Risk of Stroke in Atrial Fibrillation

Study Questions:

Is the risk of stroke lower in patients with paroxysmal compared to persistent atrial fibrillation (AF)?


The data in this study were obtained from a community-based registry of 3,304 patients with AF. The patients were categorized as having paroxysmal (n = 1,588) or persistent (n = 1,716) AF. The primary endpoint was the incidence of stroke or systemic embolism (SE) during a mean follow-up of 24.9 months.


After adjustment for multiple potential confounding variables, the risk of stroke/SE was significantly lower among patients with paroxysmal AF than in patients with persistent AF, both in patients treated with an oral anticoagulant (hazard ratio [HR], 0.59) and in those not receiving an oral anticoagulant (HR, 0.45). Multivariate analysis that accounted for multiple risk factors demonstrated that paroxysmal AF was an independent predictor of a reduced risk of stroke/SE relative to persistent AF (HR, 0.51).


Compared to persistent AF, paroxysmal AF is associated with approximately a 50% lower risk of stroke/SE.


Two randomized clinical trials and several observational registry studies reported that the risk of stroke/SE was similar among patients with paroxysmal and persistent AF. Accordingly, current guideline recommendations for anticoagulation are the same for all patients with AF. It would be imprudent to take the type of AF into account when deciding whether or not to anticoagulate a patient with AF based on this observational cohort study.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Embolism, Incidence, Risk, Risk Factors, Stroke

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