Journal of Stroke & Cerebrovascular Diseases
Volume 18, Issue 6 , Pages 453-457, November 2009

Delayed Detection of Atrial Fibrillation after Ischemic Stroke

  • Hooman Kamel, MD

      Affiliations

    • Department of Neurology, University of California, San Francisco
    • ,
  • Kennedy R. Lees, MD

      Affiliations

    • Acute Stroke Unit, Gardiner Institute, Western Infirmary, Glasgow, United Kingdom
    • ,
  • Patrick D. Lyden, MD

      Affiliations

    • Departments of Neurology, San Diego Veterans Administration Medical Center, California
    • University of California, San Diego
    • ,
  • Philip A. Teal, MD

      Affiliations

    • Division of Neurology, University of British Columbia, Vancouver, Canada
    • ,
  • Ashfaq Shuaib, MD

      Affiliations

    • Division of Neurology, University of Alberta, Edmonton, Canada
    • ,
  • Myzoon Ali, MRes

      Affiliations

    • Acute Stroke Unit, Gardiner Institute, Western Infirmary, Glasgow, United Kingdom
    • ,
  • S. Claiborne Johnston, MD, PhD

      Affiliations

    • Department of Neurology, University of California, San Francisco
    • Corresponding Author InformationAddress correspondence to S. Claiborne Johnston, MD, PhD, 505 Parnassus Ave, Box 0114, San Francisco, CA 94143.
    • ,
  • Virtual International Stroke Trials Archive Investigators

Received 13 December 2008; received in revised form 26 January 2009; accepted 30 January 2009.

Background

Detection of atrial fibrillation (AF) after ischemic stroke is important because anticoagulation is indicated to reduce the risk of recurrent stroke. However, no consensus exists about the optimum method for detecting underlying paroxysmal AF not apparent on presentation with stroke. The aim of this study was to characterize the rate, timing, and predictors of delayed detection of AF after stroke.

Methods

The Virtual International Stroke Trials Archive provided data from 3464 patients in the placebo arms of 4 clinical trials of therapies for acute ischemic stroke. Patients who had AF by history or on the baseline electrocardiogram were excluded. Electrocardiograms were obtained routinely and as clinically indicated. The time to detection of AF was evaluated using Kaplan-Meier survival statistics. Cox proportional hazards analysis was used to evaluate risk factors for AF.

Results

Among 2504 qualifying patients, AF was detected in 174 (6.9%; 95% confidence interval [CI] 6.0%-8.0%). In 68% of patients, AF was detected more than 48 hours after presentation. Detection of AF was associated with increasing age (hazard ratio [HR] 1.6/decade; 95% CI 1.4-1.9; P < .005), female sex (HR 1.7; CI 1.2-2.4; P < .005), congestive heart failure (HR 1.9; CI 1.1-3.4; P = .02), and the absence of hypertension (HR 1.6; CI 1.1-2.2; P = .01).

Conclusions

Delayed detection of AF was common in this large cohort of patients carefully monitored after ischemic stroke. Current methods of screening may fail to detect underlying paroxysmal AF in a substantial proportion of patients.

Key Words: Stroke prevention, atrial fibrillation, diagnostic methods, cardiac embolism, electrocardiography

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 Supported by the Larry L. Hillblom Foundation.

PII: S1052-3057(09)00031-7

doi:10.1016/j.jstrokecerebrovasdis.2009.01.012

Journal of Stroke & Cerebrovascular Diseases
Volume 18, Issue 6 , Pages 453-457, November 2009

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