Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-23T02:35:41.410Z Has data issue: false hasContentIssue false
  • English
  • Français

Is Atrial Fibrillation an Independent Risk Factor for Stroke?*

Published online by Cambridge University Press:  18 September 2015

Stephen J. Phillips
Stephen J. Phillips*
Affiliation:
Department of Medicine (Division of Neurology), Dalhousie University, and Camp Hill Medical Centre, Halifax, Nova Scotia
*
Camp Hill Medical Centre, Department of Medicine, Gerard Hall, 5303 Morris Street, Halifax, Nova Scotia, Canada B3J 1B6
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

That non-rheumatic atrial fibrillation is an independent risk factor for cerebral infarction has not been established with certainty. The rationale underlying contemporary clinical trials of warfarin therapy for the prevention of stroke in patients who have non-rheumatic atrial fibrillation is that the majority of strokes in such patients are due to cardiogenic cerebral embolism. However, there is evidence to suggest that the increased probability of stroke attributed to this arrhythmia is due to its association with other risk factors such as hypertension, diabetes mellitus, and atherosclerosis. The question of who should be anticoagulated is a major public health issue since atrial fibrillation is present in approximately ten per cent of the general population aged 65 or more years.

Résumé:

RÉSUMÉ:

Il n'a jamais été établi avec certitude que la fibrillation auriculaire d'origine non-rhumatismale soit un facteur de risque indépendant de l'infarcissement cérébral. La justification des essais thérapeutiques avec la warfarine pour la prévention des accidents cérébro-vasculaires (ACV) chez les patients qui ont une fibrillation auriculaire non-rhumatismale est que la majorité des ACV chez ces patients est due à une embolie cérébrale cardiogénique. Cependant, certaines données suggèrent que la probabilité accrue d'ACV attribuée à ce type d'arythmie est due à son association à d'autres facteurs de risque, tels l'hypertension, le diabète et l'athérosclérose. La question à savoir qui devrait être anticoagulé est un sujet de débat important en santé publique, car la fibrillation auriculaire est présente chez approximativement dix pourcent de la population générale âgée de 65 ans et plus.

Type
Special Features and Reviews
Information
Canadian Journal of Neurological Sciences , Volume 17 , Issue 2 , May 1990 , pp. 163 - 169
Copyright
Copyright © Canadian Neurological Sciences Federation 1990

