  In this large cohort of Japanese patients with AF, PAF was independently associated with lower incidence of stroke/systemic embolism than sustained AF. This may aid decision making for anticoagulation, especially in those patients with AF with few stroke risk factors.
  
  
  BACKGROUND
  URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000005834.
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takabayashi
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hamatani
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Yugo
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takagi
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Takashi
authors.initials: T
authors.lastname: Unoki
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ishii
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Moritake
authors.initials: M
authors.lastname: Iguchi
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Nobutoyo
authors.initials: N
authors.lastname: Masunaga
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Masahiro
authors.initials: M
authors.lastname: Esato
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Yeong-Hwa
authors.initials: YH
authors.lastname: Chun
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Hikari
authors.initials: H
authors.lastname: Tsuji
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Wada
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Koji
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Abe
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.). akao@kuhp.kyoto-u.ac.jp.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Akao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D004617:Embolism / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*
keywords: atrial fibrillation; embolism; registries; risk factors; stroke