Atrial Fibrillation Following Middle Cerebral Artery Infarct

J Korean Neurol Assoc > Volume 18(5); 2000 > Article

Journal of the Korean Neurological Association 2000;18(5): 551-555.

중대뇌동맥 경색 후 발생한 심방세동

강사윤, 나정호 ·하충건

인하대학교 의과대학 신경과학교실

Atrial Fibrillation Following Middle Cerebral Artery Infarct

Sa-yoon Kang, M.D., Joung-Ho Rha, M.D., Chung-kun Ha, M.D.

Department of Neurology, College of Medicine, Inha University

Abstract

"Background : Atrial fibrillation (AF), commonly considered as a cardiac embolic source, can itself be induced by stroke. We therefore tried to find and analyze this ‘stroke-induced’ AF. Methods : From the Inha University Stroke Registry of the past 2 years, 143 middle cerebral artery (MCA) territorial infarct patients who had been admitted within 48 hours after stroke onset were recruited to participate in the study. Electrocardiograms (EKG) on admission and fol-low- up during hospitalization were analyzed. Also, MCA infarct was subdivided according to insular involvement by brain imaging. Results : Among 143 MCA territorial infarcts, 38 patients had AF on admission (Rt:21; Lt:17). Of those, insular involvements of the MCA infarct was noted in 32 patients. All the patients had a follow-up EKG and AF disap-peared in 3 patients (Rt:2; Lt:1). In the remaining 105 patients, 10 patients subsequently developed new AF within 1 week after hospitalization. All those 10 patients had right-sided MCA infarcts and insular involvements were present in 9 patients. In summary, among the 48 MCA infarct associated with AF, 13 AF (Rt:12; Lt:1) were presumed to be the consequence and not the cause of stroke. Conclusions : Though human insular stimulation and inactivation studies have suggested that AF would be more common in left insular destructive lesions, it was not always supported in clinical series. From our study, presumed ‘stroke-induced’ AF was highly associated with right insular lesions. The mechanism of arrhythmogenesis by ischemic stroke might be more complicated than previously expected and, not merely the sim-ple inactivation of an anatomical substrate, the insular cortex. J Korean Neurol Assoc 18(5):551~555, 2000 Key Words : MCA infarct, Insular cortex, Atrial fibrillation"