Abstract 15866: The Utility of Extended Electrocardiographic Monitoring for Detecting Atrial Fibrillation in Cryptogenic Stroke in the African-american Population

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Romy Rodriguez Ortega ◽  
Mohammed AlSadawi ◽  
Violeta Capric ◽  
Baho Sidiqi ◽  
Jonathan Francois ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
African American ◽  
Univariate Analysis ◽  
Cryptogenic Stroke ◽  
Disease Diagnosis ◽  
Channel Blockers ◽  
Ecg Monitoring ◽  
Loop Recorder ◽  
Electrocardiographic Monitoring ◽  
Baseline Characteristics

Introduction: Cryptogenic stroke comprises about 25% of all ischemic strokes. Depending on modality and duration of ECG monitoring, subclinical atrial fibrillation (AF) is detectable in 2.7-30% of cryptogenic stroke patients. Hypothesis: Extended ECG monitoring has not been studied in the African American (AA) population. This retrospective study aims to study the incidence and risk factors of subclinical AF in African-Americans. Methods: We retrospectively reviewed 96 patients who received implantable loop recorders (ILR) for detecting subclinical atrial fibrillation after cryptogenic stroke. In the vast majority of patients, the ILR was implanted during the index hospitalization. Binary univariate and multivariate analyses were performed to determine predictors for AF detection. Results: AF was detected in 29% of patients (28/96) at 1000 days. All AF that was detected was exquisitely paroxysmal and ranged in duration between 0.05-103 minutes (mean 8.4 minutes with SD= 22.1 minutes). Baseline characteristics of patients are presented (Table 1A). Binary univariate analysis revealed the use of non-dihydropyridine calcium-channel blockers to be associated with decreased odds of AF detection. (Table 1B, C). Multivariate analysis found coronary artery disease diagnosis to be associated with increased odds of AF detection. Fifty-percent of the events in the AF group were detected within the first 36 days of loop recorder implantation (Fig 1). Conclusions: AF detection in our population occurs very early after index stroke and at significantly higher rates than reported in the CRYSTAL AF trial. Baseline characteristics have a poor predictive ability for the detection of AF. These findings emphasize the need for pre-discharge ILR implantation to improve AF detection in all patients with cryptogenic stroke.

Predictors of atrial fibrillation in patients with cryptogenic stroke and fifteen-days electrocardiographic monitoring. Preliminary results of the DECRYPTORING study

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Vera Sainz ◽  
A Cecconi ◽  
P Martinez Vives ◽  
A Ximenez Carrillo ◽  
C Aguirre ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Retrospective Studies ◽  
Cryptogenic Stroke ◽  
P Value ◽  
Ecg Monitoring ◽  
Funding Sources ◽  
Electrocardiographic Monitoring ◽  
3D Volume ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. onbehalf DECRYPTORING study Introduction Cryptogenic stroke (CS) represents up to 30% of all stroke types.  In one third of CS, atrial fibrillation (AF) is identified as the underlying cause. Predictors of AF in the setting of CS have been described, however these findings were based on retrospective studies and with maximum ECG monitoring of 72 hours. To overcome these limitations, we designed the prospective Decryptoring study whose objective is to create a comprehensive predictive model for AF in patients with CS. Methods From April 2019, 41 consecutive patients with a CS and age > 60 years were included. On admission, a transthoracic echocardiogram with 3D volume and left atrial (LA) strain was performed. All patients were monitored with a 15-day ECG-Holter after discharge. Patients were classified according to AF detection. Results AF was detected in 9 patients (22%). Patients with AF were older (75.9 ± 8 vs. 81.9 ± 4.3 years, p = 0.041). There was no difference in T-troponin levels. NTproBNP was higher in the group with AF (350 ± 586 pg / ml vs. 1084 ± 1416 pg / ml, p = 0.018). Regarding LA strain, patients with AF presented reservoir LA strain (25.5 ± 8.2% vs 17.4 ± 4.3%; p = 0.006) and conduct LA strain (12 ± 5.2% vs 7.2 ± 1.5%; p = 0.01) lower than patients without AF. There were no differences in contraction LA strain or other echocardiographic variables. The risk of developing AF was higher in patients with NTproBNP> 165 pg / ml (OR 11.3 [95% CI 1.2-102.9] p = 0.031), LA reservoir strain <19.1% (OR 7.7 [IC 95 % 1.5-40.0] p = 0.016) and LA conduct strain <9.1% (OR 7.8 [95% CI 1.3-45.0] p = 0.022) (Table). Conclusions This prospective study, demonstrates that high NTproBNP, low reservoir LA strain and low conduct LA strain are associated with underlying AF in patients with cryptogenic stroke. No AF (n = 32) AF (n = 9) P value Age (years) 75.9 ± 8 81.9 ± 4.3 p = 0.041 NTPROBNP (pg/ml) 350 ± 586 1084 ± 1416 P = 0.018 LA indexed diastolic volume (ml/m2) 30 ± 11.8 33.8 ± 9.8 P = 0.35 LA EF (%) 45 ± 16.7 45 ± 12.8 P = 1 Reservoir LA strain (%) 25.5± 8.2 17.4± 4.3 P = 0.006 Conduct LA strain (%) 12 ± 5.2 7.2 ± 1.5 P = 0.01 Contraction LA strain (%) 13.5 ±5.3 10.2± 3.9 P = 0.10 NTPROBNP > 165 pg/ml 12 (41%) 8 (89%) OR 11.3 [IC 95% 1.2-102.9]; p = 0.031 Reservoir LA strain <19.1% 6 (20%) 6 (67%) OR 7.7 [IC 95% 1.5-40.0]; p = 0.016 Conduct LA strain <9.1% 9 (31%) 7 (78%) OR 7.8 [IC 95% 1.3-45.1]; p = 0.022

