title: Excessive supraventricular ectopic activity is indicative of paroxysmal atrial fibrillation in patients with cerebral ischemia.
abstract: BACKGROUND
  Detecting paroxysmal atrial fibrillation (PAF) in patients with cerebral ischemia is challenging. Frequent premature atrial complexes (PAC/h) and the longest supraventricular run on 24-h-Holter (SV-run(24 h)), summarised as excessive supraventricular ectopic activity (ESVEA), may help selecting patients for extended ECG-monitoring, especially in combination with echocardiographic marker LAVI/a' (left atrial volume index/late diastolic tissue Doppler velocity).
  
  
  METHODS
  Retrospective analysis from the prospective monocentric observational trial Find-AF (ISRCTN-46104198). Patients with acute stroke or TIA were enrolled at the University Hospital Göttingen, Germany. Those with sinus rhythm at presentation received 7-day Holter-monitoring. ESVEA was quantified in one 24-hour interval free from PAF. Echocardiographic parameters were assessed prospectively.
  
  
  RESULTS
  PAF was detected in 23/208 patients (11.1%). The median was 4 [IQR 1; 22] for PAC/h and 5 [IQR 0; 9] for SV-run(24 h). PAF was more prevalent in patients with ESVEA: 19.6% vs. 2.8% for PAC/h >4 vs. ≤ 4 (p<0.001); 17.0% vs. 4.9% for SV-run(24 h >5) vs. ≤ 5 beats (p = 0.003). Patients with PAF showed more supraventricular ectopic activity: 29 PAC/h [IQR 9; 143] vs. 4 PAC/h [1]; [14] and longest SV-run(24 h = 10) [5]; [21] vs. 0 [0; 8] beats (both p<0.001). Both markers discriminated between the PAF- and the Non-PAF-group (area under receiver-operator-characteristics-curve 0.763 [95% CI 0.667; 0.858] and 0.716 [0.600; 0.832]). In multivariate analyses log(PAC/h) and log(SV-run(24 h)) were independently indicative of PAF. In Patients with PAC/h ≤ 4 and normal LAVI/a' PAF was excluded, whereas those with PAC/h >4 and abnormal LAVI/a' showed high PAF-rates.
  
  
  CONCLUSIONS
  ESVEA discriminated PAF from non-PAF beyond clinical factors including LAVI/a' in patients with cerebral ischemia. Normal LAVI/a'+PAC/h ≤ 4 ruled out PAF, while prevalence was high in those with abnormal LAVI/a'+PAC/h >4.
authors.affiliation: Clinic for Cardiology and Pneumology, University of Göttingen, Göttingen, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Weber-Krüger
authors.forename: Klaus
authors.initials: K
authors.lastname: Gröschel
authors.forename: Meinhard
authors.initials: M
authors.lastname: Mende
authors.forename: Joachim
authors.initials: J
authors.lastname: Seegers
authors.forename: Rosine
authors.initials: R
authors.lastname: Lahno
authors.forename: Beatrice
authors.initials: B
authors.lastname: Haase
authors.forename: Cord-Friedrich
authors.initials: CF
authors.lastname: Niehaus
authors.forename: Frank
authors.initials: F
authors.lastname: Edelmann
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuß
authors.forename: Rolf
authors.initials: R
authors.lastname: Wachter
authors.forename: Raoul
authors.initials: R
authors.lastname: Stahrenberg
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016279:Atrial Function, Left / Q000502:physiology*; D001783:Blood Flow Velocity / Q000502:physiology; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology