The Relationship between Ischemic Stroke and Atrial Fibrillation

AbstractObjectiveCardioembolic stroke accounts for approximately a quarter of all ischemic strokes, with nonvalvular atrial fibrillation as the predominant type. The proportion of strokes caused by atrial fibrillation increased by age, because this arrhythmia is more prevalent around the age 70 -79. Material and methods: We received 375 patients hospitalized on emergency between January 2013 - November 2014. Demographic (sex, age), clinical, imagistic (cerebral-CT, cerebral-MRI, extracranial ultrasound, minimum two ECG, one of the moment of admission and the other later, Ecocardiography, Chest X- ray), paraclinic data, as well as risk factors, treatment, evolution and neurologic recovery were all considered. Results: We studied 375 patients, 244 females and 131 males (65% vs 35%). The mean age was 78,2 years (range 41-98). According to the age groups, the biggest frequency of ischemic stroke associated with atrial fibrillation is between 70-79 years (151 cases; 40,26%), followed by the age group of 80-89 years (118 cases; 31,46%), 60-69 years (68 cases; 18,13%), 50-59 years (29 cases; 7,73%),90-99 years (8 cases; 2,13%), 40-49 years (1 case; 0,26%). We have 287 patients (76,53%) with ischemic stroke and nonvalvular atrial fibrillation and 324 patients (86,40%) with permanent atrial fibrillation. The partition of the cases according to the ischemic stroke localization shows that the most cases are in the partial territory of MCA (168 cases), followed by full territory of MCA (65 cases) as well as the other vascular territories. The risk of hemorrhage transformation is high in cardiac embolism compared to the other stroke subtypes (38 cases; 10,13%). In 311 cases (83%) it has been a favorable recovery but 64 cases (17%) died. Conclusions: Ischemic stroke associated with atrial fibrillation is a major cause of long- term, physical, emotional and social disability in the elderly, the biggest frequency is between 70-79 years (40,26%). Ischemic stroke with atrial fibrillation is more common in females (65%) and in the territory of MCA (62,13%). The development of noninvasive diagnostic technique like cerebral-MRI, echocardiography as well as new therapeutic strategies for acute cardioembolic stroke demonstrates that the letal cases decreasing at 17%. Cardioembolic strokes are associated with substantial morbidity and mortality