Cardiovascular Disease |

Atrial Fibrillation/Flutter Is the Common Mechanism Whereby the Stroke Risk Factors Cause Stroke FREE TO VIEW

Jacob Haft, MD; Louis Teichholz, MD
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Hackensack University Medical Center, Hackensack, NJ

Chest. 2012;142(4_MeetingAbstracts):110A. doi:10.1378/chest.1384557
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SESSION TYPE: Arrhythmias Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: The stroke risk factors (RF), congestive heart failure(CHF), advanced age, hypertension(BP), diabetes(DM) and coronary artery disease(CAD) are also the RF for atrial fibrillation/flutter (AF). The incidence of stroke in AF pts is well known and is related to the presence of the stroke RF. Pts with AF without these RF rarely have strokes and are usually not anticoagulated. The incidence of AF in stroke pts is unclear because AF is often transient, episodic, asymptomatic, not present on the pts stroke admission and is frequently not diagnosed. It is likely that AF is caused by the RF and is a common mechanism whereby these RF cause stroke.

METHODS: To determine the incidence of AF in ischemic stroke pts and to relate the stroke RF to AF we reviewed the clinical records, all the 12 lead ECGs in a 13 year institutional data base and the 2D echocardiograms of 985 consecutive pts with a diagnosis of ischemic stroke over 3 years.

RESULTS: AF was found in 31.3% (95% CL 28.5, 34.2) of the ischemic stroke pts. In the 784 pts with BP, 33.7% had AF; higher than the 21.9 % in the pts without BP*. Of the 168 pts with CHF 61.9% had AF, more than the 25.0 % in those without CHF**. Of 527 pts >/= 75 years old, 45.2% had AF, more than the 15.3% in those < 75**. CAD was present in 240 pts ; 33.4% had AF vs 27.5%**. DM pts had 32.8 % AF*. Pts with LA enlargement had a higher incidence of AF than those without LAE, 47.3% vs 11.7%**; as did pts with EF<50%, 49.0% vs 28.3%**. *P<.01 **P<.0001

CONCLUSIONS: Although the extensive ECG data base made it less likely that we would miss AF, recording of ECGs was random, related to ER, clinic visits and hospital admissions. Diagnosis of AF from the data base was frequently fortuitous and serendipitous. Even so, with probably many episodes of AF missed, we found a higher incidence of AF in stroke pts than previously reported. We also found that stroke pts with the risk factors had significantly more AF than those without the RF suggesting that these RF may cause the AF and that AF is frequently the mechanism whereby these risk factors cause stroke.

CLINICAL IMPLICATIONS: These findings 1) support that any stroke pts with these risk factors who are not diagnosed with AF should be meticulously studied for AF so anticoagulation can be administered to prevent a subsequent stroke, and 2) any pt with these risk factors who complains of palpitations should be investigated to diagnose AF so anticoagulation can be considered to prevent a first stroke.

DISCLOSURE: The following authors have nothing to disclose: Jacob Haft, Louis Teichholz

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