Recurrent ischemic stroke in patients with atrial fibrillation ablation and prior stroke: A study based on etiological classification.

Autor: Fukamizu S; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Hojo R; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Kitamura T; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Kawamura I; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Miyazawa S; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Karashima J; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Nakamura S; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Takeda K; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Yamaoka K; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Arai T; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Kawajiri K; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Tanabe S; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Koyano Y; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Miyahara D; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Tokioka S; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Arai M; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Inagaki D; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Miyabe T; Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan., Sakurada H; Department of Cardiology Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital Tokyo Japan., Hiraoka M; Tokyo Medical and Dental University Tokyo Japan.
Jazyk: angličtina
Zdroj: Journal of arrhythmia [J Arrhythm] 2019 Dec 03; Vol. 36 (1), pp. 95-104. Date of Electronic Publication: 2019 Dec 03 (Print Publication: 2020).
DOI: 10.1002/joa3.12285
Abstrakt: Background: Different subtypes of ischemic stroke may have different risk factors, clinical features, and prognoses. This study investigated the incidence and mode of stroke recurrence in patients with a history of stroke who underwent atrial fibrillation (AF) ablation.
Methods: Of 825 patients who underwent AF ablation from 2006 to 2016, 77 patients (9.3%, median age 69 years) with a prior ischemic stroke were identified. Patients were classified as those with prior cardioembolic (CE) stroke (n = 55) and those with prior non-CE stroke (n = 22). The incidence and pattern of stroke recurrence were investigated.
Results: The incidence of asymptomatic AF (54.5% vs 22.7%; P  = .011) and left atrial volume (135.8 mL vs 109.3 mL; P  = .024) was greater in the CE group than in the non-CE group. Anticoagulation treatment was discontinued at an average of 28.1 months following the initial ablation in 34 (44.2%) patients. None of the patients developed CE stroke during a median 4.1-year follow-up. In the non-CE group, 2 patients experienced recurrent non-CE stroke (lacunar infarction in 1 and atherosclerotic stroke in 1); however, AF was not observed at the onset of recurrent ischemic stroke.
Conclusions: In patients with a history of stroke who underwent catheter ablation for AF, the incidence of recurrent stroke was 0.54/100 patient-years. The previous stroke in these patients may not have been due to AF in some cases; therefore, a large-scale prospective study is warranted to identify the appro priate antithrombotic therapy for the prevention of potentially recurrent stroke.
Competing Interests: Authors declare no conflict of interests for this article.
(© 2019 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)
Databáze: MEDLINE
Externí odkaz: