Excessive atrial ectopic activity as an independent risk factor for ischemic stroke

Marinheiro, Rita; Parreira, Leonor; Amador, Pedro; Sá, Catarina; Duarte, Tatiana; Caria, Rui

doi:10.1016/j.ijcard.2017.08.054

Cited by 16 publications

(4 citation statements)

References 19 publications

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“…Some authors have previously identified a subgroup of patients with a higher risk of AF and stroke occurrence during follow‐up based on the presence of a high number of PACs in the 24h‐Holter monitoring. Our group of patients showed a very low number of PACs during the 24h‐Holter monitoring probably because they were younger (54.3 ± 13.7 years vs 70.6 ± 5.6 years) and had less comorbidities.…”

Section: Discussionmentioning

confidence: 99%

A lower left atrial appendage peak emptying velocity in the acute phase of cryptogenic stroke predicts atrial fibrillation occurrence during follow‐up

et al. 2019

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Background Silent atrial fibrillation is a frequent etiology of cryptogenic stroke. Spontaneous conversion of atrial fibrillation to sinus rhythm results in atrial stunning. Objective To evaluate if the presence of a lower left atrial appendage peak emptying velocity (LAAV) after a cryptogenic stroke is associated with the occurrence of atrial fibrillation (AF). Methods We retrospectively selected consecutive patients with an acute ischemic stroke that had a transoesophageal echocardiogram (TEE) performed in the first 30 days of the acute event. Documented AF or potential cardioembolic sources in the TEE were considered exclusion criteria. We assessed the LAAV. During follow‐up, we evaluated the occurrence of new‐onset AF and the combined endpoint of death or new ischemic stroke. Results We studied 73 consecutive patients, during a mean follow‐up period of 54.9 ± 19.3 months. Seven developed AF, and 13 had the combined endpoint. LAAV was independently associated with AF occurrence (HR: 0.93, 95% CI: 0.88–0.99; P = .016). Patients with a LAAV ≤ 46.5 cm/s (AUC: 0.766, 95% CI: 0.579–0.954; P = .021) had a lower survival rate free from AF occurrence (Log‐rank, P < .001) and free from the combined endpoint of death or ischemic stroke (Log‐rank, P = .010). Conclusion A lower LAAV was associated with AF occurrence and the combined endpoint of death or ischemic stroke after an initial episode of cryptogenic stroke. Patients with this finding could eventually benefit from long‐term cardiac rhythm monitoring.

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Section: Discussionmentioning

confidence: 99%

A lower left atrial appendage peak emptying velocity in the acute phase of cryptogenic stroke predicts atrial fibrillation occurrence during follow‐up

et al. 2019

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“…Old age is a recognized risk factor for development of AF and for PACs [9]. Several studies have shown that PACs and subclinical atrial arrhythmias are independent predictors of AF and stroke [10, 11, 13]. Some authors proposed that frequent PACs could be a marker of a higher prevalence of cardiovascular risk factors such as hypertension, diabetes, dyslipidemia and that could explain the higher incidence of stroke, independently of the development of AF [11, 12].…”

Section: Discussionmentioning

confidence: 99%

“…PACs have been considered a benign incident for many years. Recent studies have demonstrated an association between PACs and atrial fibrillation (AF) and stroke [10-13]. In fact, frequent PACS have been considered an independent marker of stroke, adverse cardiovascular events and death, suggesting that the risk associated with frequent PACs is beyond the association with AF [10, 12].…”

Section: Introductionmentioning

confidence: 99%

Excessive Atrial Ectopic Activity Worsens Prognosis and Predicts the Type of Major Adverse Cardiac Events in Patients With Frequent Premature Ventricular Contractions

