Differences between Atrial Fibrillation Detected before and after Stroke and TIA: A Systematic Review and Meta-Analysis

Abstract

Background: Preliminary evidence suggests that patients with atrial fibrillation (AF) detected after stroke (AFDAS) may have a lower prevalence of cardiovascular comorbidities and lower risk of stroke recurrence than AF known before stroke (KAF). Objective: We performed a systematic search and meta-analysis to compare the characteristics of AFDAS and KAF. Methods: We searched PubMed, Scopus, and EMBASE for articles reporting differences between AFDAS and KAF until June 30, 2021. We performed random- or fixed-effects meta-analyses to evaluate differences between AFDAS and KAF in demographic factors, vascular risk factors, prevalent vascular comorbidities, structural heart disease, stroke severity, insular cortex involvement, stroke recurrence, and death. Results: In 21 studies including 22,566 patients with ischemic stroke or transient ischemic attack, the prevalence of coronary artery disease, congestive heart failure, prior myocardial infarction, and a history of cerebrovascular events was significantly lower in AFDAS than KAF. Left atrial size was smaller, and left ventricular ejection fraction was higher in AFDAS than KAF. The risk of recurrent stroke was 26% lower in AFDAS than in KAF. There were no differences in age, sex, stroke severity, or death rates between AFDAS and KAF. There were not enough studies to report differences in insular cortex involvement between AF types. Conclusions: We found significant differences in the prevalence of vascular comorbidities, structural heart disease, and stroke recurrence rates between AFDAS and KAF, suggesting that they constitute different clinical entities within the AF spectrum. PROSPERO registration number is CRD42020202622.

Atrial Fibrillation Detected After Stroke and Transient Ischemic Attack: A Novel Clinical Concept Challenging Current Views

“…17 A, Proportions of heart rhythms among patients with ischemic stroke. B, Characteristics and outcomes of atrial fibrillation detected after stroke (AFDAS) relative to known atrial fibrillation before stroke (KAF), *Charts were created from estimates from the meta-analysis of Fridman et al 19 Percentages are derived from odds ratios (ORs) for dichotomic variables and standardized mean differences (SMD) for continuous variables evaluating the association between patients characteristics or outcomes and AFDAS relative to KAF. †Estimates for insular cortex involvement were not available.…”

“…The risk of death in patients with AFDAS is similar to KAF, as shown in a meta-analysis of 7 studies and 9246 patients (odds ratio, 0.87 [95% CI, 0.56-1.37]). 19 We performed an ad-hoc meta-analysis including 3 studies and 4040 patients to compare the risk of death between AFDAS and no-AF (Supplemental Methods). We found a 60% higher risk of death in AFDAS relative to no-AF (HR, 1.60 [95% CI, 1.38−1.85]; Figure 3B).…”

Prolonged Cardiac Monitoring for Atrial Fibrillation Detection After Stroke

“…7 This is compounded by the knowledge that AF detected after stroke (AFDAS) represents a relatively mild AF phenotype compared to AF known before stroke occurrence (KAF). 8 Those with AFDAS have a lower CHA 2 DS 2 -VASc score, fewer cardiovascular comorbid conditions (e.g., coronary artery disease, heart failure, and history of cerebrovascular events), less severe atrial cardiopathy (e.g., smaller left atrium), and 26% lower adjusted stroke recurrent rates (odds ratio 074, 95% CI 0.58–0.95) than individuals with KAF. 8 This benign AFDAS phenotype may also be explained by stroke-related neurogenic mechanisms triggering brief and typically self-limited AF paroxysms in patients with relatively healthy hearts.…”

Sex Hormone-Specific Neuroanatomy of Takotsubo Syndrome: Is the Insular Cortex a Moderator?

“…The main objective of an ongoing systematic review [ 61 ] is to compare the proportions of stroke involving Ic, recurrent stroke, and deaths in patient groups with no AF, KAF, and AFDAS. However, in that systematic review, sufficient data has not yet been obtained to determine whether there are significant differences in stroke involving the Ic among no AF, KAF, and AFDAS [ 62 ].…”