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Pendlebury ST. Direct Oral Anticoagulants and Prevention of Dementia in Nonvalvular Atrial Fibrillation. Stroke 2021; 52:3469-3471. [PMID: 34496623 DOI: 10.1161/strokeaha.121.035664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. NIHR Biomedical Research Centre, Departments of Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust, United Kingdom
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2
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Abstract
The past 3 decades have been characterized by an exponential growth in knowledge and advances in the clinical treatment of atrial fibrillation (AF). It is now known that AF genesis requires a vulnerable atrial substrate and that the formation and composition of this substrate may vary depending on comorbid conditions, genetics, sex, and other factors. Population-based studies have identified numerous factors that modify the atrial substrate and increase AF susceptibility. To date, genetic studies have reported 17 independent signals for AF at 14 genomic regions. Studies have established that advanced age, male sex, and European ancestry are prominent AF risk factors. Other modifiable risk factors include sedentary lifestyle, smoking, obesity, diabetes mellitus, obstructive sleep apnea, and elevated blood pressure predispose to AF, and each factor has been shown to induce structural and electric remodeling of the atria. Both heart failure and myocardial infarction increase risk of AF and vice versa creating a feed-forward loop that increases mortality. Other cardiovascular outcomes attributed to AF, including stroke and thromboembolism, are well established, and epidemiology studies have championed therapeutics that mitigate these adverse outcomes. However, the role of anticoagulation for preventing dementia attributed to AF is less established. Our review is a comprehensive examination of the epidemiological data associating unmodifiable and modifiable risk factors for AF and of the pathophysiological evidence supporting the mechanistic link between each risk factor and AF genesis. Our review also critically examines the epidemiological data on clinical outcomes attributed to AF and summarizes current evidence linking each outcome with AF.
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Affiliation(s)
- Laila Staerk
- Cardiovascular Research Centre, Herlev and Gentofte University Hospital, Copenhagen, Denmark
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
- Boston University and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, United States
| | - Jason A. Sherer
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Darae Ko
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, United States
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Emelia J. Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
- Boston University and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, United States
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, United States
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
- Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Robert H. Helm
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
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Kim YH, Roh SY. The Mechanism of and Preventive Therapy for Stroke in Patients with Atrial Fibrillation. J Stroke 2016; 18:129-37. [PMID: 27283277 PMCID: PMC4901955 DOI: 10.5853/jos.2016.00234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 01/05/2023] Open
Abstract
Atrial fibrillation is a major cardiac cause of stroke, and a pathogenesis involving thrombus formation in patients with atrial fibrillation is well established. A strategy for rhythm control that involves catheter ablation and anticoagulation therapy is evolving. A strategy for rhythm control that restores and maintains sinus rhythm should reduce the risk of ischemic stroke that is associated with atrial fibrillation; however, this is yet to be proven in large-scale randomized controlled trials. This paper reviews the emerging role of rhythm control therapy for atrial fibrillation to prevent stroke.
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Affiliation(s)
- Young-Hoon Kim
- Cardiology Division, Korea University Medical Center, Seoul, Korea
| | - Seung-Young Roh
- Cardiology Division, Korea University Medical Center, Seoul, Korea
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4
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Hahne K, Mönnig G, Samol A. Atrial fibrillation and silent stroke: links, risks, and challenges. Vasc Health Risk Manag 2016; 12:65-74. [PMID: 27022272 PMCID: PMC4788372 DOI: 10.2147/vhrm.s81807] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, with a projected number of 1 million affected subjects in Germany. Changes in age structure of the Western population allow for the assumption that the number of concerned people is going to be doubled, maybe tripled, by the year 2050. Large epidemiological investigations showed that AF leads to a significant increase in mortality and morbidity. Approximately one-third of all strokes are caused by AF and, due to thromboembolic cause, these strokes are often more severe than those caused by other etiologies. Silent brain infarction is defined as the presence of cerebral infarction in the absence of corresponding clinical symptomatology. Progress in imaging technology simplifies diagnostic procedures of these lesions and leads to a large amount of diagnosed lesions, but there is still no final conclusion about frequency, risk factors, and clinical relevance of these infarctions. The prevalence of silent strokes in patients with AF is higher compared to patients without AF, and several studies reported high incidence rates of silent strokes after AF ablation procedures. While treatment strategies to prevent clinically apparent strokes in patients with AF are well investigated, the role of anticoagulatory treatment for prevention of silent infarctions is unclear. This paper summarizes developments in diagnosis of silent brain infarction and its context to AF.
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Affiliation(s)
- Kathrin Hahne
- Division of Cardiology, University Hospital Münster, Münster, Germany
| | - Gerold Mönnig
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Alexander Samol
- Division of Cardiology, University Hospital Münster, Münster, Germany
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5
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Long-term oral anticoagulation for patients after successful catheter ablation of atrial fibrillation. Curr Opin Cardiol 2015; 30:1-7. [DOI: 10.1097/hco.0000000000000121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Kalantarian S, Ay H, Gollub RL, Lee H, Retzepi K, Mansour M, Ruskin JN. Association between atrial fibrillation and silent cerebral infarctions: a systematic review and meta-analysis. Ann Intern Med 2014; 161:650-8. [PMID: 25364886 PMCID: PMC5578742 DOI: 10.7326/m14-0538] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a common cause of stroke. Silent cerebral infarctions (SCIs) are known to occur in the presence and absence of AF, but the association between these disorders has not been well-defined. PURPOSE To estimate the association between AF and SCIs and the prevalence of SCIs in stroke-free patients with AF. DATA SOURCES Searches of MEDLINE, PsycINFO, Cochrane Library, CINAHL, and EMBASE from inception to 8 May 2014 without language restrictions and manual screening of article references. STUDY SELECTION Observational studies involving adults with AF and no clinical history of stroke or prosthetic valves who reported SCIs. DATA EXTRACTION Study characteristics and study quality were assessed in duplicate. DATA SYNTHESIS Eleven studies including 5317 patients with mean ages from 50.0 to 83.6 years reported on the association between AF and SCIs. Autopsy studies were heterogeneous and low-quality; therefore, they were excluded from the meta-analysis of the risk estimates. When computed tomography (CT) and magnetic resonance imaging (MRI) studies were combined, AF was associated with SCIs in patients with no history of symptomatic stroke (odds ratio, 2.62 [95% CI, 1.81 to 3.80]; I(2) = 32.12%; P for heterogeneity = 0.118). This association was independent of AF type (paroxysmal vs. persistent). The results were not altered significantly when the analysis was restricted to studies that met at least 70% of the maximum possible quality score (odds ratio, 3.06 [CI, 2.24 to 4.19]). Seventeen studies reported the prevalence of SCIs. The overall prevalence of SCI lesions on MRI and CT among patients with AF was 40% and 22%, respectively. LIMITATION Most studies were cross-sectional, and autopsy studies were heterogeneous and not sufficiently sensitive to detect small lesions. CONCLUSION Atrial fibrillation is associated with more than a 2-fold increase in the odds for SCI. PRIMARY FUNDING SOURCE Deane Institute for Integrative Research in Atrial Fibrillation and Stroke, Massachusetts General Hospital.
