Stroke, Vol 24, 26-30, Copyright © 1993 by American Heart Association
F Vingerhoets, J Bogousslavsky, F Regli and G Van Melle
BACKGROUND AND PURPOSE: Atrial fibrillation (AF) is a risk factor for
stroke, although it may not always be directly responsible for the stroke.
On the other hand, cardiac arrhythmias and electrocardiographic changes
have been reported after ischemic stroke and numerous other intracranial
pathologies. We tested the hypothesis that some patients with acute stroke
may develop transient AF as a consequence of the stroke. METHODS: This
study was based on 1,661 patients with first-ever stroke consecutively
hospitalized and prospectively included into the Lausanne Stroke Registry.
"Recent AF" was defined as AF discovered at or after ("after-admission" AF)
admission in patients without any previous history of AF. Populations with
recent AF and after-admission AF were compared for AF evolution, risk
factors, and lesion type and distribution with patients with previous
history of AF (known AF) and with patients with another recognized cardiac
source of embolism (cardioembolic). RESULTS: Twenty-four patients had
recent AF on admission, and 17 developed it a few hours to 3 days after
stroke. AF disappeared after a few days in 26 (63%; 94% of after-admission
AF) patients. Stroke was a primary hematoma in 9.8% of patients with recent
AF, 2.8% of patients with known AF, and 0.9% (p < 0.001) of patients
with cardiac source of embolism. Parietoinsular (32%) and brain stem (11%)
involvement were more common in recent AF than in cardioembolic stroke in
general (16.7% and 6.7%, respectively; p < 0.05). CONCLUSIONS: AF
discovered after an acute stroke lasted no more than a few days, suggesting
that it may have occurred as a consequence of the stroke. This possibility
is emphasized by the significant predominance in patients with recent AF of
primary hematoma, which cannot be caused by AF, and of parietoinsular and
brain stem involvement, which are experimentally known as arrhythmogenic.
This hypothesis should be considered in patients with acute stroke and
previously unknown AF before therapeutic decisions are made.
ARTICLES
Atrial fibrillation after acute stroke
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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