P Wave Dispersion and Silent Atrial Fibrillation in Cryptogenic Stroke: The Pathogenic Role of Inflammation

Abstract

Background: Cryptogenic stroke (CS) represents 25% of ischemic strokes. Especially after CS, the detection of atrial fibrillation (AF) is important because it provides clues to the mechanism of stroke. However, the relationship between AF and stroke appears more complex than a simple cause-effect mechanism, suggesting that the association between AF and stroke may be due to other systemic and atrial factors including systemic inflammation that may lead to atrial remodeling and subsequent atrial cardiopathy. Objective: The aim of this study was to evaluate the relationship among different electrocardiographic parameters, inflammatory markers and in-hospital AF occurrence after acute CS. Methods: 222 patients with CS underwent 12-lead resting ECG at admission and 7-day in-hospital ECG monitoring. The following indices were evaluated: P-wave dispersion (PWD), P-wave index, P-wave axis, atrial size and high-sensitivity-C reactive protein (CRP). Results: AF was detected in 44 patients. AF-group had significantly higher PWD, P-wave index, PR interval, CRP and greater frequency of abnormal P-wave axis in comparison with no-AF group. There was a significant correlation between CRP and PWD (r=0.28). By using the mediation analysis, performed according to the “bootstrapping” method, we found that PWD is a significant mediator variable of the relationship between CRP and AF occurrence, accounting for 40% of the association. Conclusions: In cryptogenic stroke, high PWD is partly due to systemic inflammation that increases AF risk possibly via atrial electric remodeling. These findings could also suggest inflammation as a possible therapeutic target in order to prevent atrial electrical alterations and finally AF occurrence in CS.

Impact of surgical weight loss on novel P‐wave‐related variables which are nominated as predictors of atrial arrhythmias

“…Some findings on the ECG can point to the risks of developing this clinical condition, though the information is difficult to detect. P‐wave‐related parameters provide clinicians with very useful information about AF 16,17 . Among these parameters, PWPT has gained an important place in predicting AF, especially in recent years 18,19 …”

The relationship of benign prostatic hyperplasia's symptoms severity with the risk of developing atrial fibrillation

“… 6 , 23 A study of stroke patients with new onset or episodes of paroxysmal AF has shown that increased serum inflammatory markers was associated with prolonged PWD and thus supporting the role of inflammation in developing AF. 24 Another important factor is the role of testosterone in BPH disease as studies have shown that low levels of serum testosterone are directly related to the development and the progress of prostatic hyperplasia aggravating lower urinary tract symptoms. 8 , 23 On the other hand, the FINRISK97 study showed that low testosterone levels have a predictive value for future atrial fibrillation development in men.…”

Comparison of serum Lp‐PLA2 levels in ischemic stroke patients with H‐type hypertension or non‐H‐type hypertension

“…Hs‐CRP is a classic risk factor for inflammation associated with atherosclerosis, and the hs‐CRP levels are known to be significantly higher in patients who had an ischemic stroke than in controls. Acampa reported that hs‐CRP levels were associated with atrial fibrillation development in patients with cryptogenic stroke, and hs‐CRP may be a potential therapeutic target for preventing atrial fibrillation in patients with cryptogenic stroke. However, in this study, no significant difference was noted between ischemic stroke patients with H‐type hypertension and those with non‐H‐type hypertension.…”