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. 2021 Oct 21:12:744607.
doi: 10.3389/fneur.2021.744607. eCollection 2021.

Atrial Fibrillation Related and Unrelated Stroke Recurrence Among Ischemic Stroke Patients With Atrial Fibrillation

Bum Joon Kim  1 , Yang-Ha Hwang  2 , Man-Seok Park  3 , Joon-Tae Kim  3 , Kang-Ho Choi  3 , Jin-Man Jung  4 , Sungwook Yu  5 , Chi Kyung Kim  6 , Kyungmi Oh  6 , Tae-Jin Song  7 , Yong-Jae Kim  8 , Kwang-Yeol Park  9 , Jeong-Min Kim  10 , Jong-Ho Park  11 , Jay Chol Choi  12 , Jong-Won Chung  13 , Oh Young Bang  13 , Gyeong-Moon Kim  13 , Sung Hyuk Heo  14 , Woo-Keun Seo  13
Affiliations

Atrial Fibrillation Related and Unrelated Stroke Recurrence Among Ischemic Stroke Patients With Atrial Fibrillation

Bum Joon Kim et al. Front Neurol. .

Abstract

Background: Ischemic stroke with atrial fibrillation (AF) may recur despite appropriate treatment. It may be AF-related or AF-unrelated. We compared the factors associated with AF-related and AF-unrelated recurrences among ischemic stroke patients with AF. Methods: Patients with ischemic stroke and AF were enrolled from 11 centers in Korea. Ischemic stroke recurrence was classified as AF-related if the lesion pattern was compatible with cardioembolism without significant stenosis or as AF-unrelated if the lesion was more likely due to small vessel disease or arterial stenosis. Factors associated with stroke recurrence (AF-related and AF-unrelated) were investigated. Results: Among the 2,239 patients, 115 (5.1%) experienced recurrence (75 AF-related and 40 AF-unrelated). Factors independently associated with any stroke recurrence included AF diagnosed before stroke, small subcortical infarctions, and small scattered lesions in a single vascular territory. Type of AF was associated with the type of stroke recurrence, with persistent AF being associated with AF-related stroke [hazard ratio (HR) = 2.94, 95% confidence interval (CI) 1.69-5.26; p < 0.001]. By contrast, paroxysmal AF (HR = 3.76, 95% CI 1.56-9.04; p = 0.003), AF diagnosed before stroke (HR = 2.38, 95% CI 1.19-4.55; p = 0.014), small scattered lesions in a single vascular territory (reference: corticosubcortical lesion, HR = 3.19, 95% CI 1.18-8.63; p = 0.022), and the use of antiplatelet agents (HR = 2.11, 95% CI 1.11-4.03; p = 0.024) were independently associated with AF-unrelated stroke. Conclusion: Persistent AF was more associated with AF-related stroke recurrence, whereas paroxysmal AF was more associated with AF-unrelated stroke recurrence. A scattered lesion in a single vascular territory may predict AF-unrelated stroke recurrence.

Keywords: atrial fibrillation; cardioembolic brain infarction; recurrence; stroke; stroke mechanism.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study profile.
Figure 2
Figure 2
AF-related and AF-unrelated stroke recurrence from index stroke according to the type of AF. AF, atrial fibrillation.
See this image and copyright information in PMC

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