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Strokes after cardioversion of atrial fibrillation--The FibStroke study

Antti Palomäki1, Pirjo Mustonen2, Juha E K Hartikainen3

  • 1Heart Center, Turku University Hospital, University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland.

International Journal of Cardiology
|November 1, 2015
PubMed

Insights

Cardioversion for atrial fibrillation (AF) can precede stroke, especially in patients not on anticoagulation. Most strokes after cardioversion occur in those with acute AF and no prior oral anticoagulation.

Area of Science:

  • Cardiology
  • Neurology
  • Public Health

Background:

  • Cardioversion for atrial fibrillation (AF) carries an inherent risk of stroke or transient ischemic attack (TIA).
  • Understanding the characteristics of cardioversions preceding these events is crucial for patient safety.

Purpose of the Study:

  • To identify and characterize cardioversions that occurred within 30 days before a stroke or TIA in patients with a prior AF diagnosis.
  • To assess the specific factors associated with post-cardioversion ischemic events.

Main Methods:

  • A cross-sectional, observational multicenter registry (FibStroke) was utilized, analyzing data from four Finnish hospitals (2003–2012).
  • The study focused on 1644 events in patients with paroxysmal or persistent AF at the time of stroke/TIA.
  • Included were patients with ischemic stroke or intracranial bleed.

Main Results:

  • A total of 78 strokes and 22 TIA episodes were preceded by cardioversion, representing 6.4% of strokes in the study population.
  • Of 100 cardioversions linked to ischemic events, 77 were acute and 23 elective; 63 occurred in patients not using anticoagulation.
  • A significant number of events (21) occurred in patients with a low stroke risk (CHA2DS2-VASc score < 2), with a median delay of 2 days from cardioversion to event.

Conclusions:

  • Cardioversion precedes approximately 1 in 16 strokes in patients with paroxysmal/persistent AF.
  • The majority of post-cardioversion strokes occur in patients with acute AF who were not on oral anticoagulation prior to the procedure.
Abstract

Keywords:
Atrial fibrillationCardioversionStrokeTransient ischemic attack

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