Frequent atrial premature beats predict paroxysmal atrial fibrillation in stroke patients: an opportunity for a new diagnostic strategy.
OBJECTIVE
For patients having suffered ischemic stroke, the current diagnostic strategies often fail to detect atrial fibrillation as a potential cause of embolic events. The aim of the study was to identify paroxysmal atrial fibrillation in stroke patients. We hypothesized that patients with frequent atrial premature beats (APBs) recorded in 24-hour ECG will show more often atrial fibrillation when followed by repeated long-term ECG recordings than patients without or infrequent APBs.


METHODS
127 patients with acute ischemic stroke and without known AF were enrolled in a prospective study to detect paroxysmal AF. Patients were stratified according to the number of APBs recorded in a 24-hour ECG (> or =70 APBs versus <70 APBs). Subsequently, they all underwent serial 7-day event-recorder monitoring at 0, 3, and 6 months.


RESULTS
Serial extended ECG monitoring identified AF in 26% of patients with frequent APBs but only in 6.5% when APBs were infrequent (P=0.0021). A multivariate analysis showed that the presence of frequent APBs in the initial 24-hour ECG was the only independent predictor of paroxysmal AF during follow-up (odds ratio 6.6, 95% confidence intervals 1.6 to 28.2, P=0.01).


CONCLUSIONS
In patients with acute ischemic stroke, frequent APBs (> or = 70/24 hours) are a marker for individuals who are at greater risk to develop or have paroxysmal AF. For such patients, we propose a diagnostic workup with repeated prolonged ECG monitoring to diagnose paroxysmal AF.
Wallmann
Dieter
D
Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
Tüller
David
D
Wustmann
Kerstin
K
Meier
Pascal
P
Isenegger
Jörg
J
Arnold
Marcel
M
Mattle
Heinrich P
HP
Delacrétaz
Etienne
E
D000328:Adult; D000368:Aged; D001146:Arrhythmia, Sinus / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D002545:Brain Ischemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D013997:Time Factors