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(Stroke. 2001;32:1443.)
© 2001 American Heart Association, Inc.

Letters to the Editor

Diurnal Variation in Stroke Onset in Atrial Fibrillation

Gregory Y.H. Lip, MD,; Eric K.H. Tan; Catherine K.Y. Lau Sridhar Kamath, MRCP

University Department of Medicine, City Hospital, Birmingham, England

To the Editor:

We read with interest the article by Engström et al¹ on cardiac arrhythmias and stroke and agree that apart from atrial fibrillation (AF), little scientific attention has been given to the associations between cardiac arrhythmias and stroke onset. Even in AF, we still need to know much more on the relation to stroke onset, as this arrhythmia is usually present in about 15% to 20% of patients with acute stroke and is associated with a 1.5- to 3.0-fold higher mortality than that for stroke patients who are in sinus rhythm.² Strokes attributed to AF also tend to be more severe, with greater disability, longer hospital stay, and lower rate of patient discharge to own home.^{3 4}

A diurnal variation in the onset of cardiac events and stroke is well recognized. Although the diurnal variation of stroke onset has generally been established in patients who are in sinus rhythm, we are unaware of any published data on diurnal variation of stroke onset in patients with AF. To investigate this further, we assessed the time of the stroke onset in 60 patients (21 men, mean±SD age 76±10 years) with first-onset stroke who were in AF on admission to our city center teaching hospital to determine the existence of any diurnal variation. Furthermore, antithrombotic therapy prescribed before admission and after discharge was noted.

There was a circadian rhythm of stroke onset among patients with atrial fibrillation, with a significantly higher number of strokes occurring between 6 AM and 6 PM and . . . [Full Text of this Article]

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