Fukamizu Seiji, Hojo Rintaro, Kitamura Takeshi, Kawamura Iwanari, Miyazawa Satoshi, Karashima Jun, Nakamura Shin, Takeda Kosuke, Yamaoka Koichiro, Arai Tomoyuki, Kawajiri Kohei, Tanabe Sho, Koyano Yasuki, Miyahara Daisuke, Tokioka Sayuri, Arai Marina, Inagaki Dai, Miyabe Tomonori, Sakurada Harumizu, Hiraoka Masayasu
Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo Japan.
Department of Cardiology Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital Tokyo Japan.
J Arrhythm. 2019 Dec 3;36(1):95-104. doi: 10.1002/joa3.12285. eCollection 2020 Feb.
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.
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.
The incidence of asymptomatic AF (54.5% vs 22.7%; = .011) and left atrial volume (135.8 mL vs 109.3 mL; = .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.
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.
缺血性中风的不同亚型可能具有不同的危险因素、临床特征和预后。本研究调查了接受心房颤动（AF）消融术的中风患者的中风复发率及复发模式。
在2006年至2016年接受AF消融术的825例患者中，确定了77例（9.3%，中位年龄69岁）既往有缺血性中风病史的患者。患者分为既往有心脏栓塞性（CE）中风患者（n = 55）和既往有非CE中风患者（n = 22）。研究中风复发的发生率和模式。
CE组无症状AF的发生率（54.5%对22.7%；P = 0.011）和左心房容积（135.8 mL对109.3 mL；P = 0.024）高于非CE组。34例（44.2%）患者在首次消融后平均28.1个月停用抗凝治疗。在中位4.1年的随访期间，没有患者发生CE中风。在非CE组中，2例患者经历了复发性非CE中风（1例为腔隙性梗死，1例为动脉粥样硬化性中风）；然而，在复发性缺血性中风发作时未观察到AF。
在接受AF导管消融术的中风患者中，中风复发率为0.54/100患者年。这些患者既往的中风在某些情况下可能并非由AF引起；因此，有必要进行大规模前瞻性研究，以确定预防潜在复发性中风的合适抗栓治疗方法。
