Association Between Slow Ventricular Response and Severe Stroke in Atrial Fibrillation-Related Cardioembolic Stroke

Atrial fibrillation (AF)-related strokes usually have a higher initial stroke severity and frequently lead to severe disability and mortality. 1,2Stroke recurrence was not found to be linked to heart rate (HR); however, there was an association between HR and mortality in patients with AF-related stroke. 3While AF typically presents with tachycardia, a slow ventricular response (SVR) is also observed, albeit less frequently.Hemodynamic changes associated with AF have been studied, and AF with SVR may lead to intracardiac hemodynamic alterations, thrombus formation, and hypoperfusion in the ischemic area. 4However, the association between SVR and initial stroke severity, early neurological deterioration, and functional outcome in patients with AF-related stroke is not known.We retrospectively reviewed the data of patients who had acute AF-related stroke (within 7 days of stroke onset) and were admitted to Asan Medical Center between January 2017 and March 2022.We included patients who fulfilled the following criteria:(1) cardioembolic stroke, (2) known or newly diagnosed AF, and (3) relevant acute ischemic lesions on diffusion-weighted imaging (DWI).We excluded patients who had (1) AF with rapid ventricular rate in the initial twelve-lead electrocardiogram (ECG), (2) poor initial magnetic resonance imaging (MRI) quality, (3) incomplete clinical data, (4) presence of stroke mechanisms other than cardioembolism, and (5) presence of low temperature or electrolyte abnormalities that may systematically reduce the HR.The study protocol was approved by the Institutional Re-