Antti Palomäki1, Pirjo Mustonen2, Juha E K Hartikainen3, Ilpo Nuotio4, Tuomas Kiviniemi5, Antti Ylitalo6, Päivi Hartikainen7, Heidi Lehtola8, Riho Luite9, K E Juhani Airaksinen10. 1. Heart Center, Turku University Hospital, University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland. Electronic address: ajpalo@utu.fi. 2. Department of Medicine, Keski-Suomi Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland. Electronic address: pirjo.mustonen@ksshp.fi. 3. Heart Center, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland. Electronic address: juha.hartikainen@kuh.fi. 4. Department of Medicine, Turku University Hospital,University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland. Electronic address: ilpo.nuotio@tyks.fi. 5. Heart Center, Turku University Hospital, University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland. Electronic address: tuoski@utu.fi. 6. Heart Center, Satakunta Central Hospital, Sairaalantie 3, 28500 Pori, Finland. Electronic address: antti.ylitalo@dnainternet.net. 7. NeuroCenter, Neurology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland. Electronic address: paivi.hartikainen@kuh.fi. 8. Department of Medicine, Keski-Suomi Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland. Electronic address: heidi.lehtola@ksshp.fi. 9. Heart Center, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland. Electronic address: riho.luite@kuh.fi. 10. Heart Center, Turku University Hospital, University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland. Electronic address: juhani.airaksinen@tyks.fi.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: FibStroke is a cross-sectional observational multicenter registry that included AFpatients with an ischemic stroke or intracranial bleed identified from a discharge registry of four Finnish hospitals. In total 3677 consecutive AFpatients 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Antti Palomäki; Tuomas Kiviniemi; Juha E K Hartikainen; Pirjo Mustonen; Antti Ylitalo; Ilpo Nuotio; Päivi Hartikainen; Jussi Jaakkola; Riho Luite; K E Juhani Airaksinen Journal: Clin Cardiol Date: 2016-05-30 Impact factor: 2.882
Authors: Jussi Jaakkola; Pirjo Mustonen; Tuomas Kiviniemi; Juha E K Hartikainen; Antti Palomäki; Päivi Hartikainen; Ilpo Nuotio; Antti Ylitalo; K E Juhani Airaksinen Journal: PLoS One Date: 2016-12-09 Impact factor: 3.240
Authors: Tapio Hellman; Tuomas Kiviniemi; Tuija Vasankari; Ilpo Nuotio; Fausto Biancari; Aissa Bah; Juha Hartikainen; Marianne Mäkäräinen; K E Juhani Airaksinen Journal: BMC Cardiovasc Disord Date: 2017-01-18 Impact factor: 2.298
Authors: Samuli Jaakkola; Ilpo Nuotio; Tuomas O Kiviniemi; Raine Virtanen; Melina Issakoff; K E Juhani Airaksinen Journal: PLoS One Date: 2017-04-20 Impact factor: 3.240
Authors: Jussi Jaakkola; Päivi Hartikainen; Tuomas O Kiviniemi; Ilpo Nuotio; Antti Palomäki; Juha E K Hartikainen; Antti Ylitalo; Pirjo Mustonen; K E Juhani Airaksinen Journal: Neurol Clin Pract Date: 2019-08