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Atrial ectopic activity in cryptogenic ischemic stroke and TIA: a risk factor for recurrence
João Pinho1, Carlos Galvão Braga2, Sofia Rocha1
1Neurology Department, Hospital de Braga, Portugal.
Summary
Frequent atrial ectopic activity, defined as over 30 atrial premature complexes per hour, significantly increases the risk of recurrent cryptogenic ischemic stroke or transient ischemic attack.
Area of Science:
- Cardiology
- Neurology
- Clinical Electrophysiology
Background:
- Cryptogenic ischemic stroke (CIS) and transient ischemic attack (TIA) represent a significant clinical challenge.
- Characterizing atrial ectopic activity is crucial for understanding stroke recurrence risk.
Purpose of the Study:
- To investigate the prevalence of atrial ectopic activity in patients with CIS or TIA.
- To determine the prognostic significance of atrial ectopic activity on stroke and TIA recurrence.
Main Methods:
- A retrospective cohort study included 184 patients with CIS or TIA undergoing 24-hour Holter monitoring.
- Patients were categorized by the number of atrial premature complexes (APCs) per hour (<10, 10-30, >30).
- Median follow-up was 27.5 months, with data on clinical characteristics and recurrence collected.
Main Results:
- 82.6% of patients had <10 APCs/hour, while 9.2% had >30 APCs/hour.
- Patients with >30 APCs/hour showed a larger median left atrium diameter (42 mm vs. 38 mm).
- The annual recurrence rate of CIS/TIA was significantly higher in patients with >30 APCs/hour (22.6%) compared to those with <10 APCs/hour (2.9%).
- Frequent atrial ectopic activity (>30 APCs/hour) was independently associated with increased recurrence risk (HR, 3.40).
Conclusions:
- Frequent atrial ectopic activity (>30 APCs/hour) is an independent predictor of recurrent stroke or TIA in patients with CIS or TIA.
- This finding highlights the prognostic importance of atrial ectopy in cryptogenic stroke.
- Further research is needed to confirm atrial ectopy as a risk factor and its role in predicting occult atrial fibrillation.
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