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Song TJ, Kim J, Lee HS, Nam CM, Nam HS, Kim EH, Lee KJ, Song D, Heo JH, Kim YD. Differential impact of unrecognised brain infarction on stroke outcome in non-valvular atrial fibrillation. Thromb Haemost 2014; 112:1312-8. [PMID: 25231184 DOI: 10.1160/th14-02-0176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/30/2014] [Indexed: 02/02/2023]
Abstract
There has been little information regarding the impact of unrecognised brain infarctions (UBIs) on stroke outcome in patients with non-valvular atrial fibrillation (NVAF). By using volumetric analysis of ischaemic lesions, we evaluated the potential impact of UBIs on clinical outcome according to their presence and categorised type. This study enrolled 631 patients with NVAF having no clinical stroke history. UBIs were categorised into three types as territorial, lacunar, or subcortical. We collected stroke severity, functional outcome at three months, and the total volume of UBIs and acute infarction lesions. We investigated the association between clinical outcome and the type or volume of UBI, using a linear mixed model and logistic regression analysis. UBIs were detected in 285 (45.2 %) patients; territorial UBIs were observed in 24.4 % of patients (154/631), lacunar UBIs in 25 % (158/631), and subcortical UBIs in 15.7 % (99/631). Although initial stroke severity was not different between patients with UBIs and those without, those with UBIs had less improvement during hospitalisation, leading to poorer outcome at three months. Among the three types of UBIs, only territorial UBIs were associated with poor outcome, especially in patients with relatively smaller acute infarction volume. UBIs, in particular, territorial UBIs, may be considered as predictors for poor outcome after ischaemic stroke in patients with NVAF. Our results suggest that the impact of UBIs on clinical outcome differs according to the type of UBIs and the acute stroke severity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Y D Kim
- Young Dae Kim, MD, PhD, Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea, Tel.: +82 2 2228 1605, Fax: +82 2 393 0705, E-mail:
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8
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Cha MJ, Park HE, Lee MH, Cho Y, Choi EK, Oh S. Prevalence of and risk factors for silent ischemic stroke in patients with atrial fibrillation as determined by brain magnetic resonance imaging. Am J Cardiol 2014; 113:655-61. [PMID: 24360776 DOI: 10.1016/j.amjcard.2013.11.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 12/01/2022]
Abstract
Varied silent ischemic stroke (SS) prevalence occurs in patients with atrial fibrillation (AF). Stroke history is worth 2 points in the CHADS2 scoring system. An unknown proportion of patients with AF with a CHADS2 score of 0 or 1 have been undertreated for stroke prevention. We investigated SS risk factors using magnetic resonance imaging and estimated SS impact on clinical outcomes in patients with AF. We analyzed a total of 1,200 patients (400 with AF and 800 with sinus rhythm) who had brain magnetic resonance imaging performed for routine health checkups. Clinical outcomes including symptomatic stroke, dementia, and cognitive disorder were also evaluated in patients with AF (follow-up duration: 66.7 ± 35.9 months; range 10 to 162). SS was observed in 113 patients with AF (28.3%), which was significantly higher than that in 53 subjects (6.6%) with sinus rhythm (p <0.001, odds ratio [OR] 5.549). Independent risk factors for SS in patients with AF were age (OR 1.049), hypertension (OR 2.086), dyslipidemia (OR 2.073), and valvular AF (OR 3.157). Symptomatic stroke incidence during the follow-up was significantly greater in patients with AF with SS than without SS (5.6% vs 2.7% per year, respectively; p = 0.022, hazard ratio 1.787, 95% confidence interval 1.089 to 2.933). Using current scoring systems without correcting for subclinical stroke, clinicians have likely underestimated the stroke risk in low-risk patients with AF; thus many patients with AF might not receive optimal anticoagulation treatment. In conclusion, a screening tool for detecting SS could be considered for stroke risk evaluation in patients with AF, especially those with valvular AF, elderly patients, and patients with dyslipidemia or hypertension.
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Affiliation(s)
- Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyo Eun Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Healthcare System Gangnam Center, Seoul, Korea
| | - Min-Ho Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Youngjin Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
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9
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Haines DE. ERACEing the Risk of Cerebral Embolism From Atrial Fibrillation Ablation. Circ Arrhythm Electrophysiol 2013; 6:827-9. [DOI: 10.1161/circep.113.001025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David E. Haines
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); and Beaumont Health System, Royal Oak, MI (D.E.H.)
