Excessive supraventricular ectopic activity and future onset of atrial fibrillation in patients with cryptogenic stroke |
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| Affiliation: | 1. Department of Cardiology, Papageorgiou Hospital, Thessaloniki, Greece;2. 3rd University Department of Cardiology, “Sotiria” General Hospital for Chest Diseases, Athens 11527, Greece;3. Department of Neurology, Papageorgiou Hospital, Thessaloniki, Greece;1. Warren Alpert Medical School of Brown University, Providence, RI, USA;2. Division of Neurology, Mount Auburn Hospital, Cambridge, MA, USA;3. Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA;4. Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA;5. Section of Medical Education, Warren Alpert Medical School of Brown University, Providence, RI, USA;1. Department of Neurology, State University of New York, Upstate Medical University, Syracuse, NY, USA;2. Department of Neurology, Georgetown University School of Medicine, Washington, D.C., USA;3. Department of Cardiology, Yale University, New Haven, Connecticut, USA;4. Molecular Neuropharmacological Unit, National Institute of Neurological Diseases and Stroke, NINDS, Bethesda, Maryland, USA;5. Department of Neurosurgery, University of Connecticut, Hartford, Connecticut, USA;6. Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA;7. Department of Critical Care, Springfield Clinic, Springfield, Illinois, USA;8. Department of Neurology, University of Maryland School of Medicine, Baltimore, USA;1. Department of Neurology, University of Massachusetts, Worcester, MA, USA;2. Department of Neurology, Brown University, Providence, RI, USA;3. Department of Neurology, Yale University, New Haven, CT, USA;4. Department of Neurology, Medical University of South Carolina, Charleston, SC, USA;5. Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA;6. Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland;7. Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave, North, Worcester, MA, 01655;1. Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada;2. Robarts Research Institute and Lawson Health Research Institute, London, Ontario, Canada;3. Department of Clinical Neurological Sciences, The University of Western Ontario, London, Ontario, Canada;4. Department of Medical Imaging, The University of Western Ontario, London, Ontario, Canada;1. Department of Neurology, UCLA Health, Los Angeles, CA, United States;2. Neurology department, State University of New York Upstate Medical University, NY, United States;3. Department of Neurology, Hartford Healthcare, CT, United States;4. Master in Public Health, Icahn School of Medicine at Mount Sinai, NY, United States;5. Department of Neurology, Massachusetts General Hospital, MA, United States;6. Neurology Department, Montpellier University Hospital, (A.D.), France;7. Laboratory Charles Coulomb UMR 5221 CNRS-UM, Montpellier University, (A.D.), France |
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| Abstract: | ObjectivesAlthough evidence has shown the association of excessive supraventricular ectopic activity (ESVEA) with future development of atrial fibrillation (AF), this relationship is not yet fully understood. This study examines whether ESVEA can predict the future onset of AF, in patients presenting with cryptogenic stroke.Materials and MethodsA retrospective cohort of 124 non-AF, consecutive patients, hospitalized for cryptogenic stroke between 2014 and 2015, was retrieved. 24-h inpatient monitoring with Holter was employed to reveal ESVEA, defined as the presence of more than 20 premature atrial complexes per hour (PACs/h) on average, or a more than 5 s duration of the longest supraventricular run (LSVR). After a median follow-up period of 5.2 years, the patients were examined for AF.ResultsFrom initial 124 patients, 12 died and one was lost during follow-up. For the total of 111 patients finally included, the median age was 56 years and 25.2% were females. The overall baseline median CHA2DS2-VASc score was 3. AF was found in 13 (11.71%) patients. Patients who were finally diagnosed with AF had a significantly higher number of PACs/h and a longer median LSVR duration at baseline (16.67 vs. 0.21, p < 0.001 and 3 vs. 0 s, p < 0.001, respectively). The presence of ESVEA was also significantly more frequent among AF patients (46.15%, 95%CI: 17.78%–74.22%) compared to non-AF ones (6.1%, 95%CI: 1.3%–10.7%, p < 0.001).ConclusionsExcessive atrial ectopy, detected with 24 h inpatient Holter monitoring, is a significant indicator of future development of AF in patients presenting originally with a cryptogenic stroke. |
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