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Strokes after cardioversion more frequent in patients with AF not on anticoagulation
A prespecified analysis of the FibStroke study showed cardioversion plays a key role in strokes among patients with paroxysmal or persistent atrial fibrillation, according to results published in the International Journal of Cardiology.
“Every 16th stroke of patients with paroxysmal or persistent AF is preceded by a cardioversion of AF,” the researchers wrote. “A majority of strokes occur in patients not using oral anticoagulation before cardioversion of acute AF and typically 2 to 3 days after successful cardioversion.”
Antti Palomäki, MD, of the Heart Center at Turku University Hospital in Finland, and colleagues set out to assess the characteristics of cardioversions leading to stroke or transient ischemic attack using data from the cross-sectional, observational, multicenter registry.
FibStroke included patients with AF who experienced an ischemic stroke or intracranial bleed, identified between 2003 and 2012 through a discharge registry of four hospitals in Finland. Overall, 3,677 patients had 3,252 strokes and 956 TIAs; however, the analysis concentrated on 1,644 events in patients who had paroxysmal or persistent AF at the time of stroke or TIA.
The investigators found cardioversion preceded 78 strokes and 22 TIAs. Further, in patients with paroxysmal or persistent AF, 6.4% of strokes occurred after cardioversion. Of the cardioversions precipitating an ischemic event, 77 were acute and 23 were elective.
Additionally, the investigators found 63 events occurred in patients not on anticoagulation, with five patients exhibiting an international normalized ratio of less than 2 periprocedurally, and 21 patients were at low risk for stroke (CHA2DS2-VASc score < 2).
On average, the delay was 2 days from cardioversion to event. Nine patients who experienced a stroke after unsuccessful cardioversion had a spontaneous cardioversion before the event.
“A significant proportion of the strokes was observed in relatively young patients with a low
CHA2DS2-VASc score, supporting the view that at least short-term anticoagulation should always be considered after cardioversion,” the researchers wrote. “Additional research is, however, needed to improve the safety of rhythm strategy in the treatment of AF.” – by Allegra Tiver
Disclosure: Palomäki reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.