Stroke / atrial fibrillation are a major cause of mortality and morbidity. FA is responsible for the formation of thrombus in the left auricle, which results in strokes. FA is a common condition that believes at the same time as the aging of the population reaching 1 to 2% of the general population and 5 to 15% of the population over 80 years[1]. It is estimated that approximately 15% to 20% of strokes are attributable to FA[2]. Once the therapeutic of these strokes /non-valval FA remains very limited by the under-delivery of the anticoagulant and the reduction of the pace hence the interest of this study to describe the therapeutic and evolutionary aspects of stroke sadr on non-valval atrial fibrillation in patients hospitalized or followed in the cardiology department of the Hospital Point “G”.

Materials and Methods

This was a prospective and analytical study conducted in the cardiology department of the Point “G” Hospital from January 1, 2016 to May 30, 2018 and involved all patients hospitalized during the study period.

The inclusion criteria were patients of both sexes hospitalized or followed in the cardiology ward for stroke on non-valval atrial fibrillation and who performed cerebral CT, ECG and cardiac Doppler ultrasound.

Included in the study were:

• Patients admitted on suspicion of stroke on FA who did not complete the inclusive check-up,

• patients with incomplete records,

The judging criteria were based on:

Valvulaire1- The positive diagnosis of atrial fibrillation, was based at the ECG on:

• a non-sinus rhythm with absence of P wave, - ripples of the baseline with abnormal ear waves of a very high frequency between 400 to 600/mn, - non-equidistant and non-equipotent QRS.

• The absence of mitral shrinkage or mitral or aortic valve prosthesis to echocardiography.

• An ischemic lesion on the territory of a cerebral artery at the CT scan

The CHA2DS2VASC score was the thrombotic score used in this work.

The HASBLED score was the hemorrhagic score used in this work.

The new oral anticoagulants have not been used in this work.

Definition of terms

Atrial fibrillation (AF) is a supra ventricular rhythm disorder characterized by anarchic and ineffective atrial electrical activity resulting in impaired mechanical function of atria. Ventricular activity is irregular, usually rapid in the absence of auriculoventricular conduction disorders.

Non-valval atrial fibrillation is an atrial fibrillation that occurs in the absence of mitral shrinkage or prosthetic.

Stroke is a neurological dysfunction of vascular origin to be intended cerebral and or reset following here to a left intra atrial thrombus.

Data collection

Patients were recruited from the hospitalization record. The parameters studied in this file were sociodemographic and clinical data, NFS results, thyroid hormone dosage, fasting blood glucose, creatinemia, blood ionogram, head chest x-ray, echocardiography, ECG and cerebral CT. Word and Excel 2013 software was used for data entry and SPSS 16.0 and Epi Info 3.3.2 software for analysis. The static test used was ki2 with a threshold of 5.

Results

During the study period on 2823 patients admitted, 50 were admitted for non-valvular stroke/FA, representing a hospital prevalence of 1.77%. The average age in the series was 66 years with distribution growth up to 80 years. The predominance was male with a sex ratio of 1.3. Cardiovascular risk factors were dominated by HTA (74%) and smoking (34%). 34% of patients had a history of non-valval heart disease. Body hemi deficiency and left heart failure were the reasons for major consultations with 76% and 48% respectively of frequency. Stroke was the time of discovery of FA in 30 percent of patients. The general condition was maintained in most of our patients (86%), 76 percent of our patients were diagnosed with body hemi. Fa was permanent in the majority of cases with 90% of cases.

Stroke is a neurological dysfunction of vascular origin to be intended cerebral and or reset following here to a left intra atrial thrombus

Data collection

Patients were recruited from the hospitalization record. The parameters studied in this file were sociodemographic and clinical data, NFS results, thyroid hormone dosage, fasting blood glucose, creatinemia, blood ionogram, head chest x-ray, echocardiography, ECG and C cerebral T. Word and Excel 2013 software was used for data entry and SPSS 16.0 and Epi Info 3.3.2 software for analysis. The static test used was ki2 with a threshold of 5.

