Evaluation of the association between stroke/transient ischemic attack and atrial electromechanical delay in patients with paroxysmal atrial fibrillation

Abstract

Objective:This study aimed to evaluate the association between the history of stroke/transient ischemic attack (TIA) and inter- and intra-atrial electromechanical delay (EMD) in patients with paroxysmal atrial fibrillation (PAF).Methods:Patients diagnosed with PAF were included in this retrospective study. Patients who had a history of stroke or TIA were defined as the symptomatic group, whereas those who did not have such a history were defined as the asymptomatic group. On the basis of the transthoracic echocardiographic records, atrial electromechanical coupling (time interval from the onset of the P wave on the surface electrocardiogram to the beginning of the A’ wave interval with tissue Doppler echocardiography) and intra- and interatrial EMD were measured.Results:In this study, 160 patients were included, 52 of whom were symptomatic. While the intra-left atrial EMD was 68.2±6.1 ms in the symptomatic group, it was found to be 50.8±6.5 ms in the asymptomatic group (p<0.001). Interatrial EMD was 91.3±5.0 ms in the symptomatic group, whereas it was 71.5±7.0 ms in the asymptomatic group (p<0.001). In multiple logistic regression analysis, intra-left atrial [odds ratio (OR): 1.417, 95% confidence interval (CI): 1.193–1.684, p<0.001] and interatrial EMDs (OR:1.398, 95% CI: 1.177–1.661, p<0.001) were found to be independently associated with the presence of stroke/TIA.Conclusion:Prolonged inter- and intra-left atrial EMDs in patients with PAF is associated with stroke/TIA. Evaluating this parameter in addition to the CHA2DS2-VASc score in patients with PAF may be helpful in identifying patients who are at a high risk of stroke/TIA. (Anatol J Cardiol 2016; 16: 572-8)

Neuro-otology- some recent clinical advances

“…or a recovered vestibular neuritis? Could the patient have had paroxysmal AF with a cerebellar embolus [121, 122]? How far to go?…”

Kaynağı belirlenemeyen embolik inmede sol atriyal ve ventriküler longitudinal strain

“…No significant correlation was found between ESUS and EMD. In contrast, Bayar et al [10] demonstrated that longer EMD was associated with stroke/TIA in patients with paroxysmal AF. They suggested that longer EMD predicts atrial conduction heterogeneity which is associated with stroke; therefore, evaluation of EMD could be helpful in determining patients at high-risk of stroke/TIA in PAF patients.…”

Predictive Value of Supraventricular Short Runs for New-Onset Atrial Fibrillation in Patients with Ischemic Stroke

“…A sequential combination of cardiac monitoring improves outcomes in patients with ischemic stroke and transient ischemic events, irrespective of the underlying anatomical defect. [ 14 ] Yet 24 to 48-h Holter monitoring is still the first-line monitoring strategy after stroke to rule out AF, during which APCs and SVRs are frequently detected even in the absence of paroxysmal AF. [ 15 ] Unlike AF, there is no consensus about the management when SVRs and APCs are detected, and the clinical approaches of neurologists and cardiologists differ due to the resultant uncertainty and ambiguity.…”