Atrial Premature Beats Predict Atrial Fibrillation in Cryptogenic Stroke Academic Article uri icon

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abstract

  • BACKGROUND AND PURPOSE: Many ischemic strokes or transient ischemic attacks are labeled cryptogenic but may have undetected atrial fibrillation (AF). We sought to identify those most likely to have subclinical AF. METHODS: We prospectively studied patients with cryptogenic stroke or transient ischemic attack aged ≥55 years in sinus rhythm, without known AF, enrolled in the intervention arm of the 30 Day Event Monitoring Belt for Recording Atrial Fibrillation After a Cerebral Ischemic Event (EMBRACE) trial. Participants underwent baseline 24-hour Holter ECG poststroke; if AF was not detected, they were randomly assigned to 30-day ECG monitoring with an AF auto-detect external loop recorder. Multivariable logistic regression assessed the association between baseline variables (Holter-detected atrial premature beats [APBs], runs of atrial tachycardia, age, and left atrial enlargement) and subsequent AF detection. RESULTS: Among 237 participants, the median baseline Holter APB count/24 h was 629 (interquartile range, 142-1973) among those who subsequently had AF detected versus 45 (interquartile range, 14-250) in those without AF (P<0.001). APB count was the only significant predictor of AF detection by 30-day ECG (P<0.0001), and at 90 days (P=0.0017) and 2 years (P=0.0027). Compared with the 16% overall 90-day AF detection rate, the probability of AF increased from <9% among patients with <100 APBs/24 h to 9% to 24% in those with 100 to 499 APBs/24 h, 25% to 37% with 500 to 999 APBs/24 h, 37% to 40% with 1000 to 1499 APBs/24 h, and 40% beyond 1500 APBs/24 h. CONCLUSIONS: Among older cryptogenic stroke or transient ischemic attack patients, the number of APBs on a routine 24-hour Holter ECG was a strong dose-dependent independent predictor of prevalent subclinical AF. Those with frequent APBs have a high probability of AF and represent ideal candidates for prolonged ECG monitoring for AF detection. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00846924.

authors

  • O'Donnell, Martin
  • Gladstone, David J
  • Dorian, Paul
  • Spring, Melanie
  • Panzov, Val
  • Mamdani, Muhammad
  • Healey, Jeffrey Sean
  • Thorpe, Kevin E
  • Aviv, R
  • Boyle, K
  • Blakely, J
  • Cote, R
  • Hall, J
  • Kapral, MK
  • Kozlowski, N
  • Laupacis, A
  • O’Donnell, M
  • Sabihuddin, K
  • Sharma, M
  • Shuaib, A
  • Vaid, H
  • Pinter, A
  • Abootalebi, S
  • Chan, R
  • Crann, S
  • Fleming, L
  • Frank, C
  • Hachinski, V
  • Hesser, K
  • Kumar, BS
  • Soros, P
  • Wright, M
  • Basile, V
  • Boyle, K
  • Hopyan, J
  • Rajmohan, Y
  • Swartz, R
  • Vaid, H
  • Valencia, G
  • Ween, J
  • Aram, H
  • Barber, PA
  • Coutts, S
  • Demchuk, AM
  • Fischer, K
  • Hill, MD
  • Klein, G
  • Kenney, C
  • Menon, B
  • McClelland, M
  • Russell, A
  • Ryckborst, K
  • Stys, P
  • Smith, EE
  • Watson, TW
  • Chacko, S
  • Sahlas, D
  • Sancan, J
  • Côté, R
  • Durcan, L
  • Ehrensperger, E
  • Minuk, J
  • Wein, T
  • Wadup, L
  • Asdaghi, N
  • Beckman, J
  • Esplana, N
  • Masigan, P
  • Murphy, C
  • Tang, E
  • Teal, P
  • Villaluna, K
  • Woolfenden, A
  • Yip, S
  • Bussière, M
  • Dowlatshahi, D
  • Sharma, Mukul
  • Stotts, G
  • Robert, S
  • Ford, K
  • Hackam, D
  • Miners, L
  • Mabb, T
  • Spence, JD
  • Buck, B
  • Griffin-Stead, T
  • Jassal, R
  • Siddiqui, M
  • Hache, A
  • Lessard, C
  • Lebel, F
  • Mackey, A
  • Verreault, S
  • Astorga, C
  • Casaubon, LK
  • del Campo, M
  • Jaigobin, C
  • Kalman, L
  • Silver, FL
  • Atkins, L
  • Coles, K
  • Penn, A
  • Sargent, R
  • Walter, C
  • Gable, Y
  • Kadribasic, N
  • Schwindt, B
  • Shuaib, A
  • Kostyrko, P
  • Selchen, D
  • Saposnik, G
  • Christie, P
  • Jin, A
  • Hicklin, D
  • Howse, D
  • Edwards, E
  • Jaspers, S
  • Sher, F
  • Stoger, S
  • Crisp, D
  • Dhanani, A
  • John, V
  • Levitan, M
  • Mehdiratta, M
  • Wong, D

publication date

  • April 2015

published in