Is occult atrial disorder a frequent cause of non-hemorrhagic stroke? Long-term ECG in 86 patients.

Abstract

To assess the importance of occult atrial disorder with possible embolization as a cause of non-hemorrhagic stroke, 68 patients with neurologic symptoms lasting 24 hours or more and 18 patients with transient ischemic attacks were examined by long-term electrocardiographic recording (LTER). Lacking matched controls we used a reference population of 103 elderly subjects selected at random from the general population for a previous LTER study. Permanent or episodic atrial arrhythmias of types known to cause cerebral embolization were detected by LTER in 32 (47%) of the 68 patients with a clinical diagnosis of cerebral embolization or thrombosis and in 6 (33%) of the 18 patients with transient ischemic attacks. Of the 38 patients with atrial arrhythmia during LTER 17 had such arrhythmias in their standard ECGs. This frequency of atrial arrhythmias during LTER differs from that of the reference population (p less than 0.025). Thirteen of 16 patients with multiple cerebral lesions had signs of atrial arrhythmia during LTER. Patients having occult atrial disorder with episodic atrial arrhythmia may be an important and common risk group for non-hemorrhagic stroke in addition to the previously recognized group of patients with atrial arrhythmia detectable in the standard ECG. LTER may be important in the evaluation of patients with unexplained stroke.

Holter monitoring in patients with transient and focal ischemic attacks of the brain.

“…The diagnosis of sick sinus syndrome was based on the criteria of Abdon et al, 8 which may seem more lenient than generally applied.…”

“…As the sick sinus syndrome is possibly related to embolism, the tapes were also reviewed for this disorder, which was defined according to Abdon et al 8 as the presence of one of the following: (1) combined sinus bradycardia and sinus arrhythmia with a difference in consecutive cycles of 20% or more and < 50 beats per minute (bpm), or (2) regular sinus bradycardia of ^ 45 bpm when awake, or (3) sinoatrial block, or (4) sinus arrests of > 1.5 seconds, all irrespective of drug effects. A combination of the sick sinus syndrome and supraventricular tachycardias (heart rate ^ 100 bpm), specified as atrial tachycardia if P' waves were visible, was classified as the bradyarrhythmia-tachyarrhythmia syndrome.…”

“…9 They found that these transient dysrhythmias occurred significantly more frequently in patients with TIAs and unexplained stroke than in a reference population. 8 However, this control group was not matched for age and sex.…”

“…Furthermore, the prevalence of cardiovascular disorders among patients with and without sinus node dysfunction was not statistically different, which is in accordance with an earlier study. 8 From the few postmortem studies in patients with sinoatrial disease, it appears that ischemic heart disease may account for some cases, but in the majority of patients the cause remains unknown. 15 In the patients from this study it would have been impossible to anticipate from the presence of clinical evidence of cardiovascular disease whether Holter monitoring would be rewarding.…”

Current approaches to antithrombotic therapy in patients with cardioembolic stroke

“…Хотя есть некоторые разногласия в том, какие типы кардиальных аритмий ассоциируются с системной эмболией, исследова-ния пациентов с эмболическим инсультом показали, что при длительном мониторинге у 44% больных имеются пер-манентные или эпизодические предсердные аритмии, из-вестные как причины церебральной эмболии, и только 45% из них обнаруживаются на ЭКГ покоя [22].…”