Excessive Supraventricular Ectopic Activity Is Indicative of Paroxysmal Atrial Fibrillation in Patients with Cerebral Ischemia

Weber-Krüger, Mark; Gröschel, Klaus; Mende, Meinhard; Seegers, Joachim; Lahno, Rosine; Haase, Beatrice; Niehaus, Cord-Friedrich; Edelmann, Frank; Hasenfuß, Gerd; Wachter, Rolf; Stahrenberg, Raoul

doi:10.1371/journal.pone.0067602

Cited by 38 publications

(28 citation statements)

References 29 publications

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“…[9][10][11][12][13][14][15][16][17][18]20,22,23 Several recent studies indicate that Holterdetected frequent APBs, or APBs present on a routine 12-lead ECG, 19,20 are an independent risk factor for stroke or death; previous studies used different thresholds for defining frequent APBs during a 24-hour recording (>100, 16 >218, 14 >228 APBs, 18 or >720 APBs or episodes of atrial tachycardia >20 beats long 15 ). In our study, we found that nearly 50% patients with cryptogenic stroke had an APB frequency >720/24 h, which is potentially clinically important based on the above literature.…”

Section: Discussionmentioning

confidence: 99%

Atrial Premature Beats Predict Atrial Fibrillation in Cryptogenic Stroke

Gladstone

Dorian

Spring

et al. 2015

Stroke

167

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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.

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Section: Discussionmentioning

confidence: 99%

Atrial Premature Beats Predict Atrial Fibrillation in Cryptogenic Stroke

Gladstone

Dorian

Spring

et al. 2015

Stroke

167

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“…Several approaches have been suggested such as BNP level at admission, PAC number, and clinic-radiological scores (e.g. STAF score) [6,20,22,23,24,25,26]. The first-hour risk score in our experience does not appear efficient enough to be included in relevant parameters.…”

Section: Discussionmentioning

confidence: 83%

Continuous ECG Monitoring for Tracking Down Atrial Fibrillation after Stroke: Holter or Automated Analysis Strategy?

Suissa¹,

Lachaud²,

Mahagne³

2014

Eur Neurol

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Background: Tracking down atrial fibrillation (AF) in the stroke unit is a relevant challenge for the prevention of recurrent AF-related stroke. The optimal terms of use of continuous ECG monitoring (CEM) are unknown. We compared 24-hour routine Holter ECG with two different CEM analysis strategies for AF detection. Methods: We prospectively enrolled consecutive ischemic stroke patients. All AF-naïve patients received CEM during hospitalization. Two methods for reading CEM data were compared: manual analysis using the Holter function (hCEM) and semiautomated analysis using software (aCEM). The McNemar test was used to compare AF detection rates. Results: Of the 362 patients included, 58 (16.0%) were non-AF-naïve patients and 304 were AF-naïve patients. AF-Naïve patients underwent CEM with a median duration of 5.3 days (3.4-9.7). We detected 22 new AF cases (7.2%) with first-24-hour hCEM, 31 (10.2%) with aCEM, and 42 (13.8%) with hCEM. hCEM and aCEM both significantly increased the AF detection rate compared to first-24-hour hCEM. hCEM detected more new AF cases than aCEM (+3.6%, p = 0.003). Conclusions: In stroke patients, early and prolonged aCEM and hCEM both increase the AF detection rate compared to first-24-hour hCEM. hCEM gives the best AF detection rate. We suggest that in aCEM, detection based only on the ventricular rhythm analysis explains its lower specificity and sensitivity.

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“…6 in their retrospective cohort study that frequent SVR was not associated with the occurrence of AF. 23 Some prospective 6,22 and retrospective cohort studies 24 have observed that excessive supraventricular ectopic activity (ESVEA) is a significant predictor of the occurrence of AF. In these studies, patients were classified in the ESVEA group if they had either frequent PAC count or SVR.…”

Section: Discussionmentioning

confidence: 99%