Footnotes

*

Canadian Stroke Society Prize Essay, 1989

References

REFERENCES

1. Phillips, SJ. Whisnant, JP, O’Fallon, WM, et al. A community blood pressure survey: Rochester, Minnesota, 1986. Mayo Clin Proc 1988; 63: 691–699.CrossRefGoogle Scholar
2. Phillips, SJ, Whisnant, JP, O’Fallon, WM. Correction. Mayo Clin Proc 1989; 64: 267.Google Scholar
3. Dillman, DA. Mail and telephone surveys: the total design method. New York, John Wiley & Sons, 1978.Google Scholar
4. Phillips, SJ, Whisnant, JP, O’Fallon, WM, et al. Prevalence of cardio vascular disease and diabetes mellitus in Rochester, Minnesota. Mayo Clin Proc 1990 (in press).CrossRefGoogle ScholarPubMed
5. Kurland, LT, Molgaard, CA. The patient record in epidemiology. Sci Am 245: 54–63, October 1981.CrossRefGoogle ScholarPubMed
6. Hiss, RG, Lamb, LE. Electrocardiographic findings in 122,043 individuals. Circulation 1962; 25: 947–961.CrossRefGoogle ScholarPubMed
7. Ostrander, LD, Brandt, RL, Kjelsbert, MO, et al. Electrocardio graphic findings among the adult population of a total natural community. Circulation 1965; 31: 888–898.CrossRefGoogle Scholar
8. Orndahl, G, Thulesius, O, Hood, B. Incidence of persistent atrial fibrillation and conduction defects in coronary artery disease. Am Heart J 1972; 84: 120–131.CrossRefGoogle Scholar
9. Kitchin, AH, Milne, JS. Longitudinal survey of ischaemic heart disease in a randomly selected sample of an older population. Br Heart J 1977; 39: 889–893.CrossRefGoogle Scholar
10. Rose, G, Baxter, PJ, Reid, DD, et al. Prevalence and prognosis of electrocardiographic findings in middle-aged men. Br Heart J 1978; 40: 636–643.CrossRefGoogle ScholarPubMed
11. Onundarson, PT, Thorgeirsson, G, Jonmundsson, E, et al. Chronic atrial fibrillation — epidemiologic features and 14 year follow up: a case control study. Eur Heart J 1987; 8: 521–527.CrossRefGoogle ScholarPubMed
12. Davis, PH, Dambrosia, JM, Schoenberg, BS, et al. Risk factors for ischemic stroke: a prospective study in Rochester, Minnesota. Ann Neurol 1987; 22: 319–327.CrossRefGoogle ScholarPubMed
13. Kopecky, SL, Gersh, BJ, McGoon, MD, et al. The natural history of lone atrial fibrillation: a population-based study over three decades. N Engl J Med 1987; 317: 669–674.CrossRefGoogle ScholarPubMed
14. Wolf, PA, Dawber, TR, Thomas, HE Jr, et al. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology 1978; 28: 973–977.CrossRefGoogle ScholarPubMed
15. Wolf, PA, Kannel, WB, McGee, DL, et al. Duration of atrial fibrillation and imminence of stroke: the Framingham study. Stroke 1983; 14: 664–667.CrossRefGoogle ScholarPubMed
16. Brand, FN, Abbott, RD, Kannel, WB, et al. Characteristics and prognosis of lone atrial fibrillation: 30-year follow-up in the Framingham study. JAMA 1985; 254: 3449–3453.CrossRefGoogle ScholarPubMed
17. Wolf, PA, Abbott, RD, Kannel, WB. Atrial fibrillation: a major contributor to stroke in the elderly. Arch Int Med 1987; 147: 1561–1564.CrossRefGoogle Scholar
18. Dawber, TR. The Framingham study: the epidemiology of atherosclerotic disease. Harvard University Press, 1980.CrossRefGoogle Scholar
19. Phillips, SJ, Whisnant, JP. Hypertension and stroke. In: Laragh, JH, Brenner, RM, eds. Hypertension; Pathophysiology, Diagnosis, and Management. New York: Raven Press 1990; 417–431.Google Scholar
20. Harrison, MJG, Marshall, J. Atrial fibrillation, TIAs and completed strokes. Stroke 1984; 15: 441–442.CrossRefGoogle ScholarPubMed
21. Mohr, JP, Caplan, LR, Melski, JW, et al. The Harvard Cooperative Stroke Registry: a prospective registry. Neurology 1978; 28: 754–762.CrossRefGoogle ScholarPubMed
22. Foulkes, MA, Wolf, PA, Price, TR, et al. The Stroke Data Bank: design, methods, and baseline characteristics. Stroke 1988; 19: 547–554.CrossRefGoogle ScholarPubMed
23. Bogousslavsky, J, Van Melle, G, Regli, F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke 1988; 19: 1083–1092.CrossRefGoogle ScholarPubMed
24. Flegel, KM, Shipley, MJ, Rose, G. Risk of stroke in non-rheumatic atrial fibrillation. Lancet 1987; 1: 526–529.CrossRefGoogle ScholarPubMed
25. Reid, DD, Brett, GZ, Hamilton, PJS, et al. Cardiorespiratory disease and diabetes among middle-aged male civil servants. Lancet 1974; 1: 469–473.CrossRefGoogle ScholarPubMed
26. Corwin, LI, Wolf, PA, Kannel, WB, et al. Accuracy of death certifi- cation of stroke: the Framingham study. Stroke 1982; 13: 818–821.CrossRefGoogle Scholar
27. Shaper, AG, Pocock, SJ, Walker, M, et al. British Regional Heart Study: cardiovascular risk factors in middle-aged men in 24 towns. Br Med J 1981; 283: 179–186.CrossRefGoogle ScholarPubMed
28. Daley, R, Mattingly, TW, Holt, CL, et al. Systemic arterial embolism in rheumatic heart disease. Am Heart J 1951; 42: 566–581.CrossRefGoogle ScholarPubMed
29. Graham, GK, Taylor, JA, Ellis, LB, et al. Studies in mitral Stenosis. II. A correlation of post-mortem findings with the clinical course of the disease in one hundred and one cases. Arch Intern Med 1951; 88: 532–547.CrossRefGoogle Scholar
30. Coulshed, N, Epstein, EJ, MacKendrick, CS, et al. Systemic embolism in mitral valve disease. Br Heart J 1970; 32: 26–34.CrossRefGoogle ScholarPubMed
31. Wallach, JB, Lukash, L, Angrist, AA. An interpretation of the inci- dence of mural thrombi in the left auricle and appendage with particular reference to mitral commissurotomy. Am Heart J 1953; 45: 252–254.CrossRefGoogle Scholar
32. Wallach, JB, Lukash, , Angrist, AA. The mechanism of formation of left auricular mural thrombi. Am J Med 1954; 16: 543–548.CrossRefGoogle ScholarPubMed
33. Aberg, H. Atrial fibrillation. I. A study of atrial thrombosis and sys- temic embolism in a necropsy material. Acta Med Scand 1969; 185: 373–379.CrossRefGoogle Scholar
34. Beer, DT, Ghitman, B. Embolization from the atria in arteriosclerotic heart disease. JAMA 1961; 177: 287–291.CrossRefGoogle ScholarPubMed
35. Hinton, RC, Kistler, JP, Fallon, JT, et al. Influence of etiology of atrial fibrillation on incidence of systemic embolism. Am J Cardiol 1977; 40: 509–513.CrossRefGoogle ScholarPubMed
36. Shrestha, NK, Moreno, FL, Narciso, FV, et al. Two-dimensional echocardiographic diagnosis of left atrial thrombus in rheumatic heart disease: a clinicopathologic study. Circulation 1983; 67: 341–347.CrossRefGoogle ScholarPubMed
37. Schweizer, P, Bardos, P, Erbel, R, et al. Detection of left atrial thrombi by echocardiography. Br Heart J 1981; 45: 148–156.CrossRefGoogle ScholarPubMed
38. Tomoda, H, Hoshiai, M, Furuya, H, et al. Evaluation of intracardiac thrombus with computed tomography. Am J Cardiol 1983; 51: 843–852.CrossRefGoogle ScholarPubMed
39. Seward, JB, Khandheria, BK, Oh, JK, et al. Transesophageal echocardiography: technique, anatomic correlations, implementation, and clinical applications. Mayo Clin Proc 1988; 63: 649–680.CrossRefGoogle ScholarPubMed
40. Helgason, CM, Chomka, E, Louie, , et al. The potential role for ultra fast cardiac computed tomography in patients with stroke. Stroke 1989; 20: 465–472.CrossRefGoogle Scholar
41. Starkey, I, Warlow, C. The secondary prevention of stroke in patients with atrial fibrillation. Arch Neurol 1986; 43: 66–68.CrossRefGoogle ScholarPubMed
42. Sherman, DG, Hart, RG, Easton, JD. The secondary prevention of stroke in patients with atrial fibrillation. Arch Neurol 1986; 43: 68–70.CrossRefGoogle ScholarPubMed
43. Cerebral Embolism Task Force. Cardiogenic brain embolism. Arch Neurol 1986; 43: 71–84.CrossRefGoogle Scholar
44. Ramirez-Lassepas, M, Cipolle, RJ, Bjork, RJ, et al. Can embolic stroke be diagnosed on the basis of neurologic clinical criteria? Arch Neurol 1987; 44: 87–89.CrossRefGoogle ScholarPubMed
45. Britton, M, Gustafsson, C. Non-rheumatic atrial fibrillation as a risk factor for stroke. Stroke 1985; 16: 182–188.CrossRefGoogle ScholarPubMed
