Early heart rhythm control linked to 44% lower recurrent stroke risk in cohort study
A nationwide cohort study in Japan found that restoring sinus rhythm within eight weeks of acute ischemic stroke was associated with fewer recurrent thromboembolic events.
Researchers at Kyoto University analyzed data from 14,355 patients hospitalized for acute ischemic stroke with co-occurring atrial fibrillation between 2014 and 2025 using the DeSC-IQVIA administrative database in Japan. According to the study published in Neurology, initiating rhythm control within eight weeks of admission was associated with a 44% lower risk of recurrent ischemic stroke or systemic embolism compared with standard care doi.org
Neurologydoi.orgOpen source ↗. The median age of the cohort was 83 years, and 48.3% were women.
Only 268 participants, representing 1.9% of the analyzed group, received early rhythm control, which included antiarrhythmic drugs, catheter ablation, or electrical cardioversion. Baseline variables and confounders between the cohorts were balanced using propensity score overlap weighting across 23,583 person-years of follow-up.
Long-Term Risk Reduction
Over a five-year follow-up period, the weighted cumulative incidence of recurrent ischemic stroke or systemic embolism was 8.0% in the early rhythm control group compared to 13.8% in the standard care cohort. This yielded an adjusted cause-specific hazard ratio of 0.56 and an absolute risk difference of -5.9 percentage points.
The researchers reported that early rhythm control was also associated with a reduction in all-cause mortality, showing a hazard ratio of 0.72 doi.org
Neurologydoi.orgOpen source ↗. The association remained stable across varying landmark intervals ranging from 4 to 24 weeks post-stroke.
Safety Profile and Study Limits
Secondary outcome assessments revealed no statistically significant association between early rhythm control and an increased incidence of major bleeding, with a hazard ratio of 1.44. Hospitalization rates for heart failure were likewise comparable between cohorts, yielding a hazard ratio of 0.73.
The authors noted that the observational nature of the claims database limits direct causal inferences, as residual confounding regarding patient selection for interventions may remain. The small proportion of treated individuals reflects current clinical patterns and highlights the need for randomized controlled trials to confirm whether early rhythm restoration can serve as a standard secondary prevention protocol.
