The Mechanism of and Preventive Therapy for Stroke in Patients with Atrial Fibrillation

Kim, Young Hoon; Roh, Seung Young

doi:10.5853/jos.2016.00234

Cited by 24 publications

(19 citation statements)

References 83 publications

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“…Furthermore, several reports have shown that neither CHA 2 DS 2 ‐VASc score nor AF recurrence is a consistent predictor of the occurrence of ES after AF ablation therapy . Our results support this finding which might imply the existence of some other factors contributing to the occurrence of ES, which could not be explained clinically.…”

Section: Discussionsupporting

confidence: 82%

Association between epicardial adipose tissue and embolic stroke after catheter ablation of atrial fibrillation

Ahn

Shin

Shim

et al. 2019

Cardiovasc electrophysiol

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Introduction Risk factors of embolic stroke (ES) after atrial fibrillation (AF) ablation have not been fully elucidated especially among the Asian subjects, particularly regarding epicardial adipose tissue (EAT) in cardiac imaging. We aimed to assess the incidence of ES during a long‐term follow‐up period after AF ablation and to identify the risk factors associated with postablation ES, specifically focusing on EAT. Methods and Results We enrolled patients who experienced postablation ES and control subjects from a consortium of AF ablation registries from three institutes in Korea. EAT was assessed using multislice computed tomography before AF ablation. A total of 3464 patients who underwent AF ablation were recruited and followed‐up. During a follow‐up of 47.2 ± 36.4 months, ES occurred in 47 patients (1.36%) with a CHA2DS2‐VASc score of 1.48 ± 1.39 and the overall annual incidence of ES was 0.34%. Compared with the control group (n = 190), the ES group showed significantly higher prior thromboembolism (TE) and AF recurrence rates, larger left atrium size, lower creatinine clearance rate (CCr), and greater total and peri‐atrial EAT volume. Multivariate regression analysis demonstrated larger peri‐atrial EAT volume (hazards ratio, 1.065; 95% confidence interval, 1.005‐1.128), in addition to a prior history of TE and lower CCr, was independently associated with postablation ES. When a cut‐off value of peri‐atrial EAT volume of ≥20.15 mL was applied, patients with smaller peri‐atrial EAT volume showed significantly higher ES‐free survival. Conclusion Larger peri‐atrial EAT volume, in addition to prior TE and lower CCr, was independently associated with postablation ES regardless of AF recurrence and CHA2DS2‐VASc score. (ClinicalTrials.gov number, NCT03479073).

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Section: Discussionsupporting

confidence: 82%

Association between epicardial adipose tissue and embolic stroke after catheter ablation of atrial fibrillation

Ahn

Shin

Shim

et al. 2019

Cardiovasc electrophysiol

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“…Embolism of cardiac origin causes up to 25% of all ischaemic strokes55, through contractile dysfunction, structural remodelling, cardiopathy and stasis, increasing the risk of thromboembolism. Simultaneously, AF increases risk of large artery atherosclerosis, ventricular systolic dysfunction and in — situ small — vessel occlusion56,57. The prevalence of AF is generally low but increases with age58,59.…”

Section: Discussionmentioning

confidence: 99%

Pattern of stroke in a rural Kenyan hospital

et al. 2019

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Background The pattern of stroke in rural population differs from that in urban ones. Although there are many studies on this condition in sub-Saharan Africa, few studies about stroke pattern in a Kenyan rural area exist.. This study therefore aims at describing the characteristics of stroke in a rural Kenyan hospital. Patients and Methods The study was conducted on 227 consecutive patients admitted with a World Health Organization (WHO) diagnosis of stroke in Kangundo Hospital, a level IV facility in Machakos, Eastern Kenya, between April 2015 and September 2016. The sub-type and anatomical distribution of stroke as well as the age, gender of the patients were recorded prospectively. Diagnosis was made through physical neurological examination and confirmed by Computerized Tomography (CT) scan imaging. Only those with complete bio-data, past medical and social history, clinical and physical findings of the patients and imaging results were included. The data were entered into a pre-formatted questionnaire, analysed for means, standard deviations and frequencies, and are presented in tables and bar charts. Results Out of 3200 medical admissions, 227 (7.09%) had a confirmed diagnosis of stroke. Ischaemic stroke was more common (67.4%) than haemorrhagic stroke (32.6%). It affected mainly the anterior circulation, especially the middle cerebral artery (39%). The mean age of patients was 68.8 years, (Range 32–96). It was more common in females (62%) than in males (38%). Hypertension was the most common (74%) risk factor followed by alcohol abuse (63%), tobacco smoking (48%) and diabetes mellitus (42%). Conclusion Ischaemic stroke was the more common major cause of morbidity in the rural hospital studied in Kenya. It occurred most commonly among elderly females, with the most frequent comorbidities being hypertension. In addition, modifiable lifestyle factors like alcohol abuse and cigarette smoking contributed to the prevalence; hence we recommend the control of blood pressure and glucose as well as lifestyle modification to reduce the scourge in our studied population.

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“…Thromboembolic risk is linked to different pathophysiological mechanisms, including hemodynamic dysfunction and modifications of hemostatic parameters. Hemodynamic problems are most often due to modifications of blood flow in the left atrium (with the loss of atrial contraction and atrio-ventricular synchronization), atrial tissue remodeling and inflammation processes [5]. Among hemostatic parameters, platelets are important players.…”

Section: Introductionmentioning

confidence: 99%

Platelet function and microparticle levels in atrial fibrillation: Changes during the acute episode

Pourtau

Sellal

Lacroix

et al. 2017

International Journal of Cardiology

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Acute episodes of AF results in a decrease in MPs-associated tissue factor activity, possibly corresponding to consumption, which in turn favors coagulation and the local production of thrombin. A decreased platelet basal aggregation to TRAP may result from PAR1 desensitization, whereas the improved response after an induced episode of AF suggests activation of coagulation and PAR1 re-sensitization.

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The Mechanism of and Preventive Therapy for Stroke in Patients with Atrial Fibrillation

Cited by 24 publications

References 83 publications

Association between epicardial adipose tissue and embolic stroke after catheter ablation of atrial fibrillation

Association between epicardial adipose tissue and embolic stroke after catheter ablation of atrial fibrillation

Pattern of stroke in a rural Kenyan hospital

Platelet function and microparticle levels in atrial fibrillation: Changes during the acute episode

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