Predicting Atrial Fibrillation after Ischemic Stroke: Clinical, Genetics, and Electrocardiogram Modelling

Abstract

Introduction: Detection of atrial fibrillation (AF) is challenging in patients after ischemic stroke due to its paroxysmal nature. We aim to determine the utility of a combined clinical, electrocardiographic and genetic variables model to predict AF in a post-stroke population. Materials and Methods: We performed a cohort study at a single comprehensive stroke centre from 09/11/2009 to 31/10/2017. All patients recruited were diagnosed with acute ischemic stroke or transient ischemic attacks. Electrocardiographic variables including p-wave terminal force (PWTF), corrected QT interval (QTc) and genetic variables including single nucleotide polymorphisms (SNP) at the 4q25 (rs2200733) were evaluated. Clinical, electrocardiographic and genetic variables of patients without AF and those who developed AF were compared. Multiple logistic regression analysis and receiver operating characteristics were performed to identify parameters and determine their ability to predict the occurrence of AF. Results: Out of 709 patients (median age of 59 years, IQR 52-67) recruited, sixty (8.5%) were found to develop AF on follow-up. Age (odds ratio (OR): 3.49, 95% confidence interval (CI): 2.03-5.98, p<0.0001), hypertension (OR: 2.76, 95% CI: 1.36-5.63, p=0.0052) and valvular heart disease (OR: 8.49, 95% CI: 2.62-27.6, p<0.004 were the strongest predictors of AF, with area under receiver operating value of 0.76 (95% CI: 0.70-0.82), and 0.82 (95% CI: 0.77-0.87) when electrocardiographic variables (PWTF and QTc) were added. SNP did not improve prediction modelling. Conclusion: We demonstrated that a model combining clinical and electrocardiographic variables provided robust prediction of AF in our post-stroke population. Role of SNP in prediction of AF was limited.

Prevalence and Factors Associated with Atrial Fibrillation in Patients with Transient Ischemic Attack or Ischemic Stroke in Northern Vietnam

“…Interestingly, our study revealed a noteworthy finding: the cohort of stroke patients with hypertension exhibited a heightened likelihood of AF detection compared to their counterparts without hypertension. This finding contrasts with the observations in the study by Poh et al [24]. Hence, further well-designed investigations are warranted to precisely ascertain the relationship between hypertension and AF within the stroke population.…”

Stroke–heart syndrome: current progress and future outlook

“…Tachycardia-associated arrhythmias, especially AF, are more frequent than bradycardias [15,26]. The incidence of AF following AIS is approximately 5-24% [21][22][23][24]. Consistent with the above-mentioned results, the incidence of AF detected after stroke (AFDAS) was higher in strokes involving the right insula (39%) than in strokes involving the left insula (4%) [61].…”

“…Dynamic analysis of the RR interval performed in the hyperacute phase of AIS can help identify high-risk paroxysmal AF episodes [110]. Several predictive models have been developed for AFDAS [23,111]. Further, a study established a multimodal approach incorporating imaging, ECG, and original biomarkers [112].…”

Temporal alterations in P-wave electrocardiographic metrics post patent foramen ovale closure: a retrospective study

“…Monitoring PWTF provides a dynamic assessment of these changes, aiding in the early detection of atrial remodelling and potential AF development. 28,29 Understanding the relationship between PW parameters and AF has important clinical implications. These electrocardiographic indices, which can be obtained from routine evaluations after PFO closure, provide a non-invasive method for identifying individuals at risk of AF.…”