Frequency of systemic embolic events in patients presenting with atrial fibrillation


  • Syeda Rubab Zahra Punjab Institute of Cardiology, Lahore
  • Imrana Nawaz Punjab Institute of Cardiology, Lahore
  • Tehseen Javed Punjab Institute of Cardiology, Lahore
  • Sajjad Ahmad Punjab Institute of Cardiology, Lahore



Systemic, Embolic events, Atrial fibrillation


INTRODUCTION: The risk of stroke in patients with atrial fibrillation (AF) is well recognized, but data from a new study published in Circulation now indicate that AF is also associated with an increased risk of extracranial systemic embolic events, and that these thromboembolic events confer high morbidity and mortality.

AIM & OBJECTIVE: To determine the frequency of systemic embolic events in patients presenting with atrial fibrillation

MATERIAL & METHODS: It was a cross sectional study conducted at Cardiology Ward, Punjab Institute of Cardiology, Lahore for the period of six months i.e. from 1st December 2016 to 31st May 2017. Total 241 patients who will fulfil the selection criteria were enrolled in the study from emergency of PIC, Lahore. Informed consent was obtained from all patients. Their demographic information was also noted. Then patients had undergone venogram for assessment of presence or absence of embolism. All venogram were done by single senior radiologist having at least 4 years’ experience. Reports were assessed and systemic embolism was noted. All this information was recorded on proforma. Patients diagnosed with embolism were managed as per hospital protocol.

RESULTS: In this study systemic embolism events were diagnosed in 101(41.91%) patients who presented with AF. These systemic embolism events did not show any statistically significant association with age, gender (male patients with higher frequency for systemic embolism events p-value=0.566), duration of AF (frequency of systemic embolism events was higher in patients with longer duration of AF p-value=0.254) and diabetic history (frequency of systemic embolism events was higher in patients without diabetes, p-value=0.892)

CONCLUSION: Results of this study demonstrated a high frequency of systemic embolism in patients presenting with AF. In routine practice systemic embolism often remain unfocused. So it is strongly suggested that as this condition have a potential impact on high morbidity, mortality, and financial healthcare so it should be managed as aggressively as stroke.

KEY WORDS: Systemic, Embolic events, Atrial fibrillation

Author Biographies

Syeda Rubab Zahra, Punjab Institute of Cardiology, Lahore

Medical Officer Cardiology

Imrana Nawaz, Punjab Institute of Cardiology, Lahore

Medical Officer Cardiology

Tehseen Javed, Punjab Institute of Cardiology, Lahore

Senior Registrar Cardiology

Sajjad Ahmad, Punjab Institute of Cardiology, Lahore

Professor of Cardiology


Albertsen IE, Rasmussen LH, Overvad TF, Graungaard T, Larsen TB, Lip GY. Risk of stroke or systemic embolism in atrial fibrillation patients treated with warfarin a systematic review and meta-analysis. Stroke 2013;44(5):1329-36.

Yuan Z, Bowlin S, Einstadter D, Cebul RD, Conners Jr AR, Rimm AA. Atrial fibrillation as a risk factor for stroke: a retrospective cohort study of hospitalized Medicare beneficiaries. American Journal of Public Health 1998;88(3):395-400.

Haruki S, Minami Y, Hagiwara N. Stroke and Embolic Events in Hypertrophic Cardiomyopathy Risk Stratification in Patients Without Atrial Fibrillation. Stroke 2016;47(4):936-42.

Bekwelem W, Connolly SJ, Halperin JL, Adabag S, Duval S, Chrolavicius S, et al. Extracranial systemic embolic events in patients with nonvalvular atrial fibrillation: incidence, risk factors, and outcomes. Circulation 2015:CIRCULATIONAHA. 114.013243.

Petersen P. Thromboembolic complications in atrial fibrillation. Stroke 1990;21(1):4-13.

Petersen P, Godtfredsen J, Boysen G, Andersen E, Andersen Br. Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFASAK study. The Lancet 1989;333(8631):175-9.

Abbott WM, Maloney RD, McCabe CC, Lee CE, Wirthlin LS. Arterial embolism: a 44 year perspective. The American Journal of Surgery 1982;143(4):460-4.

Amin A, Houmsse A, Ishola A, Tyler J, Houmsse M. The current approach of atrial fibrillation management. Avicenna journal of medicine 2016;6(1):8.

Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest Journal 2010;137(2):263-72.

Hirsch AT, Allison MA, Gomes AS, Corriere MA, Duval S, Ershow AG, et al. A call to action: women and peripheral artery disease: a scientific statement from the American Heart Association. Circulation 2012;125(11):1449-72.

Redfield MM, Rodeheffer RJ, Jacobsen SJ, Mahoney DW, Bailey KR, Burnett JC. Plasma brain natriuretic peptide concentration: impact of age and gender. Journal of the American College of Cardiology 2002;40(5):976-82.

Steinberg BA, Hellkamp AS, Lokhnygina Y, Patel MR, Breithardt G, Hankey GJ, et al. Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial. European heart journal 2014:ehu359.

Menke J, Lüthje L, Kastrup A, Larsen J. Thromboembolism in atrial fibrillation. The American journal of cardiology 2010;105(4):502-10.

Lamassa M, Di Carlo A, Pracucci G, Basile AM, Trefoloni G, Vanni P, et al. Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe. Stroke 2001;32(2):392-8.

Wasilewska M, Gosk-Bierska I. Thromboembolism associated with atrial fibrillation as a cause of limb and organ ischemia. Adv Clin Exp Med 2013;22(6):865-73.

Lim GB. Atrial fibrillation: Risk of systemic emboli in AF. Nature Reviews Cardiology 2015.

Gerth A, Nabauer M, Oeff M, Haeusler K, Limbourg T, Treszl A, et al. Stroke events in patients with CHADS2 scores 0 and 1 in a contemporary population of patients with atrial fibrillation: results from the German AFNET registry. European Heart Journal 2013;34(suppl 1):4381.

Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. Edoxaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine 2013;369(22):2093-104.

Olesen JB, Torp-Pedersen C, Hansen ML, Lip GY. The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0–1: a nationwide cohort study. Thrombosis and haemostasis 2012;107(6):1172-9.

Marzona I, O'donnell M, Teo K, Gao P, Anderson C, Bosch J, et al. Increased risk of cognitive and functional decline in patients with atrial fibrillation: results of the ONTARGET and TRANSCEND studies. Canadian Medical Association Journal 2012:cmaj. 111173.