title: Atrial ectopic activity in cryptogenic ischemic stroke and TIA: a risk factor for recurrence.
abstract: BACKGROUND
  To characterize atrial ectopic activity in patients with cryptogenic ischemic stroke (CIS) or transient ischemic attack (TIA) and determine its prognostic significance.
  
  
  METHODS
  Retrospective cohort study, in which 184 patients with CIS or TIA who had performed 24-hour Holter electrocardiogram were included. The median follow-up was 27.5 months. Baseline clinical and imagiologic characteristics, etiologic investigation results, and ischemic stroke and TIA recurrences information were collected. Number of atrial premature complexes (APCs) per hour was categorized as less than 10 APCs/hour, 10-30 APCs/hour, and more than 30 APCs/hour.
  
  
  RESULTS
  Most of the patients had less than 10 APCs/hour (82.6%), 8.2% had 10-30 APCs/hour, and 9.2% had more than 30 APCs/hour. Patients with more than 30 APCs/hour had a greater median left atrium diameter than patients with 30 APCs/hour or less (42 mm vs. 38 mm; 95% confidence interval [CI], .50-7.00; P = .003). Annual recurrence rate of CIS or TIA was 2.9% in patients with less than 10 APCs/hour, 11.0% in 10-30 APCs/hour, and 22.6% in more than 30 APCs/hour (P = .001). More than 30 APCs/hour were independently associated with recurrence risk in multivariate survival analysis (hazard ratio, 3.40; 95% CI, 1.12-10.32; P = .030).
  
  
  CONCLUSIONS
  In patients with CIS or TIA, frequent atrial ectopic activity (>30 APCs/h) was independently associated with increased risk of stroke or TIA recurrence. Further studies need to validate frequent atrial ectopic activity as a risk factor for recurrence in cryptogenic stroke and confirm its role as a predictor of occult atrial fibrillation.
authors.affiliation: Neurology Department, Hospital de Braga, Portugal. Electronic address: jdpinho@gmail.com.
authors.forename: João
authors.initials: J
authors.lastname: Pinho
authors.affiliation: Cardiology Department, Hospital de Braga, Braga, Portugal.
authors.forename: Carlos Galvão
authors.initials: CG
authors.lastname: Braga
authors.affiliation: Neurology Department, Hospital de Braga, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Rocha
authors.affiliation: Neurology Department, Hospital de Braga, Portugal.
authors.forename: Ana Filipa
authors.initials: AF
authors.lastname: Santos
authors.affiliation: Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal.
authors.forename: André
authors.initials: A
authors.lastname: Gomes
authors.affiliation: Cardiology Department, Hospital de Braga, Braga, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Cabreiro
authors.affiliation: Cardiology Department, Hospital de Braga, Braga, Portugal.
authors.forename: Sónia
authors.initials: S
authors.lastname: Magalhães
authors.affiliation: Neurology Department, Hospital de Braga, Portugal.
authors.forename: Carla
authors.initials: C
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology*; D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000503:physiopathology*
keywords: Holter electrocardiography; Ischemic stroke; atrial premature complexes; cryptogenic; risk factor