Palomäki Antti, Mustonen Pirjo, Hartikainen Juha E K, Nuotio Ilpo, Kiviniemi Tuomas, Ylitalo Antti, Hartikainen Päivi, Lehtola Heidi, Luite Riho, Airaksinen K E Juhani
Heart Center, Turku University Hospital, University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland.
Department of Medicine, Keski-Suomi Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
Int J Cardiol. 2016 Jan 15;203:269-73. doi: 10.1016/j.ijcard.2015.10.168. Epub 2015 Oct 20.
Cardioversion of atrial fibrillation (AF) is associated with an increased risk for stroke. We identified all cardioversions during the 30 days preceding stroke or transient ischemic attack (TIA) in patients with a previously diagnosed AF, and sought to assess the characteristics of cardioversions leading to stroke or TIA.
FibStroke is a cross-sectional observational multicenter registry that included AF patients with an ischemic stroke or intracranial bleed identified from a discharge registry of four Finnish hospitals. In total 3677 consecutive AF patients suffered 3252 strokes and 956 TIA episodes during 2003–2012. This pre-specified analysis focused on the 1644 events that occurred to patients with paroxysmal or persistent AF at the time of stroke/TIA.
A total of 78 strokes and 22 TIA episodes were preceded by a cardioversion. Post-cardioversion strokes accounted for 6.4% of strokes in patients with paroxysmal/persistent AF. Of the 100 cardioversions leading to an ischemic event, 77 were acute and 23 were elective, 63 events occurred in patients not using anticoagulation, and 5 patients had periprocedural INR < 2. Importantly, 21 patients were in low risk of stroke, i.e. CHA2DS2-VASc score < 2. The median delay from cardioversion to event was 2 days. All nine patients who after an unsuccessful cardioversion developed a stroke had a spontaneous cardioversion prior to stroke.
Every sixteenth stroke of patients with paroxysmal/persistent AF is preceded by a cardioversion. Most post-cardioversion strokes occur in patients not using oral anticoagulation before cardioversion of acute AF.
房颤复律与中风风险增加相关。我们确定了既往诊断为房颤的患者在中风或短暂性脑缺血发作（TIA）前30天内的所有复律情况，并试图评估导致中风或TIA的复律特征。
FibStroke是一项横断面观察性多中心注册研究，纳入了从四家芬兰医院出院登记中识别出的患有缺血性中风或颅内出血的房颤患者。在2003年至2012年期间，共有3677例连续的房颤患者发生了3252次中风和956次TIA发作。这项预先设定的分析聚焦于中风/TIA发生时阵发性或持续性房颤患者发生的1644起事件。
共有78次中风和22次TIA发作之前有过复律。复律后中风占阵发性/持续性房颤患者中风的6.4%。在导致缺血性事件的100次复律中，77次为急性复律，23次为择期复律，63起事件发生在未使用抗凝药物的患者中，5例患者围手术期国际标准化比值（INR）<2。重要的是，21例患者中风风险较低，即CHA2DS2-VASc评分<2。从复律到事件发生的中位延迟为2天。所有9例复律失败后发生中风的患者在中风前均有自发复律。
阵发性/持续性房颤患者每16次中风中有1次之前有过复律。大多数复律后中风发生在急性房颤复律前未使用口服抗凝药物的患者中。
