Evaluating patients with acute ischemic stroke with special reference to newly developed atrial fibrillation in cerebral embolism.
BACKGROUND
Cardioembolic strokes are extensive and have a poor prognosis. To identify the cardiovascular risk factors of cardioembolic stroke, we evaluated the cardiovascular status with special reference to persistent atrial fibrillation (AF) and paroxysmal atrial fibrillation (PAF) combined with the type of acute ischemic stroke.


METHODS
We divided 315 consecutive patients admitted to our Department of Neurosurgery with an acute ischemic stroke into four types of brain infarction using clinical history, onset pattern of stroke, and brain imaging: cardioembolic (group E, n = 105), lacunar (group L, n = 92), atherothrombotic (group T, n = 111), and unclassified (n = 7). All patients underwent standard electrocardiography (ECG), a 24-hour ECG recording (Holter ECG) and transthoracic echocardiography (UCG).


RESULTS
Persistent AF or PAF was detected in 97 patients (31.5%) using Holter ECG: more frequently in group E (67.6%) than in groups L (15.2%) or T (9.2%). Persistent AF or PAF was first diagnosed on admission using a standard ECG in 16 patients (5.2%) with no previous history and 14 of these patients belonged to group E (13.3%). PAF was newly detected on Holter ECG in another 26 patients (8.4%) and 13 of these patients (12.4%) belonged to group E. Concerning UCG, left atrial enlargement and mitral regurgitation were more frequent in group E than in group L or T.


CONCLUSIONS
Holter ECG in addition to ECG on admission is important for detecting persistent AF or PAF in patients with ischemic stroke, especially with cardioembolism as diagnosed by neuroimaging.
Tagawa
Minoru
M
Department of Cardiology, Nagaoka Chuo General Hospital, Niigata 940-8653, Japan. m-tagawa@dc5.so-net.ne.jp
Takeuchi
Shigekazu
S
Chinushi
Masaomi
M
Saeki
Makihiko
M
Taniguchi
Yoshinori
Y
Nakamura
Yuichi
Y
Ohno
Hideko
H
Kitazawa
Keiko
K
Aizawa
Yoshifusa
Y
D000208:Acute Disease; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis*; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis*; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology