Nonsustained Atrial Fibrillation in Ischemic Stroke Patients and Stroke-Free Controls From the Perspective of Stroke Pathophysiology.
Short-lasting (<30 s), nonsustained episodes of atrial fibrillation (NS-AF) are considered a risk factor for future development of paroxysmal or persistent AF. Nonetheless, their causal role in stroke pathogenesis is currently unknown. In this study we determined the frequency of NS-AF, together with the associated clinical and imaging features, in stroke-free controls and ischemic stroke patients.



A total of 332 controls, ≥50 years of age and no prior history of stroke or AF, were evaluated with 24-hour Holter monitoring for the presence of <30-s-long AF episodes. The demographic and cardiovascular features of this cohort, together with imaging finding on magnetic resonance imaging, were compared to a consecutive series of ≥50-year-old ischemic stroke patients without AF (n=498). The prevalence of NS-AF was significantly higher among ischemic stroke patients in comparison to controls (37% versus 27%; P=0.002). In multivariable analyses, after adjustment for demographic and cardiovascular risk factors, patients with ischemic stroke were more likely to harbor NS-AF episodes (odds ratio 1.43; 95% CI 1.01-2.02; P=0.041). The association between ischemic stroke and NS-AF weakened when the analyses were restricted to cryptogenic stroke patients (odds ratio 1.31; 95% CI 0.82-2.08). No significant association was observed between the presence of chronic cortical infarcts and NS-AF.



Our study shows a higher prevalence of NS-AF episodes in ischemic stroke patients in comparison to controls. Nonetheless, the lack of a stronger association with cryptogenic strokes and absence of a relationship with chronic cortical infarcts brings into question the causal influence of NS-AF in the ischemic stroke setting.
Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Ezgi
E
Yetim
Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Mehmet Akif
MA
Topcuoglu
Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Ugur
U
Canpolat
Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Rahsan
R
Gocmen
Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Kader K
KK
Oguz
Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Necla
N
Ozer
Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Kudret
K
Aytemir
Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey arsavaem@hotmail.com.
Ethem Murat
EM
Arsava
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D001921:Brain / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology*; D014421:Turkey / Q000453:epidemiology
atrium; cerebral infarction; embolism; fibrillation; imaging
Eur Heart J. 2013 Aug;34(31):2464-71
23594592
Stroke. 2016 Mar;47(3):895-900
26786114
Eur Heart J. 2015 Feb 1;36(5):281-7a
25187524
Eur Heart J. 2015 Feb 1;36(5):288-96
25209598
Circ Arrhythm Electrophysiol. 2009 Oct;2(5):474-80
19843914
J Am Coll Cardiol. 1999 Feb;33(2):342-9
9973013
J Am Coll Cardiol. 2005 Nov 15;46(10):1913-20
16286180
Stroke. 1988 Aug;19(8):955-7
3400107
Cardiovasc Res. 2002 May;54(2):230-46
12062329
J Am Coll Cardiol. 2015 Jul 21;66(3):232-241
26184616
J Am Heart Assoc. 2015 Jun 15;4(6):e002012
26077590
Ann Noninvasive Electrocardiol. 2015 Nov;20(6):518-25
26446367
Circulation. 2014 May 27;129(21):2094-9
24633881
Stroke. 1987 Nov-Dec;18(6):1098-100
3686584
Stroke. 2014 Mar;45(3):884-6
24425117
Heart Rhythm. 2011 Sep;8(9):1416-23
21699833
N Engl J Med. 2007 Nov 29;357(22):2262-8
18046029
Stroke. 2007 Nov;38(11):2979-84
17901381
Europace. 2012 Feb;14(2):230-7
21933802
N Engl J Med. 2012 Jan 12;366(2):120-9
22236222
J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14
25559473
J Am Coll Cardiol. 1994 Mar 15;23(4):916-25
8106697
Circulation. 2003 Apr 1;107(12):1614-9
12668495
J Am Coll Cardiol. 2014 Dec 2;64(21):e1-76
24685669
Stroke. 2015 Mar;46(3):634-40
25634003