Arterial embolism and atrial arrhythmias

In a retrospective study, the frequency of atrial arrhythmias of types known to cause systemic embolisation and the effect of anticoagulant treatment were studied in 106 patients with arterial embolism. Such embolising arrhythimas were found in 84 patients (79%). Permanent atrial fibrillation was documented in 53 patients (50%) and episodic atrial arrhythmia was encountered in 28 patients (26%). In 21 of 28 patients with sinus rhythm on admission, an embolising arrhythmia could be identified in previous ECG recordings. Patients with atrial arrhythmias had a significantly higher rate of prior embolic episodes and embolic events during follow-up (53 events in 84 patients) compared to the patients without arrhythmia (6 events in 22 patients) (P less than 0.05). In patients with atrial arrhythmias postoperative treatment with peroral anticoagulation was associated with a lower mortality (P less than 0.003) and a lower rate of reembolisation and stroke (P less than 0.0005). It is concluded that every fourth patient presenting with arterial embolism had an atrial arrhythmia of episodic nature. Most of these patients had normal sinus rhythm on admission but could be identified in previous ECG recordings. This study suggests that patients with arterial embolism and atrial arrhythmia have a higher risk of further embolisation with an ensuing risk of morbidity and death, compared to patients without arrhythmia. A positive effect of anticoagulation seemed to be present in patients with atrial arrhythmia whereas such a positive effect could not be identified in patients without arrhythmia.