Atrial Fibrillation and Arterial Embolism in Hyperthyroidism

Abstract

Atrial fibrillation and arterial embolism in hyperthyroidism. D. M. Hurley, A . N. Hunter, M . J.Hewett a n d J. R . Stockigt, Aust. N.Z. J. Med., 1981, 11, pp 391-393. Atrial fibrillation or flutter was present in 70 of 381 patients with uncontrolled hyperthyroidism; return to stable sinus rhythm occurred in 39 with antithyroid and antiarrhythmic treatment. One third of the patients who reverted did so in the first week of treatment while still hyperthyroid. As expected, reversion was more likely in younger patients, and in those with arrhythmia of recent onset, without evidence of other heart disease. Eight patients with arrhythmia had proven (five) or probable (three) major arterial embolic episodes. Four of these eight patients died. Embolism tended to occur at'an early stage, during uncontrolled hyperthyroidism, in patients with both atrial fibrillation and cardiac failure. These findings suggest that prophylactic anticoagulation may be appropriate in this high risk group, although more extensive studies are necessary before effective prevention of embolism can be claimed.

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

“…891 Studies of patients with HCM and AF 892 have consistently reported a high incidence of stroke and systemic embo-lism. [871][872][873][874] These retrospective longitudinal studies report stroke or systemic embolism in 20% to 40% of patients with HCM and AF followed up for a mean of 4 to 11 y, for a thromboembolism rate of 2.4% to 7.1% per year. In addition to AF, other factors associated with systemic embolism in patients with HCM include advanced age, 874 hypertension, 872 mitral annular calcification, and LA enlargement.…”

Effect of Hyperthyroidism on the Hypercoagulable State and Thromboembolic Events in Patients with Atrial Fibrillation

“…Furthermore, Traube and Coplan [8] stated that HT has a huge impact on the formation of coagulation, and thus increases the incidence of ischemic stroke and contributes to a prothrombotic state among AF patients. A higher prevalence of embolic events in hyperthyroid patients with AF has been reported in several studies [7,9,10] but not in others [3,11]. Therefore, it remains unclear whether HT promotes an increase in embolic events in patients with AF.…”

Hyperthyroid Atrial Fibrillation: Does It Matter for Stroke Risk?

“…However, stroke risk among hyperthyroid AF patients remains controversial. Many reports indicate that hyperthyroidism alone is associated with an increased stroke risk, with a reported incidence ranging from 2.4 to 26.7% [6,7,8,9,10,11]. Furthermore, strokes have even been observed with sinus rhythm and in young adults with hyperthyroidism and no other risk factors [6,9,12].…”