scholarly journals Potential Biological Markers of Atrial Fibrillation: A Chance to Prevent Cryptogenic Stroke

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
István Szegedi ◽  
László Szapáry ◽  
Péter Csécsei ◽  
Zoltán Csanádi ◽  
László Csiba
Keyword(s):  
Atrial Fibrillation ◽  
Biological Markers ◽  
Cryptogenic Stroke ◽  
Biological Marker ◽  
Ecg Monitoring ◽  
Inflammation Markers ◽  
Good Patient ◽  
Markers Of Inflammation ◽  
Good Patient Compliance ◽  
And Function

Stroke affects millions of people all over the world, causing death and disability. The most frequent type of this disease is ischemic stroke, which can be caused by different factors. In approximately 25 percent of cases, no obvious cause can be found. Recent observations have shown that paroxysmal atrial fibrillation could be responsible for a significant number of cryptogenic stroke events. Short- or long-lasting ECG monitoring could help with the diagnosis of transient arrhythmias. Unfortunately, these techniques either are expensive or require good patient compliance. An alternative option is the identification of biological markers that are specific for atrial fibrillation and can be used to predict arrhythmia. In this review, we give a summary of the recent advances in the research of arrhythmia markers. Based on their structure and function, we differentiated four groups of biomarkers: markers of inflammation, markers of fibrosis, markers with hormonal activity, and other markers. In spite of intensive researches, the optimal biological marker is still not available, but there are some promising markers, like NT-proBNP/BNP.

scholarly journals Detection of Subclinical Paroxysmal Atrial Fibrillation and Its Correlation with Candidate Genes in Patients with Cryptogenic Ischemic Stroke and TIA

2021 ◽  
Vol 21 (2) ◽  
pp. 42-53
Author(s):  
A Petrovicova ◽  
E Kurca ◽  
A Andrasova ◽  
J Bernatova ◽  
P Blasko ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Paroxysmal Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Preventive Treatment ◽  
Correct Choice ◽  
Control Group ◽  
Nucleotide Polymorphisms ◽  
Loop Recorder ◽  
Ischemic Attack

Abstract Introduction: Cardioembolic etiology is assumed to be the most frequent cause of cryptogenic strokes. The detection of subclinical paroxysmal atrial fibrillation (AF) is important in the correct choice of preventive treatment. The aim of this prospective study was to detect the incidence of AF in patients with a cryptogenic stroke or transient ischemic attack (TIA) and to evaluate the association between the presence of AF and selected single-nucleotide polymorphisms (SNP). Methods: Patients with a cryptogenic stroke/ TIA (n=100) and a control group (n=15) of volunteers without significant cardiovascular disease were included in the study during the period of 2014 to 2019. To detect AF they underwent 12 months of ECG monitoring using an implanted loop recorder (ILR). Genotyping for SNPs rs10033464, rs2200733, rs225132, and rs2106261 was performed by a high resolution melting analysis. Results: We found AF to be present in 24 (24%) patients with a cryptogenic stroke/TIA, versus no subjects in the control group. The SNPs rs2106261, rs2200733, rs225132, and rs10033464 were not found to be associated with AF in our study (p=0.240; 1.000; 0.887; 0.589). However, a weak trend for a higher frequency of rs2106261 risk allele A homozygotes was observed in the patients with AF compared to the patients without AF (0.416 vs. 0.263, p=0.073). Homozygotes for allele A of rs2106261 were also present in a significantly higher frequency in AF patients compared to the controls (0.416 vs. 0.133, p = 0.012). Conclusion: In our study paroxysmal AF was a probable etiological factor in 24% of patients with cryptogenic ischemic stroke / TIA during the 12 months of monitoring. The homozygous allele A of rs2106261 was identified to be the possible genetic risk factor of AF, but this should be verified in larger cohorts. The study has been registered at www.clinicaltrials.gov, identifier NCT02216370.

