Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation

Larsen, Bjørn Strøier; Kumarathurai, Preman; Falkenberg, Julie; Nielsen, Olav Wendelboe; Sajadieh, Ahmad

doi:10.1016/j.jacc.2015.05.018

Cited by 185 publications

(151 citation statements)

References 32 publications

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“…In the APAF study (A Controlled Randomized Trial of CPVA Versus Antiarrhythmic Drug Therapy in for Paroxysmal AF), 16 sustained AT (including both AF and atrial tachycardia) was defined as lasting >5 seconds although there are some definitions of long episodes of AT. 2,8 Therefore, short-run AT was defined as ≥3 consecutive supraventricular ectopic beats with mean P-P interval ≤600 ms and lasting <5 seconds.…”

Section: Assessment Of Short-run Atrial Tachyarrhythmiamentioning

confidence: 99%

“…However, in the Copenhagen Holter Study, excessive supraventricular ectopic activity, defined as the presence of either ≥30 PACs/h daily or any runs of ≥20 PACs using 48-hour ambulatory electrocardiography, was associated with an increased risk of ischemic stroke. 8 In the SMART Registry (The Stroke and Monitoring for PAF in Real Time), 10.3% patients with paroxysmal AF, defined as the standard electrocardiographic criteria for AF 16 and a minimum event duration of 5 seconds, had ischemic stroke events. 19 In our present study, short-run AT was defined as ≥3 consecutive supraventricular ectopic beats (rate ≥100 bpm) and lasting <5 seconds, which was different from previous studies.…”

Section: Short-run At and Clinical Eventsmentioning

confidence: 99%

“…7 However, the relationship between short episodes of AT and the incidence of stroke is still controversial. 2,8 In addition, it remains unclear whether short episodes of AT are related with the progression of AF. Therefore, the aim of the present study was to elucidate the association between short episodes of AT during a 24-hour Holter monitoring and clinical events, including stroke and AF.…”

mentioning

confidence: 99%

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Risk of Stroke in Patients With Short-Run Atrial Tachyarrhythmia

Yamada

Lin

Chang³

et al. 2017

Stroke

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Background and Purpose-The risk of stroke in patients with short-run atrial tachyarrhythmia (AT) remains unclear. This study aimed to investigate the relationship between short-run AT and the stroke and the use of the CHA 2 DS 2 -VASc score for the risk stratification. Methods-From the registry of 24-hour Holter monitoring, 5342 subjects without known atrial fibrillation or stroke were enrolled. Short-run AT was defined as episodes of supraventricular ectopic beats <5 seconds. Results-There were 1595 subjects (29.8%) with short-run AT. During the median follow-up period of 9.0 years, 494 subjects developed new-onset stroke. Patients with short-run AT had significantly higher stroke rates compared with patients without short-run AT (11.4% versus 8.3%; P<0.001). In patients with short-run AT, the number of strokes per 100 person-years for patients with CHA 2 DS 2 -VASc score of 0 and 1 were 0.23 and 0.67, respectively. However, the number of them for patients with CHA 2 DS 2 -VASc score of 2, 3, 4, and ≥5 were 1. . Conclusions-Short-run AT increases the risk of stroke. Therefore, the CHA 2 DS 2 -VASc score could be used for the risk stratification. Age and burden of premature atrial contractions were independent predictors for stroke in patients with CHA 2 DS 2 -VASc score of 0 or 1.

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Section: Assessment Of Short-run Atrial Tachyarrhythmiamentioning

confidence: 99%

Section: Short-run At and Clinical Eventsmentioning

confidence: 99%

mentioning

confidence: 99%

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Risk of Stroke in Patients With Short-Run Atrial Tachyarrhythmia

Yamada

Lin

Chang³

et al. 2017

Stroke

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“…AF may not be a direct causal, but it may be marker and an amplifier of underlying atrial pathology (14,15). The authors also remind the risk of excessive supraventricular ectopic activity (ESVEA) associated with risk of incident AF, stroke and mortality (16,17 …”

mentioning

confidence: 97%

Key messages to comprehend: the European Heart Rhythm Association (EHRA) consensus document - How to manage device-detected subclinical atrial tachyarrhythmias

