After stroke and AFib, restoring heart rhythm linked to lower risk of another stroke

by American Academy of Neurology

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For people hospitalized with ischemic stroke and atrial fibrillation (AFib), restoring the heart's normal rhythm within eight weeks after stroke is associated with a lower risk of having another stroke, according to a new study published in Neurology.

Ischemic stroke, the most common type of stroke, is when blood flow is blocked to part of the brain. The study does not prove that early rhythm control prevents a second stroke; it only shows an association.

Atrial fibrillation is an irregular and often very rapid heartbeat. Early rhythm control restores the heart's normal rhythm, either with medication; electrical cardioversion, which is a quick electrical shock; or catheter ablation, which uses heat, cold or electricity to create a scar to block abnormal electrical impulses.

"With just atrial fibrillation, restoring the heart's normal rhythm early reduces the risk of cardiovascular events later," said study author Yuichi Imanaka, M.D., M.P.H., Ph.D., of Kyoto University in Japan. "But less is known about the combination of ischemic stroke and AFib. Our study shows when a person has both stroke and AFib, early rhythm control is associated with a reduced risk of a second stroke."

For the study, researchers identified 14,355 people with an average age of 83 who were admitted to a hospital with both ischemic stroke and AFib. Of the participants, 2%, or 268 people, received early rhythm control: 206 received medication; 68 had catheter ablation; and 32 had electrical cardioversion. Some people had more than one of these treatments.

Researchers then looked at how many people were hospitalized again for a second ischemic stroke or a systemic embolism, a blood clot that occurs in another part of the body.

Over 23,583 person-years, 1,257 people had another stroke or blood clot. Of this group, 13 had received early rhythm control and 1,244 had not. Person-years represent both the number of people in the study and the amount of time each person spent in the study.

Researchers used a method to adjust for differences between the groups based on factors such as other medical conditions, frailty and stroke severity.

Over five years, researchers determined that people who received early rhythm control had an 8% risk of a second stroke or blood clot compared to a 14% risk for people who did not receive such treatment.

Researchers found early rhythm control was associated with a 44% lower risk of stroke and blood clot.

They also found that early rhythm control was associated with a 28% lower risk of death from all possible causes.

"People who have an ischemic stroke are prescribed anticoagulants, medications that stop the blood from clotting easily, to prevent a second stroke," said Imanaka.

"Our study suggests that early rhythm control may serve as another prevention strategy, with flexible timing of initiation, within eight weeks of stroke."

A limitation of the study was the small number of participants who received early rhythm control. Imanaka says future studies are needed in larger groups of people to confirm the findings.

Publication details

Shuhei Egashira et al., Early Rhythm Control vs Usual Care After Acute Ischemic Stroke in Patients With Atrial Fibrillation, Neurology (2026). DOI: 10.1212/wnl.0000000000218736 , www.neurology.org/doi/10.1212/WNL.0000000000218736

Journal information: Neurology

Key medical concepts

Atrial FibrillationIschemic StrokeAll-Cause Mortality

Clinical categories

NeurologyCardiologyCommon illnesses & Prevention Provided by American Academy of Neurology Who's behind this story?

Sadie Harley

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