Riccio PM, Klein F, Pagani Cassará F, Muñoz Giacomelli F, González Toledo ME, Racosta J, Delfitto M, E.S Roberts, Dra. Cecilia Bahit, Sposato L.  Newly diagnosed atrial fibrillation linked to wake-up stroke and TIA: Hypothetical implications. Neurology 2013 10.1007/s00415-012-6624-1

Newly diagnosed atrial fibrillation linked to wake-up stroke and TIA: Hypothetical implications.

Autores Riccio PM, Klein F, Pagani Cassará F, Muñoz Giacomelli F, González Toledo ME, Racosta J, Delfitto M, E.S Roberts, Dra. Cecilia Bahit, Sposato L. 
Año 2013
Journal  Riccio PM, Klein F, Pagani Cassará F, Muñoz Giacomelli F, González Toledo ME, Racosta J, Delfitto M, E.S Roberts, Dra. Cecilia Bahit, Sposato L. 
Volumen 80: 1834-1840
Abstract  BACKGROUND: Based on the higher frequency of paroxysmal atrial fibrillation during night and early morning hours, we sought to analyze the association between newly diagnosed atrial fibrillation and wake-up ischemic cerebrovascular events.METHODS: We prospectively assessed every acute ischemic stroke and TIA patient admitted to our hospital between 2008 and 2011. We used a forward step-by-step multiple logistic regression analysis to assess the relationship between newly diagnosed atrial fibrillation and wake-up ischemic stroke or TIA, after adjusting for significant covariates.RESULTS: The study population comprised 356 patients, 274 (77.0%) with a diagnosis of acute ischemic stroke and 82 (23.0%) with TIA. A total of 41 (11.5%) of these events occurred during night sleep. A newly diagnosed atrial fibrillation was detected in 27 patients of 272 without known atrial fibrillation (9.9%). We found an independent association between newly diagnosed atrial fibrillation and wake-up ischemic stroke and TIA (odds ratio 3.6, 95% confidence interval 1.2-7.7, p = 0.019).CONCLUSIONS: The odds of detecting a newly diagnosed atrial fibrillation were 3-fold higher among wake-up cerebrovascular events than among non-wake-up events. The significance of this independent association between newly diagnosed atrial fibrillation and wake-up ischemic stroke and TIA and the role of other comorbidities should be investigated in future studies.
Otra información  Este estudio utilizó la metodología de diseño prospectivo de una base de datos para responder una serie de preguntas clínicas y fisiopatológicas a lo largo de una secuencia de publicaciones sobre mecanismos e implicancias de la fibrilación auricular detectada luego del stroke. El estudio demuestra que si el stroke ocurre durante el sueño (“wake up stroke”), el riesgo de detectar una nueva fibrilación auricular es casi 4 veces mayor que si ocurre durante la vigilia. Estos resultados contribuyen, desde el punto de vista clínico, a fomentar la búsqueda de fibrilación auricular paroxística en pacientes con wake up stroke; y desde el punto de vista fisiopatológico al planteo de fenómenos autonómicos y/o relacionados con el sueño en la relación entre la enfermedad cerebrovascular y la fibrilación auricular