AUTHOR=Kim Bum Joon , Hwang Yang-Ha , Park Man-Seok , Kim Joon-Tae , Choi Kang-Ho , Jung Jin-Man , Yu Sungwook , Kim Chi Kyung , Oh Kyungmi , Song Tae-Jin , Kim Yong-Jae , Park Kwang-Yeol , Kim Jeong-Min , Park Jong-Ho , Choi Jay Chol , Chung Jong-Won , Bang Oh Young , Kim Gyeong-Moon , Heo Sung Hyuk , Seo Woo-Keun 

TITLE=Atrial Fibrillation Related and Unrelated Stroke Recurrence Among Ischemic Stroke Patients With Atrial Fibrillation

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.744607

DOI=10.3389/fneur.2021.744607

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> Ischemic stroke with atrial fibrillation (AF) may recur despite appropriate treatment. It may be AF-related or AF-unrelated. We compared the factors associated with AF-related and AF-unrelated recurrences among ischemic stroke patients with AF.</p><p><bold>Methods:</bold> Patients with ischemic stroke and AF were enrolled from 11 centers in Korea. Ischemic stroke recurrence was classified as AF-related if the lesion pattern was compatible with cardioembolism without significant stenosis or as AF-unrelated if the lesion was more likely due to small vessel disease or arterial stenosis. Factors associated with stroke recurrence (AF-related and AF-unrelated) were investigated.</p><p><bold>Results:</bold> Among the 2,239 patients, 115 (5.1%) experienced recurrence (75 AF-related and 40 AF-unrelated). Factors independently associated with any stroke recurrence included AF diagnosed before stroke, small subcortical infarctions, and small scattered lesions in a single vascular territory. Type of AF was associated with the type of stroke recurrence, with persistent AF being associated with AF-related stroke [hazard ratio (HR) = 2.94, 95% confidence interval (CI) 1.69–5.26; <italic>p</italic> &lt; 0.001]. By contrast, paroxysmal AF (HR = 3.76, 95% CI 1.56–9.04; <italic>p</italic> = 0.003), AF diagnosed before stroke (HR = 2.38, 95% CI 1.19–4.55; <italic>p</italic> = 0.014), small scattered lesions in a single vascular territory (reference: corticosubcortical lesion, HR = 3.19, 95% CI 1.18–8.63; <italic>p</italic> = 0.022), and the use of antiplatelet agents (HR = 2.11, 95% CI 1.11–4.03; <italic>p</italic> = 0.024) were independently associated with AF-unrelated stroke.</p><p><bold>Conclusion:</bold> Persistent AF was more associated with AF-related stroke recurrence, whereas paroxysmal AF was more associated with AF-unrelated stroke recurrence. A scattered lesion in a single vascular territory may predict AF-unrelated stroke recurrence.</p>