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PLoS One. 2016 Dec 9;11(12):e0168010. doi: 10.1371/journal.pone.0168010. eCollection 2016.

Stroke as the First Manifestation of Atrial Fibrillation.

Author information

1
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
2
Department of Medicine, Keski-Suomi Central Hospital, Jyväskylä, Finland.
3
Heart Center, Kuopio University Hospital, Kuopio, Finland.
4
Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland.
5
Division of Medicine, Department of Acute Internal Medicine, Turku University Hospital, Turku, Finland.
6
Heart Center, Satakunta Central Hospital, Pori, Finland.

Abstract

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.

PMID:
27936187
PMCID:
PMC5148080
DOI:
10.1371/journal.pone.0168010
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

the authors of this manuscript have the following competing interests: Pirjo Mustonen received lecture fees from Orion, Boehringer Ingelheim, Bayer, Pfizer, Bristol-Myers Squibb, Sanofi-Aventis and Leo Pharma, and membership of the advisory boards for Boehringer Ingelheim, Bayer, Pfizer, Bristol-Myers Squibb and Leo Pharma. Tuomas Kiviniemi received grants from the Finnish Foundation for Cardiovascular Research, and lectures fees from Bayer, Boehringer Ingelheim, BMS/Pfizer, AstraZeneca and St Jude Medical. K.E. Juhani Airaksinen received grants from the Finnish Foundation for Cardiovascular Research, and lecture fees from Astra Zeneca, Boehringer Ingelheim, Cardiome, MSD, Novartis and Pfizer. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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