Cardiac Arrhythmias and Stroke

Engström, Gunnar; Hedblad, Bo; Juul‐Möller, Steen; Tydén, Patrik; Janzon, Lars

doi:10.1161/01.str.31.12.2925

Cited by 95 publications

(34 citation statements)

References 33 publications

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“…We also showed that stroke of undetermined etiology and cardioembolic stroke with a prior history of PAF were similarly associated with frequent PAC. These results of the present study confirm the findings of previous studies showing an association between frequent PAC and stroke [8, 9]. Further prospective studies are needed to clarify the risk of stroke in patients with frequent PAC.…”

Section: Discussionsupporting

confidence: 92%

“…We hypothesized that a certain population with stroke of unknown etiology should have latent PAF and such patients should be associated with frequent PAC. Engstrom et al [8] reported that the risk of ischemic and hemorrhagic stroke in men is associated with a high frequency of atrial ectopic beats. Wallmannn et al [9] reported that a high frequency of atrial premature beats in ischemic stroke patients predicts PAF.…”

Section: Introductionmentioning

confidence: 99%

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Frequent Premature Atrial Contractions in Stroke of Undetermined Etiology

Todo¹,

Moriwaki²,

Saito³

2009

Eur Neurol

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Background: The cause of ischemic stroke is undetermined in 15–40% of patients. We studied the association between frequent premature atrial contractions (PAC) and stroke of undetermined etiology. Methods: We retrospectively studied ischemic stroke patients who were consecutively admitted to our department and underwent 24-hour Holter ECG recording including 163 noncardioembolic stroke patients (group A), 24 stroke patients of undetermined etiology (group B), and 37 cardioembolic stroke patients with prior-diagnosed paroxysmal atrial fibrillation (group C). The number of PAC per 24 h and the prevalence of patients with frequent PAC (200 or more per 24 h) were compared between the groups. Results: The number of PAC was significantly larger in groups B and C than in group A. The proportion of patients with frequent PAC was larger in group B (13/24, 54%) and in group C (18/37, 48%) than in group A (32/163, 20%). Conclusion: Our data suggest that frequent PAC should be regarded as a masked type of paroxysmal atrial fibrillation and should be included in one of the causes of cardioembolic stroke.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Frequent Premature Atrial Contractions in Stroke of Undetermined Etiology

Todo¹,

Moriwaki²,

Saito³

2009

Eur Neurol

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“…An association between frequent PAC on 24-hour ECG recordings and an increased incidence of PAF in patients with ischemic stroke was also demonstrated [25]. A large array of evidence demonstrates that AF is triggered by multifocal abnormal electrical activity that usually originates in the pulmonary veins [26]. Thus, PAC is one trigger of AF.…”

Section: Discussionmentioning

confidence: 99%

Revisiting Clinical Utility of Chest Radiography and Electrocardiogram to Determine Ischemic Stroke Subtypes: Special Reference on Vascular Pedicle Width and Maximal P-Wave Duration

Sugie¹,

Kamiya²,

Iizuka³

et al. 2015

Eur Neurol

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Backgrounds: It is often difficult to diagnose stroke subtypes at admission, particularly in sinus rhythm cases. Vascular pedicle width (VPW) on chest X-ray (CXR) and maximal P-wave duration (P-max) on electrocardiogram (ECG) are again realized as useful parameters reflecting intravascular volume and atrial conduction status, respectively. We investigated the utility of VPW and P-max as a tool for differentiating ischemic stroke subtypes. Methods: We studied 343 acute stroke patients showing sinus rhythm on admission. Dividing the patients into cardioembolic (CE) stroke (n = 57) and non-CE (n = 286) groups, we compared clinical backgrounds including VPW on CXR, and P-max in lead II and premature atrial contraction (PAC) on 12-leads ECG. Then, we investigated the independent factors for CE. Results: Independent factors associated with CE were VPW (≥59.3 mm) (p < 0.001; odds ratio (OR), 10.12; 95% confidence interval (CI), 4.13-24.8), P-max in lead II (≥120 ms) (p < 0.001; OR, 8.61; 95% CI, 3.96-18.7), PAC (p = 0.002; OR, 7.35; 95% CI, 2.14-25.3) and D-dimer level (≥1.11 µg/ml) (p = 0.016; OR, 2.57; 95% CI, 1.20-5.51). Conclusions: VPW, P-max, PAC and D-dimer are useful parameters for diagnosing CE stroke in patients with sinus rhythm at admission.

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“…The Nexstim system's 6-channel EMG module (SR = 1450 Hz, cut-off frequency of 350 Hz for the low pass filter) automatically calculated the motor evoked potential (MEP) amplitudes and latencies as the motor cortex (cortex area of the thumb) is stimulated [34]. Disposable Ag-AgCL surface electrodes were used to record the MEP responses that were displayed in a computer screen in order to assess the validity of the response based on the strength of MEPs reflecting the ability of that area to develop muscle contraction.…”

Section: Methodsmentioning

confidence: 99%

“…During seizures, bradycardia and asystole states can occur in some patients. Stroke can also alter the heart rhythm [34] and intense emotions can disrupt significantly the heart rate and blood pressure of a given patient [35]. An illustration of the PQRST deflections of the heart is given in Figure 1.…”

Section: Introductionmentioning

confidence: 99%

Induced Effects of Transcranial Magnetic Stimulation on the Autonomic Nervous System and the Cardiac Rhythm

Cabrerizo

Cabrera

Perez

et al. 2014

The Scientific World Journal

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Several standard protocols based on repetitive transcranial magnetic stimulation (rTMS) have been employed for treatment of a variety of neurological disorders. Despite their advantages in patients that are retractable to medication, there is a lack of knowledge about the effects of rTMS on the autonomic nervous system that controls the cardiovascular system. Current understanding suggests that the shape of the so-called QRS complex together with the size of the different segments and intervals between the PQRST deflections of the heart could predict the nature of the different arrhythmias and ailments affecting the heart. This preliminary study involving 10 normal subjects from 20 to 30 years of age demonstrated that rTMS can induce changes in the heart rhythm. The autonomic activity that controls the cardiac rhythm was indeed altered by an rTMS session targeting the motor cortex using intensity below the subject's motor threshold and lasting no more than 5 minutes. The rTMS activation resulted in a reduction of the RR intervals (cardioacceleration) in most cases. Most of these cases also showed significant changes in the Poincare plot descriptor SD2 (long-term variability), the area under the low frequency (LF) power spectrum density curve, and the low frequency to high frequency (LF/HF) ratio. The RR intervals changed significantly in specific instants of time during rTMS activation showing either heart rate acceleration or heart rate deceleration.

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Cardiac Arrhythmias and Stroke

Cited by 95 publications

References 33 publications

Frequent Premature Atrial Contractions in Stroke of Undetermined Etiology

Frequent Premature Atrial Contractions in Stroke of Undetermined Etiology

Revisiting Clinical Utility of Chest Radiography and Electrocardiogram to Determine Ischemic Stroke Subtypes: Special Reference on Vascular Pedicle Width and Maximal P-Wave Duration

Induced Effects of Transcranial Magnetic Stimulation on the Autonomic Nervous System and the Cardiac Rhythm

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