Temporal Association Between Atrial Fibrillation and Ischemic Stroke: Systematic Review and Meta-Analysis

Background:Paroxysmal atrial fibrillation (PAF) is strongly associated with ischemic stroke. Continuous cardiac implantable electronic devices (CIEDs) can assess PAF episodes over prolonged periods. Studies that attempted to find a temporal association between PAF and ischemic stroke were inconclusive. Thus, we performed a systematic review and meta-analysis to assess this relationship.Aims:To assess the temporal association between AF episodes and stroke within 30 days of the arrhythmic episode. The secondary outcome is a temporal association within a 90-day period.Summary of review:A total of 2804 studies that discussed the temporal relationship between PAF and ischemic stroke were screened, and 7 studies were included in the meta-analysis. Amongst the 4041 patients included in these studies, there were 138 patients with device detected PAF episodes and stroke. Four studies used a 30-day window for temporality and the pooled OR showed a significant association (OR 4.11 [95% CI 1.03-16.40]). The 3 studies reporting on AF and stroke within a 90 day window did not find a significant temporal relationship (OR of 0.43 [95% CI 0.13-1.41]). Finally, the pooled result of those 7 studies did not show a significant association (OR 1.51 [95% CI 0.44 – 5.17]).Conclusions:This meta-analysis supports a temporal relationship between PAF and ischemic stroke within a 30-day window. Establishing this relationship is important for individualized risk prediction and targeted anticoagulation treatment.