scholarly journals Implantable loop recorder follow-up

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Pena Mellado ◽  
R Macias ◽  
L Tercedor ◽  
M Alvarez Lopez
Keyword(s):  
Head Trauma ◽  
Type I ◽  
Av Block ◽  
Implantable Loop Recorder ◽  
Ecg Monitoring ◽  
Loop Recorder ◽  
Tertiary Center ◽  
Unexplained Syncope ◽  
Baseline Characteristics

Abstract Introduction Long ambulatory ECG monitoring can be a useful component in the evaluation of the patient with unexplained syncope or syncope with suspected arrhythmic origin, as well as a sensitive tool for detecting asymptomatic spontaneous cardiac arrhythmias or conduction abnormalities in predisposed patients. Purpose To determine the diagnostic cost-effectiveness of the implantable loop recorder (ILR) in the origin of unexplained syncope in our center. Methods A retrospective observational study was carried out in a tertiary center, those patients with an ILR between August 2014 and March 2021 were included. Baseline characteristics of the population and their previous ECG, arrythmias detected during follow-up and pacemaker implant rate were evaluated. Results One hundred twenty-seven patients with a ILR were included (age 67 years, 49.6% males). Most often cause of ILR was unexplained syncope (90.6%) followed by monitoring after TAVI implant (3.9%). Normal LVEF (>50%) was present in 85.6%,and 75.6% had NYHA I functional class. 118 patients (92.9%) presented sinus rhythm at implant time, and 8 (6.3%) presented AF. 12.6% presented first degree atrioventricular (AV) block, 2 patients (1.6%) had presented previously Mobitz Type I AV block and one patient 2:1 block. Left bundle branch block (LBBB) was present in 13.4%,RBBB in 3.1%,LAFB in 9.4%, RBBB+LAFB in 11% and RBBB+LPFB in 2.4%. Median time of follow-up was 21 months. 3rd degree AV block was the most frequent arrhythmia detected (12.1%), followed by >3s pause (8%) and previously unknown AF (2.4%).The patients with syncope who suffered head trauma (33%) presented a higher rate of pacemaker (PCM) implant compared to those without head trauma: 31.6% vs 14.7%. In total,19.8% PCM rate implant during follow-up. No complications ILR related. Conclusion In conclusion, long home ECG monitoring with ILR is a powerful and helpful tool to find out or rule out potentially dangerous arrhythmias as cause of syncope, with no complications in our experience. FUNDunding Acknowledgement Type of funding sources: None. Baseline characteristics Arrhythmias detected during follow-up

Abstract P640: Incident Atrial Fibrillation and Cardiovascular Risk Increases in Patients With Increased Burden of Atrial Ectopy

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michael N Sattin ◽  
Zhe Li ◽  
Marko Mrkobrada ◽  
Erin I Spicer
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Events ◽  
Univariate Analysis ◽  
Composite Outcome ◽  
Ecg Monitoring ◽  
Reduced Ejection Fraction ◽  
Final Sample ◽  
Atrial Ectopy ◽  
The Relationship

Introduction: Atrial fibrillation (AF) is a major risk factor for cerebral ischemia in North America. Atrial ectopy has been associated with incident AF and increased stroke risk on short-duration ECG monitoring. The objective of this study was to characterize the relationship between the burden of atrial ectopy with future AF, stroke, and cardiovascular events on prolonged ECG monitoring. Methods: A retrospective, observational study was conducted at a single centre enrolling patients >18 years old referred from TIA clinic. Data was collected from 7- and 14-day Holter monitor reports, patient charts, and cardiac investigations. The final sample included 1124 patients; a subgroup of 759 patients had echocardiograms. Univariate and multivariate logistic regression determined the odds ratio (OR) of developing the composite outcome (AF, TIA/stroke, ACS, death) or secondary outcomes (AF or TIA/stroke). Results: The population was high-risk with a mean CHA 2 DS 2 -VASc of 4.0 (±1.8); during 1-year of follow-up, the primary outcome occurred amongst 116 (10.3%) patients. Univariate analysis ORs are displayed in Table 1. There was a statistically significant relationship (p<0.001) between percentage of PACs and the composite outcome (OR 4.066), and AF (11.886) for patients with 2-5% PACs. PAC runs/day was significant if >5/day for AF (OR 5.989, p<0.01) and for the composite (OR 2.231, p<0.05). Long PAC runs (>30 beats) also had significant ORs for AF (2.849, p<0.01) and the composite (5.320, p<0.01). In the subgroup analysis, reduced ejection fraction had an OR of 2.172 (1.407-5.771) for the composite outcome, and atrial dilatation had an OR of 2.778 (1.390-5.551) for AF. Conclusions: Increased burden of atrial ectopy is associated with increased odds of developing AF and a composite of cardiovascular events. Patients with increased ectopy should be considered for further, future ECG monitoring and risk stratification with echocardiogram.

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