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

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

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2 Scopus citations


Background: 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. Methods: 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. Results: 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; p < 0.001]. By contrast, paroxysmal AF (HR = 3.76, 95% CI 1.56–9.04; p = 0.003), AF diagnosed before stroke (HR = 2.38, 95% CI 1.19–4.55; p = 0.014), small scattered lesions in a single vascular territory (reference: corticosubcortical lesion, HR = 3.19, 95% CI 1.18–8.63; p = 0.022), and the use of antiplatelet agents (HR = 2.11, 95% CI 1.11–4.03; p = 0.024) were independently associated with AF-unrelated stroke. Conclusion: 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.

Original languageEnglish
Article number744607
JournalFrontiers in Neurology
StatePublished - 21 Oct 2021

Bibliographical note

Publisher Copyright:
Copyright © 2021 Kim, Hwang, Park, Kim, Choi, Jung, Yu, Kim, Oh, Song, Kim, Park, Kim, Park, Choi, Chung, Bang, Kim, Heo and Seo.


  • atrial fibrillation
  • cardioembolic brain infarction
  • recurrence
  • stroke
  • stroke mechanism


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