title: Prolonged QTc interval predicts poststroke paroxysmal atrial fibrillation.
abstract: OBJECTIVE
  Paroxysmal atrial fibrillation (PAF) is often difficult to detect in patients with acute ischemic stroke. We aimed to assess the predictive value of a prolonged QT interval corrected for heart rate (QTc) in PAF detection after acute ischemic stroke.
  
  
  METHODS
  We enrolled 972 patients with acute ischemic stroke consecutively extracted from our observational stroke registry system. Exclusion criteria were as follows: (1) AF on the initial 12-lead ECG (n=171); (2) previously diagnosed PAF (n=47); and (3) the use of a cardiac pacemaker (n=10). Of the 972 patients, 744 (mean age, 67.6 years; men, 62.6%) were eligible for analysis. The clinical characteristics and 12-lead ECG findings of the patients with and without PAF were compared, and multiple logistic regression analysis was performed to identify predictors of poststroke PAF.
  
  
  RESULTS
  The poststroke cardiac work-up yielded 69 (9.3%) de novo PAF cases among the 744 patients. The QTc interval was significantly longer in patients with PAF than in those without PAF (436 versus 417 ms; P<0.001). Each 10-ms increase in the QTc interval was associated with an increased risk of PAF after multivariate adjustments (odds ratio, 1.41; 95% confidence interval, 1.24-1.61; P<0.001). The optimal threshold value of QTc interval calculated by a receiver-operating characteristic curve was 438 ms, and the area under the curve was 0.73 in this data set.
  
  
  CONCLUSIONS
  The QTc interval prolongation is potentially a strong and useful predictor for poststroke PAF.
authors.affiliation: From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.). thoshino@nij.twmu.ac.jp.
authors.forename: Takao
authors.initials: T
authors.lastname: Hoshino
authors.affiliation: From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.).
authors.forename: Takehiko
authors.initials: T
authors.lastname: Nagao
authors.affiliation: From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.).
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shiga
authors.affiliation: From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.).
authors.forename: Kenji
authors.initials: K
authors.lastname: Maruyama
authors.affiliation: From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.).
authors.forename: Sono
authors.initials: S
authors.lastname: Toi
authors.affiliation: From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.).
authors.forename: Satoko
authors.initials: S
authors.lastname: Mizuno
authors.affiliation: From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.).
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ishizuka
authors.affiliation: From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.).
authors.forename: Satoru
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.).
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Uchiyama
authors.affiliation: From the Department of Neurology (T.H., T.N., K.M., S.T., S.M., K.I., S.U., K.K.), Department of Cardiology (T.S.), and Medical Research Institute (S.S.), Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Center for Medicine, International University of Health and Welfare, Tokyo, Japan (S.U.); and Center for Brain and Cerebral Vessels, Sanno Hospital Sanno Medical Center, Tokyo, Japan (S.U.).
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitagawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis*; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020521:Stroke / Q000150:complications*; D013997:Time Factors
keywords: atrial fibrillation; electrocardiography; stroke