title: Frequent atrial premature beats predict paroxysmal atrial fibrillation in stroke patients: an opportunity for a new diagnostic strategy.
abstract: 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.
authors.affiliation: Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
authors.forename: Dieter
authors.initials: D
authors.lastname: Wallmann
authors.forename: David
authors.initials: D
authors.lastname: Tüller
authors.forename: Kerstin
authors.initials: K
authors.lastname: Wustmann
authors.forename: Pascal
authors.initials: P
authors.lastname: Meier
authors.forename: Jörg
authors.initials: J
authors.lastname: Isenegger
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Etienne
authors.initials: E
authors.lastname: Delacrétaz
mesh_terms: 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