Supraventricular Premature Beats and Short Atrial Runs Predict Atrial Fibrillation in Continuously Monitored Patients With Cryptogenic Stroke

Abstract

Background and Purpose-Supraventricular premature beats (SPBs) may help to assess the risk of atrial fibrillation (AF) in patients with cryptogenic stroke and therefore guide therapy. Methods-An internal loop recorder was implanted in consecutive patients with acute cryptogenic stroke. The occurrence and quantity of SPBs and short supraventricular runs (SVRs) in 24-hour ECG in patients with and without future AF were analyzed. We evaluated the relative risk of the upper quartile of SPB and SVR patients against the remainder and used binary logistic regression to evaluate a possible independent influence of SPBs and SVRs on AF occurrence.

Atrial Premature Beats Predict Atrial Fibrillation in Cryptogenic Stroke

“…[9][10][11][12][13][14][15][16][17][18]20,22,23 Several recent studies indicate that Holterdetected frequent APBs, or APBs present on a routine 12-lead ECG, 19,20 are an independent risk factor for stroke or death; previous studies used different thresholds for defining frequent APBs during a 24-hour recording (>100, 16 >218, 14 >228 APBs, 18 or >720 APBs or episodes of atrial tachycardia >20 beats long 15 ). In our study, we found that nearly 50% patients with cryptogenic stroke had an APB frequency >720/24 h, which is potentially clinically important based on the above literature.…”

Prognostic factors of recurrent acute cerebrovascular incidents in patients with ischemic stroke

“…Так, ранее было показано, что увеличение количества НЖЭ свидетельствует об электрической нестабильности миокарда левого предсердия и ассо-циировано с высоким риском развития ФП, вклю-чая бессимптомные пароксизмы [16]. В ряде про-спективных исследований была выявлена прямая ассоциация частоты НЖЭ с вероятностью развития ФП и риском кардиоэмболического инсульта [17,18]. Те же параллели проводят между инсультом и частой ЖЭ.…”

Ischemic Stroke Phenotype in Patients With Nonsustained Atrial Fibrillation

“…[25][26][27] All these findings fit well into the recent observations that short supraventricular runs designate initial stages of left atrial remodeling and therefore are a predictor of future AF. 12,13 Leaving aside the prognostic value in predicting conversion into persistent AF, the more critical question is whether nonsustained AF plays a similar role in stroke pathophysiology like its persistent or paroxysmal equivalents. One way to answer this question might be to assess the presence of nonsustained AF in various stroke subtypes and look for a higher prevalence of this arrhythmia in cryptogenic strokes.…”

“…Несмотря на сходство с ФП, эти ритмы нельзя формально классифицировать как пароксизмальную ФП из-за их неустойчивого характера [11]. Еще более важно то, что несмотря на известную предсказатель-ную ценность в отношении будущей трансформа-ции в хроническую ФП [12,13], в настоящее время неизвестно, играют ли эпизоды неустойчивой ФП такую же роль в патофизиологии инсульта, как посто-янная и пароксизмальная ФП. В ранее проведенных исследованиях выявили тесную связь между наличием ФП и развитием эмболических осложнений.…”

“…10 Despite their resemblance to AF, these rhythms cannot be formally classified as paroxysmal AF because of their nonsustained nature. 11 More importantly, although shown to be predictive of future conversion to chronic AF, 12,13 it is currently unknown whether nonsustained AF episodes play a similar role in stroke pathophysiology like their persistent and paroxysmal counterparts. Previous studies have revealed a close relationship between total AF burden and embolic complications; data obtained from recordings in patients with implanted pacemakers show an increase in the incidence of embolic events when the duration of AF is >5 minutes, and this risk further escalates when the episodes last >24 hours.…”