Key result
Successful restoration of sinus rhythm was associated with a lower rate of recurrent embolic events compared to rate control (3.4% vs 14.6%, P=0.049) over 3 years.
Why the study?
It was unclear whether attempts to restore and maintain sinus rhythm reduce recurrent stroke in patients with AF.
Does a rhythm control strategy reduce recurrent stroke and death in patients with atrial fibrillation and prior ischemic stroke or TIA?
Cohort (n=245)
Does a rhythm control strategy reduce recurrent stroke and death in patients with atrial fibrillation and prior ischemic stroke or TIA?
Restoring and maintaining sinus rhythm may significantly reduce recurrent embolic events and mortality in patients with atrial fibrillation and a recent history of ischemic stroke or TIA.
Answers are grounded in this paper and cite their sources.
May support rhythm control to lower recurrent stroke in post-stroke AF; leaves open need for randomized trials.
We aimed to determine whether attempts to restore and maintain sinus rhythm will reduce recurrent stroke in patients with atrial fibrillation (AF). Patients (n = 245) between March 1998 and May 2002 with AF who had an ischemic stroke including transient ischemic attack 1 to 12 months before transesophageal echocardiographic examination and had been followed for 3 years were retrospectively reviewed. Cardioversion was attempted in 130 patients; 117 (90%) patients were successfully cardioverted (rhythm control group). The 13 patients who could not be cardioverted and 115 patients who did not undergo cardioversion were assigned to the rate control group. Age, gender, ischemic heart disease, hypertension, diabetes mellitus, congestive heart failure, mitral valve disease, and left atrial diameter were similar in both groups. The rhythm control group included 56 patients (48.7%) who were still in sinus rhythm after 3 years. During follow-up, there were 2 embolic events (3.4%) and 2 deaths (3.4%) in the rhythm control group, whereas 18 embolic events (14.6%) and 18 deaths (14.6%) occurred in the rate control group ( P = .049 and P = .049, respectively). Restoration and maintenance of sinus rhythm seems to have a beneficial effect on secondary prevention of stroke in patients with AF.
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Conkbayır et al. (2019) conducted a cohort in Atrial fibrillation with prior ischemic stroke or TIA (n=245). Rhythm control (successful cardioversion) vs. Rate control (failed or no cardioversion) was evaluated on embolic events (p=.049). Successful restoration of sinus rhythm was associated with a lower rate of recurrent embolic events compared to rate control (3.4% vs 14.6%, P=0.049) over 3 years.
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