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THE RISK OF SILENT STROKES IN PATIENTS UNDERGOING ELECTRICAL CARDIOVERSION FOR ATRIAL FIBRILLATION. THE NORWEGIAN ATRIAL FIBRILLATION AND STROKE TRIAL (THE NOR-FIB STUDY II)

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ESOC-2019

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Abstract

The risk of silent strokes in atrial fibrillation and electrical cardioversion. The Norwegian Atrial Fibrillation and Stroke Trial (The NOR-FIB Study II) Gudrun Anette Hoeie1, Anne Hege Aamodt2, Dan Atar3, Mona-Elisabeth Revheim4, Kjetil Steine5, Bente E. Halvorsen6, David Russell6. 1 Department of Cardiology, Oestfold Hospital Trust, Norway 2Department of Neurology, Oslo University Hospital, Norway 3Department of Cardiology, Oslo University Hospital, Norway 4Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway 5Department of Cardiology, Oslo University Hospital, Norway 6Institute of Clinical Medicine, University of Oslo, Norway Session type: Abstract submission Topic: Ongoing trial Presentation preference: Oral presentation Background and Aims: Patients with persistent atrial fibrillation (AF) needs a strategy for rhythm control, symptom relief and restoring sinus rhythm. Electrical cardioversion is widely used and associated with a non-negligible risk of peri-procedural stroke or systemic embolism. Prior anticoagulation of 3 to 4 weeks before and after cardioversion reduces the risk of clinical embolism to less than 1%. However, it is not known if this procedure causes cerebral micro-embolization and small silent brain infarcts. The aim of the NOR-FIB II Study is to find the risk of new small cerebral infarcts detected with diffusion-weighted MRI after direct-current cardioversion of persistent AF and assess the impact of inflammation and fibrosis measured by biomarkers in blood and cardiac 18F-FDG-PET. We will also assess cognitive and cerebral structural and metabolic changes after direct-current cardioversion for AF using cognitive tests and cerebral and cardiac 18F-FDG-PET before and 12 months after treatment. Method: This study is an ongoing prospective single-center observational study on patients with persistent AF who are scheduled for non-urgent direct-cardioversion taking a cerebral DWMRI before and one to two weeks after direct-current cardioversion. After 12 months a follow-up with cardiological and neurological assessments, blood samples, cerebral DWMRI, cardiac and cerebral 18F-FDG examinations. Conclusion: The study will increase the knowledge regarding the risk of new cerebral infarcts when persistent AF is treated with electrical cardioversion and the risk of reduced cognitive function and new cerebral infarcts after 12 months follow-up. Keywords: atrial fibrillation cardioversion stroke risk

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All rights reserved.