et al. 2019

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BackgroundThe aim of the study was to evaluate the impact of premature atrial contractions (PACs) burden, and the presence of non-sustained ventricular tachycardia (NSVT) on prognosis and type of major adverse cardiovascular events in patients with frequent premature ventricular contractions (PVCs).MethodsWe retrospectively studied 285 consecutive patients with frequent PVCs defined as PVC count equal or higher than 1% of total beats assessed with 24-h Holter recording. Patients with atrial fibrillation (AF) were excluded. We evaluated the impact of PAC burden and the presence of NSVT on the primary end points of all-cause mortality, stroke and new-onset AF, and secondary end points; arrhythmic end point (arrhythmic death or hospitalizations for ventricular arrhythmias) or heart failure (HF)-related end point (death or hospitalizations due to HF).ResultsThe PAC number showed an adjusted hazard ratio (HR) (95% confidence interval (CI), P value) of 1.077 (1.014 - 1.145, P = 0.017) for all-cause mortality, 1.250 (1.080 - 1.447, P = 0.003) for stroke, 1.090 (1.006 - 1.181, P = 0.036) for new-onset AF and 1.376 (1.128 - 1.679, P = 0.002) for the HF end point. The presence of NSVT showed an adjusted HR (95% CI) of 3.644 (1.147 - 11.57, P = 0.028) for the arrhythmic end point.ConclusionsIn patients with frequent PVCs a high PAC count was independently associated with increased mortality, higher rate of AF, stroke and HF adverse events, but not with arrhythmic adverse events. The presence of NSVT was independently associated with increased arrhythmic adverse events, but not with overall mortality, AF, stroke or HF events.

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“…33 PACs are common in healthy people, however at high percentages they can be a predictor of atrial arrhythmias and stroke. [72][73][74][75] If the ectopic foci excitation repeatedly occurs, it becomes the pacemaker of the heart and can trigger a tachycardia or a fibrillation. AT and AF might be both paroxysmal, which means that they would begin suddenly, last for a short period of time (minutes, hours or a few days) and then also suddenly stop.…”

Section: Premature Atrial Contractionsmentioning

confidence: 99%

Mapping of the electrical activity of human atria. Multiscale modelling and simulations

Martinez-Mateu¹

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Atrial fibrillation is one of the most common cardiac arrhythmias seen in clinical practice. Therefore, it is of vital importance to develop new technologies aimed at diagnosing and terminating this kind of arrhythmia, to improve the quality of life of patients and to reduce costs to national health systems. In the last years, new atrial mapping techniques based on multi-electrode systems are increasingly being used to map the atrial electrical activity in humans and localise and target atrial fibrillation drivers in the form of focal sources or rotors. However, significant concerns remain about their accuracy and experimental approaches to analyse them are limited due to their invasive character. Therefore, computer simulations are a helpful tool to overcome these limitations since they can reproduce with fidelity experimental observations, permit to split the problem to treat into more simple substudies, and allow the possibility of performing preliminary investigations impossible to carry out in the clinical practice. This PhD thesis is focused on the analysis for accuracy of the multielectrode mapping systems through computational models and simulations. For this purpose, we developed realistic multiscale models in order to simulate atrial electrical reentrant activity, first in a sheet of atrial tissue and, then, in the whole atria. Then, we analysed the effects of the multi-electrode geometrical configurations on the accuracy of localizing rotors, by using multi-electrode arrays with equidistant inter-electrode distances, as well as multi-electrode basket catheters with non-equidistant inter-electrode distances. After computing the intracavitary unipolar electrograms, we performed phase maps, phase singularity detections to track rotors, and dominant frequency maps. We finally found out that the accuracy of multi-electrode mapping systems depends on their position inside the atrial cavity, the electrodeto-tissue distance, the inter-electrode distance, and the contribution of far field sources. Furthermore, as a consequence of these factors, false rotors might appear and could contribute to failure of atrial fibrillation ablation procedures. xii RESUM llunyà. A més, com a conseqüència d'aquests factors, es va observar l'aparició de rotors falsos que podrien contribuir al fracàs de l'ablació de la fibril•lació auricular.

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Excessive atrial ectopic activity as an independent risk factor for ischemic stroke

Cited by 16 publications

References 19 publications

A lower left atrial appendage peak emptying velocity in the acute phase of cryptogenic stroke predicts atrial fibrillation occurrence during follow‐up

A lower left atrial appendage peak emptying velocity in the acute phase of cryptogenic stroke predicts atrial fibrillation occurrence during follow‐up

Excessive Atrial Ectopic Activity Worsens Prognosis and Predicts the Type of Major Adverse Cardiac Events in Patients With Frequent Premature Ventricular Contractions

Mapping of the electrical activity of human atria. Multiscale modelling and simulations

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