Thyrotoxic Atrial Fibrillation: Factors Associated with Persistence and Risk of Ischemic Stroke. (12th December 2017)

• Record Type: Journal Article
• Authors: Wong, Cheuk-Lik; Tam, Ho-Kee Vicki; Fok, Chun-Kit Vincent; Lam, Pong-Kai Ellen; Fung, Lai-Ming
• Other Names: Bogazzi Fausto Academic Editor.
• Is Part Of: Journal of thyroid research. Volume 2017(2017)
• Publication Date: 2017-12-12
• Subjects: Thyroid gland -- Cancer -- Periodicals; Thyroid gland -- Diseases -- Periodicals; 616.99444
• DOI: 10.1155/2017/4259183
• Languages: English
• ISSNs: 2090-8067

Abstract

Abstract : Background . Atrial fibrillation (AF) is one of the commonest cardiovascular manifestations of thyrotoxicosis. A significant proportion of patients have persistent AF which may have long term consequences, for example, ischemic stroke. Methods . We performed a retrospective cohort study in a regional hospital from January 2004 to June 2016 to examine the clinical characteristics and outcomes of thyrotoxic patients who presented with atrial fibrillation and to investigate possible factors associated with persistent atrial fibrillation and ischemic stoke. Results . Among 1918 patients who had a diagnosis of thyrotoxicosis, 133 (6.9%) patients presented with AF. Spontaneous sinus conversion occurred in 89 (66.9%) patients in which 85 (94%) patients developed sinus conversion before or within 6 months after having achieved euthyroidism. The remaining 44 (33.1%) had persistent AF. The rate of ischemic stroke was numerically higher among patients who had persistent AF than those with spontaneous sinus conversion (15.9% versus 10.1%; log-rank 0.442, p = 0.506 ). Patients who sustained an ischemic stroke were older (71 ± 11 years versus 62 ± 16 years, p = 0.023 ) and had a trend towards higherC H A 2 D S 2 -VASc score (2.9 ± 1.7 versus 2.3 ± 1.7, p = 0.153 ). History of smoking (adjusted odds ratio 4.9, 95% CI[ 1.8, 14.0 ], p = 0.002 ), a larger left atrial diameter (adjusted odd ratio 2.6, 95% CI[ 1.2, 5.5 ], p = 0.014 ), and a relatively lower free thyroxine level at diagnosis (adjusted odd ratio 2.1, 95% CI[ 1.2, 3.5 ], p = 0.008 ) were associated with persistence of AF on multivariate analysis. Conclusion . Persistence of thyrotoxic AF occurred in one-third of patients and spontaneous sinus conversion was unlikely after six months of euthyroidism. High rate of ischemic stroke was observed among patients with persistent thyrotoxic AF and older age. Patients with factors associated with persistent AF, especially older people, should be closely monitored beyond 6 months so that anticoagulation can be initiated in a timely manner to reduce risk of ischemic stroke.