Vingerhoets F, Bogousslavsky J, Regli F, Van Melle G
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Stroke. 1993 Jan;24(1):26-30. doi: 10.1161/01.str.24.1.26.
Atrial fibrillation (AF) is a risk factor for stroke, although it may not always be directly responsible for the stroke. On the other hand, cardiac arrhythmias and electrocardiographic changes have been reported after ischemic stroke and numerous other intracranial pathologies. We tested the hypothesis that some patients with acute stroke may develop transient AF as a consequence of the stroke.
This study was based on 1,661 patients with first-ever stroke consecutively hospitalized and prospectively included into the Lausanne Stroke Registry. "Recent AF" was defined as AF discovered at or after ("after-admission" AF) admission in patients without any previous history of AF. Populations with recent AF and after-admission AF were compared for AF evolution, risk factors, and lesion type and distribution with patients with previous history of AF (known AF) and with patients with another recognized cardiac source of embolism (cardioembolic).
Twenty-four patients had recent AF on admission, and 17 developed it a few hours to 3 days after stroke. AF disappeared after a few days in 26 (63%; 94% of after-admission AF) patients. Stroke was a primary hematoma in 9.8% of patients with recent AF, 2.8% of patients with known AF, and 0.9% (p < 0.001) of patients with cardiac source of embolism. Parietoinsular (32%) and brain stem (11%) involvement were more common in recent AF than in cardioembolic stroke in general (16.7% and 6.7%, respectively; p < 0.05).
AF discovered after an acute stroke lasted no more than a few days, suggesting that it may have occurred as a consequence of the stroke. This possibility is emphasized by the significant predominance in patients with recent AF of primary hematoma, which cannot be caused by AF, and of parietoinsular and brain stem involvement, which are experimentally known as arrhythmogenic. This hypothesis should be considered in patients with acute stroke and previously unknown AF before therapeutic decisions are made.
心房颤动（AF）是卒中的一个危险因素，尽管它可能并非总是直接导致卒中。另一方面，缺血性卒中及许多其他颅内病变后曾有心脏心律失常及心电图改变的报道。我们检验了这样一个假设，即一些急性卒中患者可能因卒中而发生短暂性AF。
本研究基于1661例首次发生卒中并连续住院且前瞻性纳入洛桑卒中登记处的患者。“近期AF”定义为既往无AF病史的患者在入院时或入院后（“入院后”AF）发现的AF。将近期AF和入院后AF患者的AF演变、危险因素、病变类型及分布与有AF病史（已知AF）的患者以及有其他公认心脏栓塞源（心源性栓塞）的患者进行比较。
24例患者入院时存在近期AF，17例在卒中后数小时至3天发生AF。26例（63%；94%的入院后AF）患者的AF在数天后消失。近期AF患者中9.8%的卒中为原发性血肿，已知AF患者中为2.8%，心源性栓塞患者中为0.9%（p<0.001）。近期AF患者中顶叶岛叶（32%）和脑干（11%）受累比一般的心源性栓塞性卒中更常见（分别为16.7%和6.7%；p<0.05）。
急性卒中后发现的AF持续不超过数天，提示其可能是卒中的结果。原发性血肿（AF不会导致其发生）以及顶叶岛叶和脑干受累（实验已知其具有致心律失常性）在近期AF患者中显著占优势，这一可能性得到了强调。在对急性卒中和既往不明AF的患者做出治疗决策之前，应考虑这一假设。
