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

Stroke ◽  
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.

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

Stroke ◽  
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.

Abstract P12: Alteplase Reduces Mortality in Patients With Ischemic Stroke and Atrial Fibrillation: Analysis of the IAC Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Eva Mistry ◽  
Adam H De Havenon ◽  
Christopher Leon Guerrero ◽  
Amre Nouh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Intravenous Thrombolysis ◽  
The United States ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Increased Risk ◽  
Significant Difference

Background and Purpose: Multiple studies have established that intravenous thrombolysis with alteplase improves outcome after acute ischemic stroke. However, assessment of thrombolysis’ efficacy in stroke patients with atrial fibrillation (AF) has yielded mixed results. We sought to determine the association of alteplase with mortality, hemorrhagic transformation (HT), infarct volume, and mortality in patients with AF and acute ischemic stroke. Methods: We retrospectively analyzed consecutive acute ischemic stroke patients with AF included in the Initiation of Anticoagulation after Cardioembolic stroke (IAC) study, which pooled data from 8 comprehensive stroke centers in the United States. 1889 (90.6%) had available 90-day follow up data and were included. For our primary analysis we used a cohort of 1367/1889 (72.4%) patients who did not undergo mechanical thrombectomy (MT). Secondary analyses were repeated in the patients that underwent MT (n=522). Binary logistic regression was used to determine whether alteplase use was independently associated with risk of HT, final infarct volume, and 90-day mortality, respectively, adjusting for potential confounders. Results: In our primary analyses we found that alteplase use was independently associated with an increased risk for HT (adjusted OR 2.14, 95% CI 1.49 - 3.07, p <0.001) but overall reduced risk of 90-day mortality (adjusted OR 0.58, 95% CI 0.39 - 0.87, p = 0.009). Among patients undergoing MT, alteplase use was associated with a trend towards a reduction in 90-day mortality (adjusted OR 0.68 95% CI 0.45 - 1.04, p = 0.077). In the subgroup of patients prescribed DOAC treatment (n = 327; 24 received alteplase), alteplase treatment was associated with a trend towards smaller infarct size (< 10 mL), (adjusted OR 0.40, 95% CI 0.15 - 1.12, p = 0.082) without a significant difference in the odds of 90-day mortality (adjusted OR 0.51, 95% CI 0.12 - 2.13, p = 0.357) or hemorrhagic transformation (adjusted OR 0.27, 95% CI 0.03 - 2.07, p = 0.206). Conclusion: Thrombolysis with intravenous alteplase was associated with reduced 90-day mortality in AF patients with acute ischemic stroke not undergoing MT. Further study is required to assess the safety and efficacy of alteplase in AF patients undergoing MT and those on DOACs.

Abstract 2922: Patent Foramen Ovale Is A Cause Of Ischemic Stroke In Patients With Antiphospholipid Syndrome

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Yoshiaki Shimada
Keyword(s):  
Ischemic Stroke ◽  
Antiphospholipid Syndrome ◽  
Patent Foramen Ovale ◽  
Multiple Logistic Regression Analysis ◽  
Cryptogenic Stroke ◽  
Control Group ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Significant Difference

Background: The antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by a combination of arterial and/or venous thrombosis and recurrent fetal loss, and can be an independent risk factor for a first-ever ischemic stroke especially in young female patients. Patent foramen ovale (PFO) has been established as a cause of cryptogenic stroke. Atrial septal aneurysm (ASA) is associated with PFO. Until recently, the precise pathophysiology of APS as causing ischemic stroke has been essentially unknown. In the present study, we investigated the relationship between APS and potential embolic sources including PFO and ASA using transesophageal echocardiography (TEE). Methods: This study was a retrospective case series design. From July 2006 to June 2008, 120 patients with ischemic stroke who admitted to Juntendo University Hospital underwent TEE. In this study period, consecutive ischemic stoke patients diagnosed as APS based on the modified Sapporo criteria were enrolled and classified into APS group. Controls were selected among age- and gender-matched stroke patients without APS who also underwent TEE. We assessed clinical characteristics and presence of embolic sources including PFO and atrial septal aneurysm (ASA) between APS and Control groups. Results: Nine of ischemic stroke patients with APS and 41 controls were included. Primary APS was present in one patient (11.1%) of the APS group, and APS with SLE were found in eight patients (88.9%). There is no significant difference in age, risk factors for ischemic stroke, and MRI findings between two groups. The prevalence of PFO and ASA were significantly higher in APS group compared to Control group (89% vs 41%, P=0.027; 67% vs 20%, P=0.015, respectively). C reactive protein was relatively higher in APS group. Multiple logistic regression analysis showed that PFO (OR: 13.71; 95% CI: 1.01 to 185.62; P=0.049) and ASA (OR: 8.06; 95% CI: 1.17 to 55.59; P=0.034) were independently associated with the APS group. Conclusion: Atrial septal abnormalities including PFO and ASA are strongly associated with APS group, and could be potential embolic sources in ischemic stroke patients with APS.

