Stroke, Vol 16, 182-188, Copyright © 1985 by American Heart Association
M Britton and C Gustafsson
The association between non-rheumatic atrial fibrillation (AF) and stroke
has been studied in 402 patients consecutively admitted to a stroke unit.
Brain infarction patients with sinus rhythm (n = 196) and non-rheumatic AF
(n = 92) were further compared. Some findings supported an embolic origin
of the stroke: half of the deceased AF patients (n = 24) at autopsy either
had left atrial thrombosis or arterial embolism compared to none of the ten
with sinus rhythm. Patients with AF also had a higher mortality and more
severe brain lesions, findings compatible with a sudden occlusion of blood
flow. However, these differences might also be explained by an
atherothrombotic occlusion with impaired autoregulation in the ischaemic
region in conjunction with heart failure, which was more common in the AF
patients. Other findings supporting an atherothrombotic mechanism were: the
prevalence of AF was higher (19- 29%) in all kinds of stroke, including
haemorrhage, than in age-matched controls (3-9%). Also patients with
previous AF and no present embolic source resembled the whole AF group and
differed from patients with sinus rhythm. Thus embolism is a plausible
cause of stroke in many AF patients, whereas an atherothrombotic origin is
more likely in others. Characteristics identifying the mechanism in an
individual case were not found.
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