Clinical Research in Stroke

Blackie H.a,b· Thijs V.a,c· Churilov L.a· Han H.-C.a,b· Lin T.b· Teh A.W.a,b,d· Jones E.F.b· Horrigan M.a,b· Farouque O.a,b· Lim H.S.a,b,e

Author affiliations

aDepartment of Medicine, University of Melbourne, Melbourne, VIC, Australia
bDepartment of Cardiology, Austin Health, Melbourne, VIC, Australia
cDepartment of Stroke, Austin Health, Melbourne, VIC, Australia
dDepartment of Cardiology, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
eDepartment of Cardiology, Northern Health, Melbourne, VIC, Australia

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Article / Publication Details

First-Page Preview

Received: February 08, 2022
Accepted: June 27, 2022
Published online: September 09, 2022

Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Background and Purpose: Research into the temporal relationship between atrial tachyarrhythmias (atrial tachycardia [AT] and atrial fibrillation [AF]) and stroke has produced conflicting findings. Systematic categorization of stroke subtypes may help clarify the discussion. Objectives: The objective of the study was to examine the presence and timing of AT/AF in relation to ischemic stroke subtypes, categorized as either cardioembolic (CE) or non-CE. Methods: Consecutive patients presenting to the Austin Hospital with acute stroke from 2012 to 2019 and a cardiac implantable electronic device (CIED) were identified. Using a case-control design, the temporal proximity of AT/AF episodes in the 90 days prior to stroke was compared in the CE and non-CE stroke groups. Results: 5,591 patients presented to the Austin Hospital with acute stroke from 2012 to 2019, of whom 31 patients with an ischemic stroke and a CIED with ≥90 days of monitoring were identified. Twelve strokes were adjudicated as CE and 19 as non-CE by a stroke neurologist. Six of the 12 CE stroke patients (50%) experienced AT/AF within 30 days preceding their stroke, while none of the 19 non-CE stroke patients recorded any AT/AF in the same period (p = 0.001). Four CE stroke patients (33%) had no AT/AF preceding their strokes at any time. The odds ratio for CE stroke was highest (39; 95% confidence interval [CI]: 1.92–791.5) when AT/AF occurred in the 30 days prior, declining to 20.65 (95% CI: 1.00–427.66) and 6.07 (95% CI: 0.94–39.04) in the subsequent 31–60- and 61–90-day windows, respectively. Conclusions: CE strokes were associated with a significantly higher proportion of preceding AT/AF compared with non-CE strokes. These findings support a potential temporal relationship between AT/AF and CE stroke and demonstrate that stroke subtyping can better characterize the relationship between AF and ischemic stroke. However, this study’s findings are limited by its sample size and small number of informative cases.

© 2022 S. Karger AG, Basel

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First-Page Preview

Received: February 08, 2022
Accepted: June 27, 2022
Published online: September 09, 2022

Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

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