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10
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Kirchhof P, Breithardt G, Aliot E, Al Khatib S, Apostolakis S, Auricchio A, Bailleul C, Bax J, Benninger G, Blomstrom-Lundqvist C, Boersma L, Boriani G, Brandes A, Brown H, Brueckmann M, Calkins H, Casadei B, Clemens A, Crijns H, Derwand R, Dobrev D, Ezekowitz M, Fetsch T, Gerth A, Gillis A, Gulizia M, Hack G, Haegeli L, Hatem S, Georg Hausler K, Heidbuchel H, Hernandez-Brichis J, Jais P, Kappenberger L, Kautzner J, Kim S, Kuck KH, Lane D, Leute A, Lewalter T, Meyer R, Mont L, Moses G, Mueller M, Munzel F, Nabauer M, Nielsen JC, Oeff M, Oto A, Pieske B, Pisters R, Potpara T, Rasmussen L, Ravens U, Reiffel J, Richard-Lordereau I, Schafer H, Schotten U, Stegink W, Stein K, Steinbeck G, Szumowski L, Tavazzi L, Themistoclakis S, Thomitzek K, Van Gelder IC, von Stritzky B, Vincent A, Werring D, Willems S, Lip GYH, Camm AJ. Personalized management of atrial fibrillation: Proceedings from the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association consensus conference. Europace 2013; 15:1540-56. [DOI: 10.1093/europace/eut232] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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11
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Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJB, Culebras A, Elkind MSV, George MG, Hamdan AD, Higashida RT, Hoh BL, Janis LS, Kase CS, Kleindorfer DO, Lee JM, Moseley ME, Peterson ED, Turan TN, Valderrama AL, Vinters HV. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44:2064-89. [PMID: 23652265 PMCID: PMC11078537 DOI: 10.1161/str.0b013e318296aeca] [Citation(s) in RCA: 1910] [Impact Index Per Article: 173.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the global impact and advances in understanding the pathophysiology of cerebrovascular diseases, the term "stroke" is not consistently defined in clinical practice, in clinical research, or in assessments of the public health. The classic definition is mainly clinical and does not account for advances in science and technology. The Stroke Council of the American Heart Association/American Stroke Association convened a writing group to develop an expert consensus document for an updated definition of stroke for the 21st century. Central nervous system infarction is defined as brain, spinal cord, or retinal cell death attributable to ischemia, based on neuropathological, neuroimaging, and/or clinical evidence of permanent injury. Central nervous system infarction occurs over a clinical spectrum: Ischemic stroke specifically refers to central nervous system infarction accompanied by overt symptoms, while silent infarction by definition causes no known symptoms. Stroke also broadly includes intracerebral hemorrhage and subarachnoid hemorrhage. The updated definition of stroke incorporates clinical and tissue criteria and can be incorporated into practice, research, and assessments of the public health.
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12
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Abstract
Silent brain infarctions are frequently found by modern cerebral imaging. Up to 30% of persons without a clinical history of stroke were found to have silent brain infarction in epidemiological studies. "Silent" refers to ischemic brain lesions for which no matching clinical syndrome can be found based on history or clinical investigation. Age, education, and ethnic background have a strong impact on noticing and reporting stroke symptoms. The current clinical definition of stroke is insensitive for cognitive deficits which can also be caused by brain infarctions. The majority of silent brain infarctions are localized in the subcortical white matter of the brain; however, about 10% of silent brain infarctions are cortical. Silent brain infarctions are strongly associated with stroke risk factors and comorbidities that are known to cause clinically overt stroke. Silent brain infarctions are 5 to 10 times more frequent than clinically overt strokes. Silent brain infarctions as defined by DWI lesions on MRI imaging are a frequent finding during operative or interventional procedures and their monitoring may help improve the respective techniques in order to decrease the risk of periprocedural stroke.
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14
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Nolte CH, Albach FN, Heuschmann PU, Brunecker P, Villringer K, Endres M, Fiebach JB. Silent New DWI Lesions within the First Week after Stroke. Cerebrovasc Dis 2012; 33:248-54. [DOI: 10.1159/000334665] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 10/21/2011] [Indexed: 11/19/2022] Open
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Brockmann C, Seker F, Weiss C, Groden C, Scharf J. Acetylsalicylic Acid Does Not Prevent Digital Subtraction Angiography-Related High Signal Intensity Lesions in Diffusion-Weighted Imaging in Cerebrovascular Patients. Clin Neuroradiol 2011; 22:15-20. [DOI: 10.1007/s00062-011-0076-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
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Gaita F, Caponi D, Pianelli M, Scaglione M, Toso E, Cesarani F, Boffano C, Gandini G, Valentini MC, De Ponti R, Halimi F, Leclercq JF. Radiofrequency Catheter Ablation of Atrial Fibrillation: A Cause of Silent Thromboembolism? Circulation 2010; 122:1667-73. [PMID: 20937975 DOI: 10.1161/circulationaha.110.937953] [Citation(s) in RCA: 287] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Radiofrequency left atrial catheter ablation has become a routine procedure for treatment of atrial fibrillation. The aim of this study was to assess with preprocedural and postprocedural cerebral magnetic resonance imaging the thromboembolic risk, either silent or clinically manifest, in the context of atrial fibrillation ablation. The secondary end point was the identification of clinical or procedural parameters that correlate with cerebral embolism.
Methods and Results—
A total of 232 consecutive patients with paroxysmal or persistent atrial fibrillation who were candidates for radiofrequency left atrial catheter ablation were included in the study. Pulmonary vein isolation or pulmonary vein isolation plus linear lesions plus atrial defragmentation with the use of irrigated-tip ablation catheters was performed. All of the patients underwent preprocedural and postablation cerebral magnetic resonance imaging. A periprocedural symptomatic cerebrovascular accident occurred in 1 patient (0.4). Postprocedural cerebral magnetic resonance imaging was positive for new embolic lesions in 33 patients (14). No clinical parameters such as age, hypertension, diabetes mellitus, previous history of stroke, type of atrial fibrillation, and preablation antithrombotic treatment showed significant correlation with ischemic cerebral embolism. Procedural parameters such as activated clotting time value and, in particular, electric or pharmacological cardioversion to sinus rhythm correlated with an increased incidence of cerebral embolism. Cardioversion was also associated with an increased risk of 2.75 (95 confidence interval, 1.29 to 5.89;
P
=0.009).
Conclusions—
Radiofrequency left atrial catheter ablation carries a low risk of symptomatic cerebral ischemia but is associated with a substantial risk of silent cerebral ischemia detected on magnetic resonance imaging. Independent risk factors for cerebral thromboembolism are the level of activated clotting time and, in particular, the electric or pharmacological cardioversion to sinus rhythm during the procedure.
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Affiliation(s)
- Fiorenzo Gaita
- From the Department of Cardiology, School of Medicine, Cardinal Massaia Hospital, University of Turin, Asti, Italy (F.G., D.C., M.P., M.S., E.T.); Department of Radiology, Cardinal Massaia Hospital, Asti, Italy (F.C., C.B.); Department of Radiology, School of Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy (G.G.); Department of Neuroradiology, CTO Hospital, University of Turin, Turin, Italy (M.C.V.); Department of Cardiology, Hospital of Circolo Insubria University,
| | - Domenico Caponi
- From the Department of Cardiology, School of Medicine, Cardinal Massaia Hospital, University of Turin, Asti, Italy (F.G., D.C., M.P., M.S., E.T.); Department of Radiology, Cardinal Massaia Hospital, Asti, Italy (F.C., C.B.); Department of Radiology, School of Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy (G.G.); Department of Neuroradiology, CTO Hospital, University of Turin, Turin, Italy (M.C.V.); Department of Cardiology, Hospital of Circolo Insubria University,
| | - Martina Pianelli
- From the Department of Cardiology, School of Medicine, Cardinal Massaia Hospital, University of Turin, Asti, Italy (F.G., D.C., M.P., M.S., E.T.); Department of Radiology, Cardinal Massaia Hospital, Asti, Italy (F.C., C.B.); Department of Radiology, School of Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy (G.G.); Department of Neuroradiology, CTO Hospital, University of Turin, Turin, Italy (M.C.V.); Department of Cardiology, Hospital of Circolo Insubria University,
| | - Marco Scaglione
- From the Department of Cardiology, School of Medicine, Cardinal Massaia Hospital, University of Turin, Asti, Italy (F.G., D.C., M.P., M.S., E.T.); Department of Radiology, Cardinal Massaia Hospital, Asti, Italy (F.C., C.B.); Department of Radiology, School of Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy (G.G.); Department of Neuroradiology, CTO Hospital, University of Turin, Turin, Italy (M.C.V.); Department of Cardiology, Hospital of Circolo Insubria University,
| | - Elisabetta Toso
- From the Department of Cardiology, School of Medicine, Cardinal Massaia Hospital, University of Turin, Asti, Italy (F.G., D.C., M.P., M.S., E.T.); Department of Radiology, Cardinal Massaia Hospital, Asti, Italy (F.C., C.B.); Department of Radiology, School of Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy (G.G.); Department of Neuroradiology, CTO Hospital, University of Turin, Turin, Italy (M.C.V.); Department of Cardiology, Hospital of Circolo Insubria University,
| | - Federico Cesarani
- From the Department of Cardiology, School of Medicine, Cardinal Massaia Hospital, University of Turin, Asti, Italy (F.G., D.C., M.P., M.S., E.T.); Department of Radiology, Cardinal Massaia Hospital, Asti, Italy (F.C., C.B.); Department of Radiology, School of Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy (G.G.); Department of Neuroradiology, CTO Hospital, University of Turin, Turin, Italy (M.C.V.); Department of Cardiology, Hospital of Circolo Insubria University,
| | - Carlo Boffano
- From the Department of Cardiology, School of Medicine, Cardinal Massaia Hospital, University of Turin, Asti, Italy (F.G., D.C., M.P., M.S., E.T.); Department of Radiology, Cardinal Massaia Hospital, Asti, Italy (F.C., C.B.); Department of Radiology, School of Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy (G.G.); Department of Neuroradiology, CTO Hospital, University of Turin, Turin, Italy (M.C.V.); Department of Cardiology, Hospital of Circolo Insubria University,
| | - Giovanni Gandini
- From the Department of Cardiology, School of Medicine, Cardinal Massaia Hospital, University of Turin, Asti, Italy (F.G., D.C., M.P., M.S., E.T.); Department of Radiology, Cardinal Massaia Hospital, Asti, Italy (F.C., C.B.); Department of Radiology, School of Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy (G.G.); Department of Neuroradiology, CTO Hospital, University of Turin, Turin, Italy (M.C.V.); Department of Cardiology, Hospital of Circolo Insubria University,
| | - Maria Consuelo Valentini
- From the Department of Cardiology, School of Medicine, Cardinal Massaia Hospital, University of Turin, Asti, Italy (F.G., D.C., M.P., M.S., E.T.); Department of Radiology, Cardinal Massaia Hospital, Asti, Italy (F.C., C.B.); Department of Radiology, School of Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy (G.G.); Department of Neuroradiology, CTO Hospital, University of Turin, Turin, Italy (M.C.V.); Department of Cardiology, Hospital of Circolo Insubria University,
| | - Roberto De Ponti
- From the Department of Cardiology, School of Medicine, Cardinal Massaia Hospital, University of Turin, Asti, Italy (F.G., D.C., M.P., M.S., E.T.); Department of Radiology, Cardinal Massaia Hospital, Asti, Italy (F.C., C.B.); Department of Radiology, School of Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy (G.G.); Department of Neuroradiology, CTO Hospital, University of Turin, Turin, Italy (M.C.V.); Department of Cardiology, Hospital of Circolo Insubria University,
| | - Franck Halimi
- From the Department of Cardiology, School of Medicine, Cardinal Massaia Hospital, University of Turin, Asti, Italy (F.G., D.C., M.P., M.S., E.T.); Department of Radiology, Cardinal Massaia Hospital, Asti, Italy (F.C., C.B.); Department of Radiology, School of Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy (G.G.); Department of Neuroradiology, CTO Hospital, University of Turin, Turin, Italy (M.C.V.); Department of Cardiology, Hospital of Circolo Insubria University,
| | - Jean François Leclercq
- From the Department of Cardiology, School of Medicine, Cardinal Massaia Hospital, University of Turin, Asti, Italy (F.G., D.C., M.P., M.S., E.T.); Department of Radiology, Cardinal Massaia Hospital, Asti, Italy (F.C., C.B.); Department of Radiology, School of Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy (G.G.); Department of Neuroradiology, CTO Hospital, University of Turin, Turin, Italy (M.C.V.); Department of Cardiology, Hospital of Circolo Insubria University,
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Abstract
As the availability and quality of imaging techniques improve, doctors are identifying more patients with no history of transient ischaemic attack or stroke in whom imaging shows brain infarcts. Until recently, little was known about the relevance of these lesions. In this systematic review, we give an overview of the frequency, causes, and consequences of MRI-defined silent brain infarcts, which are detected in 20% of healthy elderly people and up to 50% of patients in selected series. Most infarcts are lacunes, of which hypertensive small-vessel disease is thought to be the main cause. Although silent infarcts, by definition, lack clinically overt stroke-like symptoms, they are associated with subtle deficits in physical and cognitive function that commonly go unnoticed. Moreover, the presence of silent infarcts more than doubles the risk of subsequent stroke and dementia. Future studies will have to show whether screening and treating high-risk patients can effectively reduce the risk of further infarcts, stroke, and dementia.
