Strokes after cardioversion of atrial fibrillation — The FibStroke study

Palomäki, Antti; Mustonen, Pirjo; Hartikainen, Juha; Nuotio, Ilpo; Kiviniemi, Tuomas; Ylitalo, Antti; Hartikainen, Päivi; Lehtola, Heidi; Luite, Riho; Airaksinen, Juhani

doi:10.1016/j.ijcard.2015.10.168

Cited by 34 publications

(30 citation statements)

References 20 publications

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“…The FinCV2 study ([http://www.ClinicalTrials.gov], identifier NCT02850679) is part of a wider protocol in progress to assess thrombotic and bleeding complications of AF in Finland [7, 8]. …”

Section: Methodsmentioning

confidence: 99%

Prediction of ineffective elective cardioversion of atrial fibrillation: a retrospective multi-center patient cohort study

Hellman

Kiviniemi

Vasankari

et al. 2017

BMC Cardiovasc Disord

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BackgroundElective cardioversion (ECV) of atrial fibrillation (AF) is a standard procedure to restore sinus rhythm. However, predictors for ineffective ECV (failure of ECV or recurrence of AF within 30 days) are unknown.MethodsWe investigated 1998 ECVs performed for AF lasting >48 h in 1,342 patients in a retrospective multi-center study. Follow-up data were collected from 30 days after ECV.ResultsMedian number of cardioversions was one per patient with a range of 1–10. Altogether 303/1998 (15.2%) ECVs failed. Long (>5 years) AF history and over 30 days duration of the index AF episode were independent predictors for ECV failure and low (<60/min) ventricular rate of AF predicted success of ECV. In patients with successful ECVs an early recurrence of AF was detected in 549 (32.4%) cases. Female gender, high (>60/min) ventricular rate, renal failure and antiarrhythmic agents at discharge were the independent predictors for recurrence. In total ECV was ineffective in 852 (42.6%) cases. Female gender (OR 1.44, CI95% 1.15–1.80, p < 0.01), young (<65 years) age (OR 1.31, CI95% 1.07–1.62, p = 0.01), ventricular rate >60/min (OR 1.92, CI95% 1.08–3.41, p = 0.03), antiarrhythmic medication at discharge (OR 1.48, CI95% 1.14–1.93, p < 0.01) and low (<60/ml/min) estimated glomerular filtration rate (OR 1.59, CI95% 1.08–2.33, p = 0.02) were predictors of ineffective ECV.ConclusionsFemale gender, use of antiarrhythmic drug therapy and renal failure predicted both recurrence of AF and the composite end point. For the first time in a large real-life study several clinical predictors for clinically ineffective ECV were identified.

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Section: Methodsmentioning

confidence: 99%

Prediction of ineffective elective cardioversion of atrial fibrillation: a retrospective multi-center patient cohort study

Hellman

Kiviniemi

Vasankari

et al. 2017

BMC Cardiovasc Disord

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“…The Excessive Warfarin Anticoagulation (EWA) study (ClinicalTrials.gov Identifier: NCT02761941) is part of a series of research projects addressing anticoagulation and complications related to AF [8, 9]. In this study, we screened with computer searches all INR results between the years 2003 and 2015 from the laboratory database provided by Turku University Hospital laboratory service (TYKSLAB).…”

Section: Methodsmentioning

confidence: 99%

Incidence and predictors of excessive warfarin anticoagulation in patients with atrial fibrillation—The EWA study

et al. 2017

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Vitamin K antagonist warfarin is widely used in clinical practice and excessive anticoagulation is a well-known complication of this therapy. Little is known about permanent and temporary predictors for severe overanticoagulation. The aim of this study was to investigate the occurrence and predicting factors for episodes with very high (≥9) international normalized ratio (INR) values in warfarin treated patients with atrial fibrillation (AF). Excessive Warfarin Anticoagulation (EWA) study screened all patients (n = 13618) in the Turku University Hospital region with an INR ≥2 between years 2003–2015. Patients using warfarin anticoagulation for AF with very high (≥9) INR values (EWA Group) were identified (n = 412 patients) and their characteristics were compared to a control group (n = 405) of AF patients with stable INR during long-term follow-up. Over 20% (n = 92) of the EWA patients had more than one event of very high INR and in 105 (25.5%) patients EWA led to a bleeding event. Of the several temporary and permanent EWA risk factors observed, strongest were excessive alcohol consumption in 9.6% of patients (OR 24.4, 95% CI 9.9–50.4, p<0.0001) and reduced renal function (OR 15.2, 95% CI 5.67–40.7, p<0.0001). Recent antibiotic or antifungal medication, recent hospitalization or outpatient clinic visit and the first 6 months of warfarin use were the most significant temporary risk factors for EWA. Excessive warfarin anticoagulation can be predicted with several permanent and temporary clinical risk factors, many of which are modifiable.

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“…This study is a pre-specified analysis of the multicenter retrospective FibStroke Study (ClinicalTrials.gov Identifier: NCT02146040) assessing thromboembolic complications and intracranial hemorrhages in patients with AF[9–10]. It is also a part of ongoing wider protocol in Western Finland to evaluate thromboembolic and bleeding complications of AF[11–13].…”

Section: Methodsmentioning

confidence: 99%

Stroke as the First Manifestation of Atrial Fibrillation

et al. 2016

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Atrial fibrillation may remain undiagnosed until an ischemic stroke occurs. In this retrospective cohort study we assessed the prevalence of ischemic stroke or transient ischemic attack as the first manifestation of atrial fibrillation in 3,623 patients treated for their first ever stroke or transient ischemic attack during 2003–2012. Two groups were formed: patients with a history of atrial fibrillation and patients with new atrial fibrillation diagnosed during hospitalization for stroke or transient ischemic attack. A control group of 781 patients with intracranial hemorrhage was compiled similarly to explore causality between new atrial fibrillation and stroke. The median age of the patients was 78.3 [13.0] years and 2,009 (55.5%) were women. New atrial fibrillation was diagnosed in 753 (20.8%) patients with stroke or transient ischemic attack, compared to 15 (1.9%) with intracranial hemorrhage. Younger age and no history of coronary artery disease or other vascular diseases, heart failure, or hypertension were the independent predictors of new atrial fibrillation detected concomitantly with an ischemic event. Thus, ischemic stroke was the first clinical manifestation of atrial fibrillation in 37% of younger (<75 years) patients with no history of cardiovascular diseases. In conclusion, atrial fibrillation is too often diagnosed only after an ischemic stroke has occurred, especially in middle-aged healthy individuals. New atrial fibrillation seems to be predominantly the cause of the ischemic stroke and not triggered by the acute cerebrovascular event.

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Strokes after cardioversion of atrial fibrillation — The FibStroke study

Cited by 34 publications

References 20 publications

Prediction of ineffective elective cardioversion of atrial fibrillation: a retrospective multi-center patient cohort study

Prediction of ineffective elective cardioversion of atrial fibrillation: a retrospective multi-center patient cohort study

Incidence and predictors of excessive warfarin anticoagulation in patients with atrial fibrillation—The EWA study

Stroke as the First Manifestation of Atrial Fibrillation

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