Electrocardiographic findings in patients with cryptogenic ischemic stroke and patent foramen ovale.
BACKGROUND
A characteristic electrocardiogram (ECG) pattern called crochetage has been described in patients with atrial septal defects. Nevertheless, there are discrepancies regarding its frequency in patients with patent foramen ovale (PFO).


OBJECTIVE
We analyzed the ECGs of patients who had cryptogenic stroke to study crochetage and other possible patterns in relation to PFO.


METHODS
We prospectively included consecutive patients who have had a cryptogenic stroke and are undergoing a right-to-left shunt (RLS) study with transesophageal echocardiography and simultaneous transcranial Doppler. Two blinded and independent cardiologists analyzed the ECGs for crochetage, defined as a notch near the apex of the R wave in inferior limb leads, P wave abnormalities, and right bundle branch block (RBBB).


RESULTS
We studied 104 patients whose mean age was 55.1 +/- 12.7 years; 60.6% were men. PFO was detected in 40.4% of patients. Cardiologists recorded crochetage in 26.2% of patients with PFO and 14.5% of patients without PFO (P = .204) and RBBB in 19% and 8% of patients, respectively (P = .132). P wave abnormalities were also detected in 54.8% of patients with PFO and 35.5% of patients without PFO (P = .070). In patients with PFO, biphasic P waves were more frequent in small RLS (P = .006). Although higher frequencies of crochetage in small RLS and RBBB in moderate RLS were detected, these differences did not reach statistical significance (P = .067 and P = .05, respectively).


CONCLUSIONS
There is no characteristic ECG pattern to identify the patients with cryptogenic stroke.
Belvís
Robert
R
Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. 32353rbn@comb.es
Leta
Rubén Gabriel
RG
Martínez-Domeño
Alejandro
A
Planas
Francesc
F
Martí-Fàbregas
Joan
J
Carreras
Francesc
F
Cocho
Dolores
D
Pons-Lladó
Guillem
G
Martí-Vilalta
Jose Luís
JL
Bayés de Luna
Antonio
A
D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology; D002037:Bundle-Branch Block / Q000150:complications / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology