Nonvalvular Atrial Fibrillation as a Cause of Fatal Massive Cerebral Infarction in the Elderly

By studying 3,408 consecutive autopsied elderly patients, we found that two thirds of the 132 massive cerebral infarctions (86) were embolic, of cardiac origin. Embolic infarction associated with nonvalvular atrial fibrillation was seen in 48 cases (36%), half due to the first stroke. Embolic infarction associated with heart diseases other than nonvalvular atrial fibrillation was seen in 23 cases (17%), and that from nonbacterial thrombotic endocarditis was seen in 15 cases (11%). Thrombotic infarction or infarction of nonembolic cardiac origin was found in only 39 cases (30%). Of 56 patients with fatal massive cerebral infarction who died <2 weeks after their stroke, 25 (45%) had embolic strokes associated with nonvalvular atrial fibrillation. Our study shows that nonvalvular atrial fibrillation is a very important cause of fatal massive cerebral infarction in the elderly. (Stroke 1989;20:1653-1656) The incidence of atrial fibrillation (AF)increases with age.1'2 Kuramoto et al1reported that approximately 17 % of all autopsied elderly patients had AF, and 20 % of these had large cerebral infarcts at autopsy. Although nonvalvular atrial fibrillation (NVAF) is empha-sized as a cause of embolic stroke,3-7 there is littl