• Kensuke Takabayashi, Yasuhiro Hamatani, Yugo Yamashita, Daisuke Takagi, Takashi Unoki, Mitsuru Ishii, Moritake Iguchi, Nobutoyo Masunaga, Hisashi Ogawa, Masahiro Esato, Yeong-Hwa Chun, Hikari Tsuji, Hiromichi Wada, Koji Hasegawa, Mitsuru Abe, Gregory Y H Lip, and Masaharu Akao.
• From the Department of Cardiology (K.T., Y.H., Y.Y., D.T., T.U., M. Ishii, M. Iguchi, N.M., H.O., M. Abe, M. Akao) and Divison of Translational Research (H.W., K.H.), National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E., Y.-H.C.); Tsuji Clinic, Kyoto, Japan (H.T.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.).
• Stroke. 2015 Dec 1; 46 (12): 3354-61.

Background And PurposeThere is controversy on the relationship of the type of atrial fibrillation (AF) to stroke. Although several studies show that patients with paroxysmal AF (PAF) have a stroke risk similar to those with persistent or permanent AF, recent studies suggest that PAF is associated with a lower rate of stroke. Limited data on stroke risk associated with PAF are evident in Asian populations.MethodsThe Registry Study of Atrial Fibrillation Patients in Fushimi-ku (Fushimi AF Registry) is a community-based survey of patients with AF in Fushimi-ku, Kyoto, Japan. Patients were categorized into 2 types of AF: PAF or sustained (persistent or permanent) AF. We compared clinical events between PAF (n=1588) and sustained AF (n=1716).ResultsPatients with PAF were younger, had less comorbidities, and received oral anticoagulants (OAC) less commonly. A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed (non-OAC users: hazard ratio, 0.45; 95% confidence intervals, 0.27-0.75; P<0.01 and OAC users: hazard ratio, 0.59; 95% confidence interval, 0.35-0.93; P=0.03). The composite end point of stroke/systemic embolism/all-cause mortality was also lower in PAF, whether among OAC users (hazard ratio, 0.77; 95% confidence interval, 0.59-0.99; P=0.046) or non-OAC users (hazard ratio, 0.59; 95% confidence interval, 0.46-0.75; P<0.01). On multivariate analysis, PAF was an independent predictor of lower stroke/systemic embolism risk.ConclusionsIn this large cohort of Japanese patients with AF, PAF was independently associated with lower incidence of stroke/systemic embolism than sustained AF. This may aid decision making for anticoagulation, especially in those patients with AF with few stroke risk factors.Clinical Trial RegistrationURL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000005834.© 2015 American Heart Association, Inc.

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