46. Fisher, CM, Pearlman, A. The nonsudden onset of cerebral embolism. Neurology 1967; 17: 1025–1032.CrossRefGoogle ScholarPubMed
47. Roden, A, Britton, M. Progression of stroke after arrival at hospital. Acta Nuerol Scand 1982; 66 (Suppl 91): 43.Google Scholar
48. Fisher, CM, Adams, RD. Observations on brain embolism with special reference to hemorrhagic infarction. In: Furlan, AJ, ed. The Heart and Stroke: Exploring Mutual Cerebrovascular and Cardiovascular Issues. Berlin Heidelberg: Springer-Verlag 1987: 17–36.CrossRefGoogle Scholar
49. Kannel, WB, Abbott, RD, Savage, DD, et al. Epidemiologic features of chronic atrial fibrillation: the Framingham Study. N Eng J Med 1982; 306: 1018–1022.CrossRefGoogle ScholarPubMed
50. Lavy, S, Stern, S, Melamed, E, et al. Effect of chronic atrial fibrillation on regional cerebral blood flow. Stroke 1980; 11: 35–38.CrossRefGoogle ScholarPubMed
51. Caplan, LR, D’Cruz, I, Hier, DB, et al. Atrial size, atrial fibrillation, and stroke. Ann Neurol 1986; 19: 158–161.CrossRefGoogle ScholarPubMed
52. Aronow, WS, Gutstein, H, Hsieh, FY. Risk factors for thromboembolic stroke in elderly patients with chronic atrial fibrillation. Am J Cardiol 1989; 63: 366–367.CrossRefGoogle ScholarPubMed
53. Flegel, KM, Hanley, J. Risk factors for stroke and other embolic events in patients with nonrheumatic atrial fibrillation. Stroke 1989; 20: 1000–1004.CrossRefGoogle ScholarPubMed
54. Levine, HJ, Pauker, SG, Salzman, EW. Antithrombotic therapy in valvular heart disease. Chest 1986; 89: 36S–45S.Google ScholarPubMed
55. Cerebral Embolism Task Force. Cardiogenic brain embolism: the second report of the Cerebral Embolism Task Force. Arch Neurol 1989; 46: 727–743.CrossRefGoogle Scholar
56. Genton, E. Barnett, HJM, Fields>, WS, et al. Cerebral ischemia: the role of thrombosis and of antithrombotic therapy. Stroke 1977; 8: 150–175.CrossRefGoogle ScholarPubMed
57. Roberts, HR Braunstein, K. The thrombotic state. In: Lundblad, RL, Roberts, HR, eds. Chemistry and Biology of Heparin. New York/Amsterdam: Elsevier Science Publishing Co Inc, 1981: 487–496.Google Scholar
58. Wessler, S, Gitel, SN. Pharmacology of heparin and warfarin. J Coll Cardiol 1986; 8: 10B–20B.Google ScholarPubMed
59. Antiplatelet Trialists’ Collaboration. Secondary prevention of vascular disease by prolonged antiplatelet treatment. Br Med J 1988; 296: 320–331.CrossRefGoogle Scholar
60. Petersen, P, Boysen, G, Godtfredsen, J, et al. Placebo-controlled ran domized trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. Lancet 1989; 1: 175–179.CrossRefGoogle Scholar
61. Levine, MN, Raskob, G, Hirsh, J. Haemorrhagic complications of long-term anticoagulant therapy. Chest 1986; 89 (Suppl): 16S–25S.CrossRefGoogle Scholar
62. Hirsh, J. Levine, MN. Therapeutic range for the control of oral anticoagulant therapy. Arch Neurol 1986; 43: 1162–1164.CrossRefGoogle ScholarPubMed
63. Walker, MD. Atrial fibrillation and antithrombotic prophylaxias: a prospective meta-analysis. Lancet 1989;1: 325–326.CrossRefGoogle ScholarPubMed
64. Feinberg, WM, Biller, J, Helgason, CM, et al. Stroke prevention in atrial fibrillation study: progress report of an ongoing cooperative study. (Abstract). Neurology 1989; 39 (Suppl 1): 159.Google Scholar
65. Miller, VT, Cohen, BA, Feinberg, WH, et al. Strokes in patients with nonvalvular atrial fibrillation (Abstract). Circulation 1989; 80 (Suppl 2): 11–404.Google Scholar
66. Tegeler, CH. Stroke prevention in atrial fibrillation study: carotid stenosis study group. Carotid stenosis in atrial fibrillation. (Abstract). Neurology 1989; 39 (Suppl 1): 159.Google Scholar
67. Stroke Prevention in Atrial Fibrillation Study Group Investigators. Preliminary report of the Stroke Prevention in Atrial Fibrillation Study. N Engl J Med 1990; 322: 863–868.CrossRefGoogle Scholar