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Affiliation(s)
- Sarah E Vermeer
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
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18
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Kozdag G, Ciftci E, Vural A, Selekler M, Sahin T, Ural D, Kahraman G, Agacdiken A, Demirci A, Komsuoglu S, Komsuoglu B, Fici F. Silent cerebral infarction in patients with dilated cardiomyopathy: Echocardiographic correlates. Int J Cardiol 2006; 107:376-81. [PMID: 15913815 DOI: 10.1016/j.ijcard.2005.03.055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Revised: 03/16/2005] [Accepted: 03/26/2005] [Indexed: 12/20/2022]
Abstract
BACKGROUND Patients with dilated cardiomyopathy (DCM) have an increased risk of thromboembolic events. Incidence of silent cerebral infarction (SCI) has not been investigated in these patients. The aim of this study was to investigate the incidence of SCI in patients with DCM and to determine its associations with echocardiographic parameters. METHODS AND RESULTS Seventy-two patients (mean age 62+/-12 years) with DCM underwent cranial magnetic resonance imaging in addition to transthoracic and transesophageal echocardiographic examination. A total of 56 age-matched healthy volunteers served as a control group for comparison SCI prevalence. Prevalence of SCI was significantly higher in patients with DCM (35% vs. 3.6%; p<0.001). In DCM group, patients with SCI had significantly impaired left ventricular systolic function, higher frequency of restrictive diastolic filling, moderate to severe left atrial spontaneous echo contrast (SEC), aortic SEC, and complex atherosclerosis or calcified plaques in the aorta. In logistic regression analysis, type of diastolic filling emerged as the only independent risk factor for SCI (p<0.001). When the type of diastolic filling was removed from the analysis, ejection fraction, marked left atrial SEC, complex-calcified aortic atheroma and age appeared as the other independent risk factors (p = 0.003, p = 0.009, p = 0.013 and p = 0.018, respectively). CONCLUSION SCI is a frequent finding in DCM patients. Impaired systolic function, restrictive filling pattern, presence of moderate to severe left atrial SEC, and complex atherosclerosis in the aorta are the factors contributing to the development of SCI.
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Affiliation(s)
- Guliz Kozdag
- Kocaeli University Medical Faculty, Cardiology, Kocaeli, Turkey.
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Corea F, Tambasco N, Luccioli R, Ciorba E, Parnetti L, Gallai V. Brain CT-scan in acute stroke patients: silent infarcts and relation to outcome. Clin Exp Hypertens 2002; 24:669-76. [PMID: 12450242 DOI: 10.1081/ceh-120015343] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Silent infarcts (SIs) are common findings in stroke patients, but their clinical significance remains controversial. Aim of this study was to evaluate the prevalence of SI in consecutive stroke patients, characteristics, associated factors, and influence on in-hospital mortality. The population consisted of 191 patients, consecutively admitted for an acute stroke. Of 191 patients, 74 had SI on CT-scan. Silent infarcts were often multiple, right sided, lacunar. We found SI more frequently in older patients, smokers, with an ischemic stroke having small vessel disease as presumed cause. In our study SI were associated with ageing, smoke habit and lacunar stroke. Silent infarcts size influenced the rate of in-hospital mortality.
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Affiliation(s)
- Francesco Corea
- Stroke Unit, Dip Neuroscienze, Univ Perugia, Perugia, Italy.
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