Supraventricular Premature Beats and Short Atrial Runs Predict Atrial Fibrillation in Continuously Monitored Patients With Cryptogenic Stroke

• Published in: Stroke (1970) Vol. 45; no. 3; pp. 884 - 886
• Main Authors: KOCHHÄUSER, Simon, DECHERING, Dirk G, DITTRICH, Ralf, REINKE, Florian, RITTER, Martin A, RAMTIN, Shahram, DUNING, Thomas, FROMMEYER, Gerrit, ECKARDT, Lars
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.03.2014
• Subjects: Aged; Arrhythmias, Cardiac - physiopathology; Atrial Fibrillation - physiopathology; Atrial Fibrillation - therapy; Atrial Premature Complexes - physiopathology; Atrial Premature Complexes - therapy; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Confidence Intervals; Electrocardiography; Electrocardiography, Ambulatory; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Heart; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Risk Assessment; ROC Curve; Stroke - physiopathology; Stroke - therapy; Vascular diseases and vascular malformations of the nervous system; Human; Premature; atrial premature complexes; Stroke; Nervous system diseases; Arrhythmia; Atrial fibrillation; Cardiovascular disease; Excitability disorder; Cerebral disorder; Vascular disease; Heart disease; Central nervous system disease; Cerebrovascular disease; stroke; atrial fibrillation
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.113.003788

Supraventricular premature beats (SPBs) may help to assess the risk of atrial fibrillation (AF) in patients with cryptogenic stroke and therefore guide therapy. An internal loop recorder was implanted in consecutive patients with acute cryptogenic stroke. The occurrence and quantity of SPBs and short supraventricular runs (SVRs) in 24-hour ECG in patients with and without future AF were analyzed. We evaluated the relative risk of the upper quartile of SPB and SVR patients against the remainder and used binary logistic regression to evaluate a possible independent influence of SPBs and SVRs on AF occurrence. Twelve of 70 included patients (mean age, 59±13 years) experienced development of AF during a mean monitoring duration of 536±212 days. Patients with AF had a median of 22.8 SPBs/h versus 1.2 SPBs/h (P<0.0001) in patients without AF and a median of 0.7 SVRs/h (AF) versus 0 SVR/h (non-AF). Patients in the upper quartile of SPBs (>14.1/h) and SVRs (>0.2/h) demonstrated a relative risk of 4.0 (95% confidence interval, 1.1-14.6; P=0.04) and 6.9 (95% confidence interval, 1.8-26.7; P=0.005) for future AF, respectively. In binary logistic regression, SPBs (P=0.02) and SVRs (P=0.05) remained significant independent predictors for occurrence of AF. Numerous SPBs and SVRs demonstrated a high risk for future AF in patients with cryptogenic stroke.