Kensuke Takabayashi1, Yasuhiro Hamatani1, Yugo Yamashita1, Daisuke Takagi1, Takashi Unoki1, Mitsuru Ishii1, Moritake Iguchi1, Nobutoyo Masunaga1, Hisashi Ogawa1, Masahiro Esato1, Yeong-Hwa Chun1, Hikari Tsuji1, Hiromichi Wada1, Koji Hasegawa1, Mitsuru Abe1, Gregory Y H Lip1, Masaharu Akao2. 1. From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.). 2. From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.). akao@kuhp.kyoto-u.ac.jp.
Abstract
BACKGROUND AND PURPOSE: There is controversy on the relationship of the type of atrial fibrillation (AF) to stroke. Although several studies show that patients with paroxysmal AF (PAF) have a stroke risk similar to those with persistent or permanent AF, recent studies suggest that PAF is associated with a lower rate of stroke. Limited data on stroke risk associated with PAF are evident in Asian populations. METHODS: The Registry Study of Atrial Fibrillation Patients in Fushimi-ku (Fushimi AF Registry) is a community-based survey of patients with AF in Fushimi-ku, Kyoto, Japan. Patients were categorized into 2 types of AF: PAF or sustained (persistent or permanent) AF. We compared clinical events between PAF (n=1588) and sustained AF (n=1716). RESULTS: Patients with PAF were younger, had less comorbidities, and received oral anticoagulants (OAC) less commonly. A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed (non-OAC users: hazard ratio, 0.45; 95% confidence intervals, 0.27-0.75; P<0.01 and OAC users: hazard ratio, 0.59; 95% confidence interval, 0.35-0.93; P=0.03). The composite end point of stroke/systemic embolism/all-cause mortality was also lower in PAF, whether among OAC users (hazard ratio, 0.77; 95% confidence interval, 0.59-0.99; P=0.046) or non-OAC users (hazard ratio, 0.59; 95% confidence interval, 0.46-0.75; P<0.01). On multivariate analysis, PAF was an independent predictor of lower stroke/systemic embolism risk. CONCLUSIONS: In this large cohort of Japanese patients with AF, PAF was independently associated with lower incidence of stroke/systemic embolism than sustained AF. This may aid decision making for anticoagulation, especially in those patients with AF with few stroke risk factors. CLINICAL TRIAL REGISTRATION: URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000005834.
BACKGROUND AND PURPOSE: There is controversy on the relationship of the type of atrial fibrillation (AF) to stroke. Although several studies show that patients with paroxysmal AF (PAF) have a stroke risk similar to those with persistent or permanent AF, recent studies suggest that PAF is associated with a lower rate of stroke. Limited data on stroke risk associated with PAF are evident in Asian populations. METHODS: The Registry Study of Atrial FibrillationPatients in Fushimi-ku (Fushimi AF Registry) is a community-based survey of patients with AF in Fushimi-ku, Kyoto, Japan. Patients were categorized into 2 types of AF: PAF or sustained (persistent or permanent) AF. We compared clinical events between PAF (n=1588) and sustained AF (n=1716). RESULTS:Patients with PAF were younger, had less comorbidities, and received oral anticoagulants (OAC) less commonly. A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed (non-OAC users: hazard ratio, 0.45; 95% confidence intervals, 0.27-0.75; P<0.01 and OAC users: hazard ratio, 0.59; 95% confidence interval, 0.35-0.93; P=0.03). The composite end point of stroke/systemic embolism/all-cause mortality was also lower in PAF, whether among OAC users (hazard ratio, 0.77; 95% confidence interval, 0.59-0.99; P=0.046) or non-OAC users (hazard ratio, 0.59; 95% confidence interval, 0.46-0.75; P<0.01). On multivariate analysis, PAF was an independent predictor of lower stroke/systemic embolism risk. CONCLUSIONS: In this large cohort of Japanese patients with AF, PAF was independently associated with lower incidence of stroke/systemic embolism than sustained AF. This may aid decision making for anticoagulation, especially in those patients with AF with few stroke risk factors. CLINICAL TRIAL REGISTRATION: URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000005834.
Authors: Nathan E Wineinger; Paddy M Barrett; Yunyue Zhang; Ikram Irfanullah; Evan D Muse; Steven R Steinhubl; Eric J Topol Journal: Heart Rhythm Date: 2018-08-14 Impact factor: 6.343