Abstract 25: Paroxysmal Atrial Fibrillation is Common in Patients With Defined Etiology for Stroke: Prolonged Monitoring of Cardiac Rhythm for Detection of Atrial Fibrillation After a Cerebral Ischemic Event (PEAACE) Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Esseddeeg M Ghrooda ◽  
Peter Dobrowolski ◽  
Ghazala Basir ◽  
Ibrahim Yaseen ◽  
Nazim khan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Cardiac Rhythm ◽  
Previous History ◽  
Cryptogenic Stroke ◽  
Predictive Score ◽  
Stroke Patients ◽  
Similar Frequency ◽  
Stroke Team ◽  
Rhythm Monitoring

Introduction: Atrial fibrillation (AF) related cardioembolic stroke accounts for over 20% of ischemic stroke. Recent reports using prolonged cardiac rhythm monitoring (PCRM) in cryptogenic stroke reveal paroxysmal AF (PAF) in an additional 20% of patients. We report our findings with PCRM in patients with and without cryptogenic stroke patients in whom an initial 24-h Holter was negative. Methods: Patients admitted to the stroke service with no previous history of AF and no AF on Holter monitoring were enrolled for 3 weeks of PCRM. We used a PAF predictive score to determine the risk of the arrhythmia. All studies were interpreted by the stroke team prior to final review by the cardiologist. Results: Between Sept 2012 and June 2013, 96 patients were evaluated. Over all PAF was diagnoses in 37.5 % of patients. PAF was diagnosed in 32% of patients with cryptogenic stroke and 36 % of patients where an additional etiology may account for the stroke diagnosis. The AF prediction score was not useful in the recognition of patients that were more likely to be at risk for AF. 96 of 98 recordings were correctly identified by the stroke team prior to final diagnosis by the cardiologist. Interpretation: PAF is more common in stroke patients than was previously suspected. It occurs with similar frequency in patients with and without cryptogenic stroke. Our data strongly supports the need for prolonged cardiac rhythm monitoring in all stroke patients to diagnose this important preventable cause of ischemic stroke.

Slow Sinus Heart Rate as a Potential Predictive Factor of Paroxysmal Atrial Fibrillation in Stroke Patients

2013 ◽  
Vol 36 (2) ◽  
pp. 120-125 ◽  
Author(s):  
Takao Hoshino ◽  
Kentaro Ishizuka ◽  
Takehiko Nagao ◽  
Satoru Shimizu ◽  
Shinichiro Uchiyama
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Predictive Factor ◽  
Paroxysmal Atrial Fibrillation ◽  
Stroke Patients

New-Onset Paroxysmal Atrial Fibrillation Diagnosis in Ischemic Stroke Patients

2015 ◽  
Vol 74 (3-4) ◽  
pp. 211-217 ◽  
Author(s):  
Eva Giralt-Steinhauer ◽  
Elisa Cuadrado-Godia ◽  
Carolina Soriano-Tárraga ◽  
Ángel Ois ◽  
Jordi Jiménez-Conde ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Paroxysmal Atrial Fibrillation ◽  
Stroke Patients ◽  
New Onset

scholarly journals Atrial fibrillation trial to evaluate real-world procedures for their utility in helping to lower stroke events: A randomized clinical trial

2020 ◽  
pp. 174749302093829
Author(s):  
Wen-Yi Huang ◽  
Meng Lee ◽  
Sheng-Feng Sung ◽  
Sung-Chun Tang ◽  
Kuo-Hsuan Chang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trial ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Randomized Clinical Trial ◽  
Paroxysmal Atrial Fibrillation ◽  
Detection Rate ◽  
Stroke Patients ◽  
Clinical Trial Registration ◽  
Detection Rates

Background Enhancing detection of unrecognized atrial fibrillation among acute ischemic stroke patients is crucial for secondary stroke prevention. Aim To evaluate whether the detection rate of new atrial fibrillation in acute ischemic stroke patients without known atrial fibrillation could be improved by doing serial 12-lead electrocardiograms once daily for five days, compared with conventional 24-h Holter monitoring (24-h Holter). Methods We conducted a randomized clinical trial to compare the detection rates of paroxysmal atrial fibrillation between serial electrocardiograms versus 24-h Holter from October 2015 to October 2018 at six hospitals. Eligible participants were acute ischemic stroke patients with aged ≥65 years, with neither atrial fibrillation history nor any presence of atrial fibrillation on baseline electrocardiogram at admission. The primary outcome was newly detected electrocardiogram in the serial electrocardiograms and 24-h Holter group. Results Among 826 patients, baseline characteristics were similar between both groups. In the intention-to-treat analysis, there was no statistical difference between serial electrocardiograms versus 24-Holter to detect atrial fibrillation (8.4% vs. 6.9%; adjusted odds ratio 1.17, 95% confidence interval 0.69–2.01). Stepwise multivariate logistic regression revealed age ≥80 years and history of heart failure were associated with detection of paroxysmal atrial fibrillation whereas patients with lacunar infarction had lower odds for detection of paroxysmal atrial fibrillation. Conclusions Serial electrocardiograms had comparable detection rate of paroxysmal atrial fibrillation compared with 24-h Holter and might be a viable alternative to 24-h Holter as a first-line approach to survey for potential paroxysmal atrial fibrillation among elderly patients with acute ischemic stroke. Clinical Trial Registration: URL https://clinicaltrials.gov/ct2/show/NCT02578979 Unique Identifiers: NCT02578979

