Abstract 1: Early Recurrence in Paroxysmal Versus Sustained Atrial Fibrillation in Patients With Acute Ischemic Stroke

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Background and purpose: To date, there have been no thorough investigations on the possible role of atrial fibrillation (AF) pattern in stroke recurrence during early-phase post stroke. We investigated for differences in ischemic outcome between patients with paroxysmal AF (PAF) and those with sustained AF (SAF), within 90 days from acute ischemic stroke (AIS).Methods: Patients from the RAF and RAF-DOAC study databases were categorized into 2 groups: PAF and SAF (persistent + permanent AF). Early recurrence was defined as the composite of ischemic stroke, transient ischemic attack and symptomatic systemic embolism within 90 days from AIS.Results: A total of 2,150 patients (1,155 females, 53.7%) were enrolled: 930 (43.3%) had PAF and 1220 (56.7%) SAF. Patients with SAF were on average older, were more likely to have: diabetes mellitus, hypertension, a history of stroke/TIA, congestive heart failure, atrial enlargement, pacemaker and a high NIHSS. During the 90-day follow-up, 107 recurrent ischemic events were recorded from index stroke. Multivariate analysis for predictive factors of early ischemic recurrence indicated that SAF was associated with a non-significant increase in ischemic events at 90 days, compared to PAF (HR 1.23; 95% CI 0.74-2.04; p = 0.418) (Figure).Conclusions: PAF and SAF patients with acute stroke resulted having similar risks of ischemic recurrence within 90 days from index event. Therein, these findings suggest that AF pattern should not influence decision making concerning the timing of anticoagulant administration after an acute stroke.

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