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Lone atrial fibrillation and stroke.

J Bogousslavsky1, C Adnet-Bonte, F Regli

  • 1Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Acta Neurologica Scandinavica
|August 1, 1990
PubMed
Summary

Cardioembolism is a likely cause of first-ever ischemic stroke in lone atrial fibrillation patients. Recurrence risk is low, with no major adverse events during long-term follow-up.

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Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • Atrial fibrillation is a common cause of ischemic stroke.
  • Identifying the specific cause of stroke in patients with lone atrial fibrillation is crucial for effective management.
  • Cardioembolism is suspected but often lacks direct echocardiographic evidence.

Purpose of the Study:

  • To investigate the etiology of first-ever ischemic stroke in patients with lone atrial fibrillation.
  • To assess the risk of stroke recurrence and adverse events in this patient group.

Main Methods:

  • Study included 21 consecutive patients with first-ever ischemic stroke and lone atrial fibrillation.
  • Standard investigations included brain CT, non-invasive cardiac and arterial tests, and early angiography.

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  • Patients were followed for a mean of 4.8 years, with anticoagulant therapy initiated in 18 patients.

    • Main Results:

    • Cardioembolism was suggested by stroke characteristics (distal occlusions, infarct topography) despite infrequent atrial thrombus detection.
    • No stroke recurrence occurred during the initial 14-day post-stroke period without antithrombotic therapy.
    • Long-term stroke recurrence risk was low at 0.99 per 100 patient-years.
    • No deaths, severe cardiac events, or disabling hemorrhages related to anticoagulation were observed.

    Conclusions:

    • Cardioembolism is a probable cause of ischemic stroke in lone atrial fibrillation, even without clear echocardiographic thrombus.
    • The long-term risk of stroke recurrence is low in these patients.
    • Anticoagulant therapy appears safe and effective, with no significant bleeding complications in this cohort.