Frequent Atrial Premature Beats Predict Paroxysmal Atrial Fibrillation in Stroke Patients: An Opportunity for a New Diagnostic Strategy

Background and Purpose. Paroxysmal Atrial fibrillation/Flutter (PAF) detection rates in cryptogenic strokes have been variable. We sought to determine the percentage of patients with cryptogenic stroke who had PAF on prolonged non-invasive cardiac monitoring.Methods and Results. Sixty-two consecutive patients with stroke and TIA in a single center with a mean age of 61 (+/− 14) years were analyzed. PAF was detected in 15 (24%) patients. Only one patient reported symptoms of shortness of breath during the episode of PAF while on monitoring, and 71 (97%) of these 73 episodes were asymptomatic. A regression analysis revealed that the presence of PVCs (ventricular premature beats) lasting more than 2 minutes (OR 6.3, 95% CI, 1.11–18.92;P=.042) and strokes (high signal on Diffusion Weighted Imaging) (OR 4.3, 95% CI, 5–36.3;P=.041) predicted PAF. Patients with multiple DWI signals were more likely than solitary signals to have PAF (OR 11.1, 95% CI, 2.5–48.5,P<.01).Conclusion. Occult PAF is common in cryptogenic strokes, and is often asymptomatic. Our data suggests that up to one in five patients with suspected cryptogenic strokes and TIAs have PAF, especially if they have PVCs and multiple high DWI signals on MRI.

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Abstract WP135: Sinus Bradycardia as a Potential Predictive Factor for Paroxysmal Atrial Fibrillation in Stroke Patients

Stroke ◽

10.1161/str.44.suppl_1.awp135 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Takao Hoshino ◽

Kentaro Ishiduka ◽

Takehiko Nagao ◽

Satoru Shimizu ◽

Shinichiro Uchiyama

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Predictive Factors ◽

Predictive Factor ◽

Paroxysmal Atrial Fibrillation ◽

Multiple Logistic Regression Analysis ◽

Previous History ◽

Stroke Patients ◽

Holter Ecg ◽

Significant Difference

Background and Purpose The detection rate of paroxysmal atrial fibrillation (PAF) in stroke patients is limited because they are often asymptomatic, or presenting sinus rhythm on ECG. To estimate the likelihood of PAF as a cause of ischemic stroke, we attempted to identify predictive factors for PAF using the data of sinus heart rate (SHR) on monitoring ECG. Methods We enrolled 711 consecutive patients admitted to our hospital with acute ischemic stroke. Exclusion criteria were (1) persistent AF; (2) cardiac pacemaker; and (3) incomplete clinical investigations. Minimum and mean SHR on 24-hour Holter ECG were obtained. The presence of PAF was judged based on previous history, initial ECG, 24-hour Holter ECG, and cardiac monitoring by inpatient telemetry. The clinical characteristics were compared between patients with and without PAF (PAF and non-PAF group, respectively), and multiple logistic regression analysis was performed to identify predictors for PAF. Results Of all enrolled patients, 577 patients were eligible for analysis, and PAF was confirmed in 110 (19.1%). Clinical parameters showing a significant difference between PAF and non-PAF groups included: age (mean, 74.1 vs. 66.6, P <0.001); dyslipidemia (32.7% vs. 50.8%, P =0.001); lack of intra- or extracranial stenosis (54.0% vs. 79.1%, P <0.001); chronic heart failure (17.3% vs. 4.9%, P <0.001); and NIHSS score (median, 8 vs. 6, P =0.002). Minimum and mean SHR were lower in PAF group than in non-PAF group (46.4 vs. 54.1 bpm, P <0.001; 71.0 vs. 73.8 bpm, P =0.021, respectively). Percentages of patients with PAF were highest in the lowest quartiles of minimum and mean SHR (Figure). Multivariate analysis showed minimum SHR as one of independent predictive factors of PAF (OR 1.08; 95% CI 1.05 to 1.12; P <0.001). Conclusions Low SHR on monitoring ECG can be a novel predictive factor for PAF in ischemic stroke patients.

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Paroxysmal Atrial Fibrillation in Cryptogenic Stroke Patients With Major-Vessel Occlusion

Frontiers in Neurology ◽

10.3389/fneur.2020.580572 ◽

2020 ◽

Vol 11 ◽

Author(s):

Ryosuke Doijiri ◽

Hiroshi Yamagami ◽

Masafumi Morimoto ◽

Tomonori Iwata ◽

Tetsuya Hashimoto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Cryptogenic Stroke ◽

Stroke Patients ◽

Vessel Occlusion ◽

Major Vessel

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Automatic Holter electrocardiogram analysis in ischaemic stroke patients to detect paroxysmal atrial fibrillation: ready to replace physicians?

European Journal of Neurology ◽

10.1111/ene.14250 ◽

2020 ◽

Vol 27 (7) ◽

pp. 1272-1278 ◽

Cited By ~ 2

Author(s):

S. Gröschel ◽

B. Lange ◽

M. Grond ◽

M. Jauss ◽

P. Kirchhof ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischaemic Stroke ◽

Paroxysmal Atrial Fibrillation ◽

Stroke Patients

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Atrial Refractory Periods after Atrial Premature Beats in Patients with Paroxysmal Atrial Fibrillation

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.1989.tb01919.x ◽

1989 ◽

Vol 12 (7) ◽

pp. 1018-1026 ◽

Cited By ~ 7

Author(s):

MICHEL CHAUVIN ◽

CLAUDE BRECHENMACHER

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Refractory Periods ◽

Premature Beats

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Abstract T P160: Are Severity and Outcome of Ischemic Stroke With Paroxysmal Atrial Fiblliration Different From Those With Chronic Atrial Fibrillation?

Stroke ◽

10.1161/str.45.suppl_1.tp160 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Seiji Miura ◽

Masahiro Yasaka ◽

Koichiro Maeda ◽

Takeshi Uwatoko ◽

Takahiro Kuwashiro ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Paroxysmal Atrial Fibrillation ◽

Medical Records ◽

Chronic Atrial Fibrillation ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Significant Difference ◽

Scale Scores

Background and Purpose: Previous studies indicated that incidence of ischemic stroke did not differ between patients with paroxysmal atrial fibrillation (PAF) and those with chronic atrial fibrillation (CAF). However, it has been under dispute whether severity and outcome of ischemic stroke in patients with PAF differ from those with CAF. Then, we compared them between ischemic stroke patients with PAF and those with CAF. Methods: We obtained data from the medical records of 372 consecutive patients admitted to our hospital, who had acute ischemic stroke with atrial fibrillation, from January, 2008, to December, 2012.We compared neurological severities (NIH stroke scale scores) on admission and discharge, functional outcome evaluated by modified Rankin scale, (mRS) on discharge between patients with PAF and those with CAF. Results: Of 372 patients, 123 patients had PAF (men 62.6%, 78.0 +- 10.0 years old) and 249 patients (men 62.1%, 77.9 +- 9.5 years old) had CAF. There were no significant differences in NIH stroke scale on admission between the PAF group (media 5 with IQR 2-14) and the CAF group (6, 2-16)(P=0.2772). NIH stroke scale scores (1, 0-8.75, vs. 2, 0-10, p=0.1549) and mRS(2, 1-4, vs. 3, 1-4, p=0.2105) on discharge did not differ between the two groups, either. After adjustment for age, sex, modified Rankin scale before admission, diabetes, hypertension, dyslipidemia, there was no significant difference in mRS at discharge between the two groups. (P=0.1416). Conclusion: It seems that the severity and outcome of ischemic stroke with PAF are not different from those with CAF.

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