Abstract WMP23: Well-controlled Warfarin Therapy in Acute Ischemic Stroke Patients with Atrial Fibrillation Associated with Lower Rate of Lesion Recurrence

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Eiichi Nomura ◽  
Tomohiko Ohshita ◽  
Eiji Imamura ◽  
Shinichi Wakabayashi ◽  
Hiroshi Kajikawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Warfarin Therapy ◽  
International Normalized Ratio ◽  
Optimal Timing ◽  
Diffusion Weighted Mri ◽  
Stroke Patients ◽  
Diffusion Weighted ◽  
Significant Difference

Objectives: The optimal timing of warfarin administration for acute ischemic patients with atrial fibrillation (AF) has not yet been established because the risk of early symptomatic recurrence is not high and hemorrhagic transformation commonly occurs. Recent studies have reported a high frequency of recurrent lesions detectable on diffusion-weighted MRI within a few weeks after acute ischemic stroke. We hypothesized that well-controlled warfarin therapy could prevent acute ischemic stroke patients with AF from developing recurrent lesions. Methods: We retrospectively examined consecutive acute ischemic stroke patients with AF treated in our hospital between 2008 and 2011 who were given warfarin within 2 weeks of admission and had diffusion-weighted MRI and blood test for prothrombin time and international normalized ratio (PT-INR) both on admission and at 2 weeks. Warfarin was started as early as possible and heparin (10,000 units a day) was also administered until the PT-INR target (2.0-3.0 for patients aged < 70 years or 1.6-2.6 for those ≥ 70 years recommended for the stroke patients with AF at chronic stage by Japanese Guideline for the Management of Stroke 2009) was achieved. We classified the enrolled patients into 2 groups according to their PT-INR: The well-controlled group (WCG) was defined as those in whom target PT-INR was achieved at 2 weeks, and those in whom the target could not be achieved at 2 weeks were classified as the poorly-controlled group (PCG). Results: There were 123 patients (median age of 79.0, 62 male and 61 female) who met the criteria for the present study, consisting of 52 WCG patients and 71 PCG patients. There were also no significant differences in demographics, common risk factors, severity of stroke, or median starting day of warfarin (second day from admission) between the 2 groups. The median PT-INR of WCG was 1.9 (1.7-2.3) and that of PCG was 1.6 (1.3-2.9), showing significant difference (P=0.0169). WCG had a significantly lower rate of new recurrent lesions on diffusion-weighted MRI at 2 weeks than PCG (17.3% vs. 36.6%, respectively, p=0.0190). Conclusions: Our findings suggested that well-controlled warfarin therapy with heparin bridging reduces the recurrence of lesions in acute ischemic stroke patients with AF.

scholarly journals Screening of Paroxysmal Atrial Fibrillation after Ischemic Stroke: 48-Hour Holter Monitoring versus Prolonged Intermittent ECG Recording

ISRN Stroke ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Gustav Orrsjö ◽  
Björn Cederin ◽  
Eric Bertholds ◽  
Salmir Nasic ◽  
Lennart Welin
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Paroxysmal Atrial Fibrillation ◽  
Screening Method ◽  
Final Analysis ◽  
Holter Monitoring ◽  
Screening Methods ◽  
Stroke Registry ◽  
Significant Difference ◽  
Basic Characteristics

Aims. Screening of paroxysmal atrial fibrillation (PAF) after ischemic stroke and TIA is important. The ideal method is not known and studies of intermittent screening methods in particular are lacking. In this retrospective study we compared a shorter continuous screening method with an intermittent screening method. Methods. Since early 2011 our stroke unit has used two different methods of screening: either a 48-hour continuous screening with Holter monitor or a 21-day twice daily intermittent screening with a hand-held ECG recorder. Through the Swedish National Stroke Registry and medical records reviewing all screening episodes between 2011-02-01 and 2013-01-31 were collected and analysed.   Results. Of 386 screenings, 26 screenings were excluded leaving 360 screenings for the final analysis of which 114 screenings were made with hand-held ECG recorder and 246 with Holter monitoring. No significant difference between the groups concerning basic characteristics was observed. In the hand-held ECG recorder group a total of 13 PAF screenings (11.4%) were detected compared with 7 (2,8%) in the Holter group (P=0.001). Conclusions. A prolonged intermittent screening is a better method than a shorter continuous screening in terms of detecting PAF after ischemic stroke and TIA.

Sign in / Sign up

Export Citation Format

Share Document