Association between atrial fibrillation and silent cerebral infarctions: a systematic review and meta-analysis

Shadi Kalantarian, Hakan Ay, Randy L Gollub, Hang Lee, Kallirroi Retzepi, Moussa Mansour, Jeremy N Ruskin
Annals of Internal Medicine 2014 November 4, 161 (9): 650-8

BACKGROUND: Atrial fibrillation (AF) is a common cause of stroke. Silent cerebral infarctions (SCIs) are known to occur in the presence and absence of AF, but the association between these disorders has not been well-defined.

PURPOSE: To estimate the association between AF and SCIs and the prevalence of SCIs in stroke-free patients with AF.

DATA SOURCES: Searches of MEDLINE, PsycINFO, Cochrane Library, CINAHL, and EMBASE from inception to 8 May 2014 without language restrictions and manual screening of article references.

STUDY SELECTION: Observational studies involving adults with AF and no clinical history of stroke or prosthetic valves who reported SCIs.

DATA EXTRACTION: Study characteristics and study quality were assessed in duplicate.

DATA SYNTHESIS: Eleven studies including 5317 patients with mean ages from 50.0 to 83.6 years reported on the association between AF and SCIs. Autopsy studies were heterogeneous and low-quality; therefore, they were excluded from the meta-analysis of the risk estimates. When computed tomography (CT) and magnetic resonance imaging (MRI) studies were combined, AF was associated with SCIs in patients with no history of symptomatic stroke (odds ratio, 2.62 [95% CI, 1.81 to 3.80]; I(2) = 32.12%; P for heterogeneity = 0.118). This association was independent of AF type (paroxysmal vs. persistent). The results were not altered significantly when the analysis was restricted to studies that met at least 70% of the maximum possible quality score (odds ratio, 3.06 [CI, 2.24 to 4.19]). Seventeen studies reported the prevalence of SCIs. The overall prevalence of SCI lesions on MRI and CT among patients with AF was 40% and 22%, respectively.

LIMITATION: Most studies were cross-sectional, and autopsy studies were heterogeneous and not sufficiently sensitive to detect small lesions.

CONCLUSION: Atrial fibrillation is associated with more than a 2-fold increase in the odds for SCI.

PRIMARY FUNDING SOURCE: Deane Institute for Integrative Research in Atrial Fibrillation and Stroke, Massachusetts General Hospital.

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