The Influence Of First-detected Episode Of And Chronic Atrial Fibrillation On The Intravenous Thrombolysis In Acute Ischemic Stroke

Objective:To investigate the influence of first-detected episode of and chronic atrial fibrillation on the recanalization, hemorrhagic transformation and90-day neurological outcome in acute ischemic stroke after intravenous recombinant tissue plasminogen activator (rtPA).Methods:Between June2009and August2013, consecutive patients with acute ischemic stroke who received intravenous rtPA at Second Affiliated Hospital of Zhejiang University were included in our study. The patients were divided into3groups, no atrial fibrillation group, first-detected episode of atrial fibrillation and chronic atrial fibrillation (have a history of AF before stroke onset). Multivariate regression analysis was performed to identify the predictor of3groups on arterial occlusive lesion recanalization (AOL) score, hemorrhagic transformation (defined by ECASS Ⅱ) and90days neurological outcome (modified Rankin Score<2).Results:In total,327patients were included in our study,57(17.4%) patients had first-detected episode of atrial fibrillation, and78(23.9%) patients had chronic atrial fibrillation. Multivariate regression analysis demonstrated that chronic atrial fibrillation increased Parenchymal Hematoma (PH)(OR=3.461,95%CI:1.185-10.370; P=0.023) and symptomatic intracranial hemorrhage(sICH)(OR=5.507,95%CI:1.364-22.240; P=0.017), didn’t affect Hemorrhagic Infarction (HI)(OR=1.239,95%CI:0.602-2.550; P=0.560). First-detected episode of atrial fibrillation was the risk factor of PH (OR=3.220,95%CI:1.000-10.370; P=0.05), and had a tendency of increasing HI (OR=1.943,95%CI:0.916-4.118; P=0.083). Atrial fibrillation didn’t influence the90-day neurological outcome (First-detected episode of atrial fibrillation:OR=1.330,95%CI:0.636-2.793; P=0.449; Chronic atrial fibrillation:OR=1.104,95%CI:0.559-2.181; P=0.766). In58(16.5%) patients with AOL score, first-detected episode of atrial fibrillation was not an independent risk of recanalization(OR=6.600,95%CI:1.484-29.355; P=0.013), while chronic atrial fibrillation not(OR=0.818,95%CI:0.221-3.031; P=0.764).Conclusion:Atrial fibrillation is not an independent risk of90-day neurological outcome in acute ischemic stroke after thrombolysis. First-detected episode of atrial fibrillation increase recanalization, HI and PH, chronic atrial fibrillation increase PH and sICH. At least, first-detected episode of atrial fibrillation is more effective than chronic atrial fibrillation on thrombolytic treatment.