Results

During the study period on 2823 patients admitted, 50 were admitted for non-valvular stroke / FA, representing a hospital prevalence of 1.77%. The average age in the series was 66 years with distribution growth up to 80 years. The predominance was male with a sex ratio of 1.3. Cardiovascular risk factors were dominated by HTA (74%) and smoking (34%). 34% of patients had a history of non-valval heart disease. Body hemi deficiency and left heart failure were the reasons for major consultations with 76 % and 48% respectively of frequency. Stroke was the time of discovery of FA in 30 percent of patients. The general condition was maintained in most of our patients (86%), 76 percent of our patients were diagnosed with body hemi. Fa was permanent in the majority of cases with 90% of cases is explained by fibrosis, enlarged heart muscle and hypercoagulability of the elderly. The pre-eminence of high blood pressure and smoking is also found in Fofana[5]. Stroke was the time of discovery of FA in 30% of patients with a delayed diagnosis. The body hemi deficiency was present with 76 percent frequency, same in Triki and all[6]. We deduce that this syndrome should prompt us to pay more attention to the search for atrial fibrillation in elderly patients. The FA was permanent in the majority of cases (90%), same observation in Levy. S. and all[7] which reported a permanent FA frequency of 70 per cent. On echocardiography, the atrial dilation found in our study has a role in the installation of atrial fibrillation as described in Kalifa’s work[8]. The ischemic nature of stroke on FA to the brain scan found in our series is classic. Therapeutically, all of our patients were indebted to anticoagulation according to the CHA2DS2VASC score, but given the high hemorrhagic risk in 27% and for financial and geographical reasons making it difficult to achieve INR in some, only 58% were able to benefit from this anticoagulation with the antivitamin k. Our AVK utilization rate was higher than 45.20% of Samba S.[9]. Direct oral anticoagulants were not used. A chemical reduction with cordarone was attempted without success in 8% of patients. The other drugs used were IECs, diuretics, anti-arrhythmics and digital. Beta-blockers were the most commonly used anti-arrhythmic class with 48% of cases, less than 52.40% of Samba S[9]. No hemorrhagic incidents were recorded.

The average hospital stay was 15 days and a favourable natural development without hospital complications in 76% of cases. Mortalitywas 24%.

Conclusion

Ischemic stroke on atrial fibrillation is an entity frequently encountered in hospitalization in the cardiology ward; the search for an FA must be performed in front of any neurological deficit that is most often revealing. Anticoagulant treatment should be tailored to each clinical situation, taking into account age, the presence of comorbidity and certain contraindications

Table 1: Distribution of patients by age and sex

Table 2: Distribution of patients according to personal medical history

Table 3: Distribution of patients according to anti-thrombotic, anti-arrhythmic and digital therapy

Table 4: Distribution according to hospital development and length of hospital stay

References

1. 1. Naccarelli, G. V., Varker, H., Lin, J., et al. Prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 2009; 104(11): 1534-1539.

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2. 2. Kirchhof, P., Auricchio, A., Bax, J., et al. Outcome parameters for trials in atrial fibrillation: executive summary. Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence Network (AFNET) and the European Heart Rhythm Association. (2007) (EHRA) J 28(22) :28 :2803-2817

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3. 3. fibrillation atriale non valvulaire et AVC. (2003) La lettre du cardiologue 374 Avril 2004.

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4. 4. Bembilab –Perrot B Fibrillation auriculaire. (2010) EMC 11-034A-1028.

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5. 5. Fofana, D. étude de la fibrillation atriale dans le service de cardiologie du CHU Mère-Enfant le Luxembourg Aspect étiologique, thérapeutique et pronostique.

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6. 6. Triki et all : caractéristiques épidémiologiques et pronostique de la FA à propos de 642 cas au service de cardiologie hôpital

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7. 7. Levy, S., Maarek, M., Coumel, P., et al. Characterisation of different subsets of atrial fibrillation general practice in France. (1999) Circulation 99(23) : 3028-3035.

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8. 8. Diallo, K. Aspects cliniques et évolutifs de la fibrillation atriale non valvulaire au CHU du Point G, service de cardiologie. Thèse de médecine (2015).

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9. 9. Samba, S., Diall, I. B., Diallo, B., et al. problématique de l’anticoagulation dans la fibrillation atriale du sujet âgé au service de cardiologie du CHU du Point G. (2018) Researchfr Ù¥ : ٢٦١٦.

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