Özcan¹,

Kudaiberdieva²,

Görenek³

2017

HVT

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“…Não se pode excluir a possibilidade de episódios de FA < 6 minutos serem suficientes para a formação de um trombo 19 e, neste contexto, está descrita a associação de episódios de taquicardia auricular com ≥ 20 batimentos consecutivos ou ≥ 30 extra-sístoles supra-ventriculares por hora com ocorrência de AVC. 20,21 No entanto uma futura sub-análise da amostra do estudo ASSERT com períodos de menor duração não será possível, já que o protocolo deste estudo contemplou por definição apenas registo de episódios superiores a seis minutos. 22 Contudo, os autores não consideram isto uma limitação, já que dos episódios de <6 minutos que foram eventualmente analisados, < 50% correspondiam a FA.…”

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Duração dos Episódios de Fibrilhação Auricular e Implicações no Risco Tromboembólico

2015

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Acta Med Port 2015 Nov-Dec;28(6):766-772 RESUMOIntrodução: A fibrilhação auricular é uma arritmia comum e com risco tromboembólico bem documentado, estando definidas nas recomendações internacionais indicações referentes ao uso de anticoagulantes orais. Existem, contudo, lacunas de informação nomeadamente no que se refere à duração dos episódios de fibrilhação auricular e sua relação com o risco de tromboembolismo. Esta questão tem particular interesse em doentes com dispositivos electrónicos cardíacos implantados com documentação contínua da duração de episódios de taquidisritmias auriculares, que são frequentemente curtos e assintomáticos. Material e Métodos: Foi feita uma análise crítica da evidência disponível sobre a relação da duração dos episódios de FA paroxística e a ocorrência de eventos embólicos, com base numa pesquisa na base de dados bibliográfica PubMed. Resultados: Foram selecionados oito artigos com abordagens diferentes no estudo deste tema; sete com recurso a monitorização cardíaca com dispositivos electrónicos cardíacos implantados (pacemakers, cardioversores-desfibilhadores implantáveis e ressincronizadores cardíacos) e um com base em registo de Holter. Metade destas publicações, correspondendo globalmente às maiores amostragens, aborda a questão do ponto de vista do somatório diário de episódios de fibrilhação auricular (carga diária) e não da duração de cada episódio. O risco tromboembólico aumenta gradualmente com a carga arrítmica, tendo sido demonstrado um aumento significativo do risco quando esta ultrapassa os cinco minutos num dia. Discussão: A formação de um trombo intracavitário, e consequente potencial embólico, é um processo dinâmico que resulta da interacção de várias condicionantes anatómicas e funcionais. O risco individual dependerá da interacção destes factores. A associação entre fenómenos embólicos e curtos períodos de fibrilhação auricular é inequívoca, apesar do mecanismo não ser óbvio, tendo em conta a discrepância frequentemente observada entre os períodos de fibrilhação auricular e os eventos clínicos. Conclusões: O risco de eventos tromboembólicos aumenta significativamente mesmo para períodos curtos de fibrilhação auricular (≥ cinco minutos de fibrilhação auricular em um dia), apesar da relação causa-efeito não estar definida. A decisão final sobre o recurso à anticoagulação oral deve basear-se na avaliação clínica individualizada. Palavras-chave: Fibrilhação Auricular; Tromboembolia/etiologia. ABSTRACT Introduction:Atrial fibrillation is the most common chronic arrhythmia in clinical practice, which is associated with a well known increased thromboembolic risk. The use of oral anticoagulants in this context is well established. However, there are some gaps in information that warrant further studies, such as the duration of an atrial fibrillation event that is long enough to increase the risk of embolic phenomena. This may be of important clinical concern, particularly in patients with cardiac implanted devices, in which very short periods of asymptomatic atrial fi...

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Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation

Abstract: ESVEA was associated with an increased risk of ischemic stroke beyond manifest AF in this middle-aged and older population. Stroke was more often the first clinical presentation, rather than AF, in these study subjects.

Cited by 185 publications

References 32 publications

Risk of Stroke in Patients With Short-Run Atrial Tachyarrhythmia

Risk of Stroke in Patients With Short-Run Atrial Tachyarrhythmia

Key messages to comprehend: the European Heart Rhythm Association (EHRA) consensus document - How to manage device-detected subclinical atrial tachyarrhythmias

Duração dos Episódios de Fibrilhação Auricular e Implicações no Risco Tromboembólico

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