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Meta-Analysis
. 2024 Dec;19(10):1083-1092.
doi: 10.1177/17474930241253482. Epub 2024 May 24.

Temporal association between atrial fibrillation and ischemic stroke: Systematic review and meta-analysis

Jessica D'lima  1   2 , Vincent Thijs  1   2   3 , Han S Lim  1   4 , Thalys Sampaio Rodrigues  1 , Ann-Marie Beaudoin  5
Affiliations
Meta-Analysis

Temporal association between atrial fibrillation and ischemic stroke: Systematic review and meta-analysis

Jessica D'lima et al. Int J Stroke. 2024 Dec.

Abstract

Background: Paroxysmal atrial fibrillation (PAF) is strongly associated with ischemic stroke. Continuous cardiac implantable electronic devices (CIEDs) can assess PAF episodes over prolonged periods. Studies that attempted to find a temporal association between PAF and ischemic stroke were inconclusive. Thus, we performed a systematic review and meta-analysis to assess this relationship.

Aims: This study aimed to assess the temporal association between AF episodes and stroke within 30 days of the arrhythmic episode. The secondary outcome is a temporal association within a 90-day period.

Summary of review: A total of 2804 studies that discussed the temporal relationship between PAF and ischemic stroke were screened, and 7 studies were included in the meta-analysis. Among the 4041 patients included in these studies, there were 138 patients with device detected PAF episodes and stroke. Four studies used a 30-day window for temporality and the pooled odds ratio (OR) showed a significant association (OR 4.11 (95% CI 1.03-16.40)). The three studies reporting on AF and stroke within a 90-day window did not find a significant temporal relationship (OR 0.43 (95% CI 0.13-1.41)). Finally, the pooled result of those seven studies did not show a significant association (OR 1.51 (95% CI 0.44-5.17)).

Conclusion: This meta-analysis supports a temporal relationship between PAF and ischemic stroke within a 30-day window. Establishing this relationship is important for individualized risk prediction and targeted anticoagulation treatment.

Data access statement: The data will be made available upon reasonable request.

Keywords: Atrial fibrillation; ischemic stroke; paroxysmal atrial fibrillation.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: V.T. receives consulting fees from Medtronic and lecture, and consulting fees from Boehringer Ingelheim and Bayer. H.S.L. reports having received research support from St Jude Medical (now Abbott).

Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
Figure 2.
Figure 2.
Forest plot analyzing the temporal relationship between episodes of AF and stroke within 30 and 90 days.
Figure 3.
Figure 3.
Bubble plot of meta-regression variables (age, duration of AF, CHA2DS2-VASc score, duration of AF, and percentage of participants with a prior stroke).
Figure 4.
Figure 4.
Risk of publication bias assessed via inspection of Egger’s test.
See this image and copyright information in PMC

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