High maintenance rate of sinus rhythm after cardioversion in post-thyrotoxic chronic atrial fibrillation

Nakazawa, Hiroe; Handa, Shunnosuke; Nakamura, Yoshiro; Oyanagi, Hiroshi; Hasegawa, Makoto; Ishikawa, Naofumi; Ozaki, Osamu; Ito, Kunihiko

doi:10.1016/0167-5273(87)90269-5

Cited by 12 publications

(6 citation statements)

References 16 publications

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“…In terms of ischemic stroke and thromboembolic event risk stratification, according to CHA 2 DS 2 -VASc score, the incidence rates in the HT AF group were significantly lower in those with a CHA 2 DS 2 -VASc score of ≤ 4 but comparable to those with a CHA 2 DS 2 -VASc score ≥ 5 in the non-thyroid AF group. Atrial fibrillation in patients with clinical hyperthyroidism is often considered as reversible, with a high sinus rhythm maintenance rate after the restoration of thyroid function compared to those with non-hyperthyroid AF [11,16,17]. Thyroid hormone increases automaticity and enhances triggered activity of the cardiomyocytes of pulmonary veins, and this may increase the arrhythmogenic activity of pulmonary veins and thus induce the occurrence of AF [18].…”

Section: Discussionmentioning

confidence: 99%

“…Thyroid hormone increases automaticity and enhances triggered activity of the cardiomyocytes of pulmonary veins, and this may increase the arrhythmogenic activity of pulmonary veins and thus induce the occurrence of AF [18]. This hinted at a lower burden of AF in patients with hyperthyroidism when the thyroid is in a euthyroid status [11]. In terms of burden of AF, it was reported to have high correlation with thromboembolic event from patients with cardiac implanted electronic devices implantation [19].…”

Section: Discussionmentioning

confidence: 99%

“…However, there are currently no recommendations focusing on AF patients with clinical hyperthyroidism (HT AF) [8]. In addition, AF related to hyperthyroidism is sometimes considered to be reversible atrial tachyarrhythmia due to the high maintenance rate of sinus rhythm after controlling thyroid hormone [11], and because hypercoagulable and endothelial function can also be improved after correcting hyperthyroidism [6]. Moreover, better adherence to antithyroid drugs was reported to result in a lower risk of stroke in patients with hyperthyroidism in a national cohort study [12].…”

Section: Introductionmentioning

confidence: 99%

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Risk of Thromboembolism in Non-Valvular Atrial Fibrillation With or Without Clinical Hyperthyroidism

Lin

Tsai

Lin

et al. 2021

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Background: Patients with hyperthyroidism have higher risk of atrial fibrillation (AF). However, the risk of thromboembolic event in patients with hyperthyroidism-related AF is controversial. Objectives: The aim of the study was to examine the risk of thromboembolic events in AF patients with/without hyperthyroidism. Methods: The national retrospective cohort study enrolled AF population was derived from the Taiwan National Health Insurance Research Database. The comparison between the AF patients with clinical hyperthyroidism (HT-AF group) and AF patients without hyperthyroidism (nonthyroid AF group) was made in a propensity score matched cohort and in a real-world setting, of which, the CHA 2 DS 2 -VASc level was treated as a stratum variable. The outcomes were ischemic stroke and systemic thromboembolism. Results: There were 3,880 patients in HT AF group and 178,711 in non-thyroid AF group. After propensity score analysis, the incidence of thromboembolism event and ischemic stroke were lower in HT AF patients than non-thyroid AF patients (1.6 versus 2.2 events per 100 personyears; HR, 0.73; 95% CI, 0.64-0.82 and 1.4 versus 1.8 events per 100 person-years; HR, 0.74; 95% CI, 0.64-0.84, respectively) in the 4.3 ± 3.2 year follow up period. The differences persistently existed in those receiving anticoagulants or not. In AF patients without anticoagulants, the incidence densities of ischemic stroke/systemic thromboembolism were significantly lower in HT AF group than those in non-thyroid AF group at CHA 2 DS 2 -VASc scores ≤ 4 (HR, 0.41; 95% CI, 0.35-0.48, p < 0.001), while the differences disappeared in case of score ≥ 5 (HR, 0.80; 95% CI, 0.63-1.02, p = 0.071). Conclusion:Patients with HT AF had lower incidence of thromboembolic events as compared to non-thyroid AF patients. The threshold of CHA 2 DS 2 -VASc score for anticoagulation in AF patients with clinical hyperthyroidism should be further evaluated. Highlights• The incidence of thromboembolic event was different between hyperthyroidism-related atrial fibrillation (HT-AF) and non-thyroid AF patients. • Hyperthyroidism did not confer additional risk of thromboembolic event at CHA 2 DS 2 -VASc of ≤ 4. • The benefit of anticoagulation strategy in patients with hyperthyroidism-related AF should be further evaluated, especially at low CHA 2 DS 2 -VASc score.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of Thromboembolism in Non-Valvular Atrial Fibrillation With or Without Clinical Hyperthyroidism

Lin

Tsai

Lin

et al. 2021

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“…Randomized controlled trials have demonstrated the benefits of long‐term warfarin therapy over placebo in reducing AF‐related ischemic stroke . Atrial fibrillation in the presence of hyperthyroidism is often regarded as reversible, and recurrence following normalization of thyroid status is considered less likely in contrast to nonthyroid AF . Long‐term anticoagulation may thus be deemed unnecessary.…”

Section: Discussionmentioning

confidence: 99%

“…In most observational reports, contemporary ischemic stroke risk‐stratification schemes such as CHADS 2 (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke) and CHA 2 DS 2 ‐VASc scores have seldom been utilized . Second, hyperthyroidism is often regarded as a reversible cause of AF; AF recurrence following normalization of thyroid status is considered less likely in contrast to nonthyroid AF, thus long‐term anticoagulation may be deemed unnecessary. Nonetheless, randomized controlled trials that target specifically patients with hyperthyroidism‐related AF are lacking.…”

Section: Introductionmentioning

confidence: 99%

Benefit of Anticoagulation Therapy in Hyperthyroidism‐Related Atrial Fibrillation

Chan

Hai

Yeung

et al. 2015

Clinical Cardiology

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Background: Existing data on the risk of ischemic stroke in hyperthyroidism-related atrial fibrillation (AF) and the impact of long-term anticoagulation in these patients, particularly those with self-limiting AF, remain inconclusive. Hypothesis: Risk of stroke in hyperthyroidism-related AF is the same as nonhyperthyroid counterparts. Methods: This was a single-center observational study of 9727 Chinese patients with nonvalvular AF from July 1997 to December 2011. Patients with AF diagnosed concomitantly with hyperthyroidism were identified. Primary and secondary endpoints were defined as hospitalization with ischemic stroke and intracranial hemorrhage in the first 2 years. Patient characteristics, duration of AF, and choice of antithrombotic therapy were recorded. Self-limiting AF was defined as <7 days' duration. Results: Out of 9727 patients, 642 (6.6%) had concomitant hyperthyroidism and AF at diagnosis. For stroke prevention, 136 and 243 patients (21.1% and 37.9%) were prescribed warfarin and aspirin, respectively, whereas the remaining patients (41.0%) received no therapy. Ischemic stroke occurred in 50 patients (7.8%), and no patient developed hemorrhagic stroke. Patients with CHA 2 DS 2 -VASc of 0 did not develop stroke. Warfarin effectively reduced the incidence of stroke compared with aspirin or no therapy in patients with CHA 2 DS 2 -VASc ≥1 and non-self-limiting AF, but not in those with self-limiting AF or CHA 2 DS 2 -VASc of 0. Presence of hyperthyroidism did not confer additional risk of ischemic stroke compared with nonhyperthyroid AF. Conclusions: Patients with hyperthyroidism-related AF are at high risk of stroke (3.9% per year). Warfarin confers stroke prevention in patients with CHA 2 DS 2 -VASc ≥1 and non-self-limiting AF. Overall stroke risk was lower in hyperthyroid non-self-limiting AF patients compared with nonhyperthyroid counterparts.

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Elektrische Therapie von Vorhofflimmern und Vorhofflattern

Fach

Heuberger

1994

Vorhofflimmern

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High maintenance rate of sinus rhythm after cardioversion in post-thyrotoxic chronic atrial fibrillation

Cited by 12 publications

References 16 publications

Risk of Thromboembolism in Non-Valvular Atrial Fibrillation With or Without Clinical Hyperthyroidism

Risk of Thromboembolism in Non-Valvular Atrial Fibrillation With or Without Clinical Hyperthyroidism

Benefit of Anticoagulation Therapy in Hyperthyroidism‐Related Atrial Fibrillation

Elektrische Therapie von Vorhofflimmern und Vorhofflattern

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