Junctional bradycardia is a potential risk factor of stroke
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Published on: July 5, 2021
Gwang Sil Kim1, Jae-Sun Uhm1, Tae-Hoon Kim1
1Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, Republic of Korea.
Insights
Junctional bradycardia (JB) significantly increases the risk of ischemic stroke, especially when a retrograde P wave is absent. This finding highlights JB as a potential risk factor for thromboembolic events.
Area of Science:
- Cardiology
- Neurology
Background:
- Junctional bradycardia (JB) is a cardiac arrhythmia that may be associated with thromboembolic events.
- The specific risk of stroke in patients with JB, particularly concerning the presence or absence of a retrograde P wave, requires further investigation.
Purpose of the Study:
- To determine the association between junctional bradycardia and the risk of thromboembolic events.
- To compare the incidence of ischemic stroke and other thromboembolic events in patients with JB versus a control group.
Main Methods:
- Retrospective analysis of electrocardiograms (ECGs) from 380,682 patients to identify those with JB.
- Inclusion criteria for JB: diagnosis on ECG at least twice over a ≥3-month interval.
- Comparison with 138 CHADS2 score-matched controls in sinus rhythm, assessing incidences of ischemic stroke and a composite of thromboembolic events.
Main Results:
- The prevalence of JB was 0.02% (69 out of 380,682 patients).
- JB patients without a retrograde P wave showed a significantly higher incidence of ischemic stroke (13.3%) compared to controls (2.2%; P = 0.007).
- The incidence of composite thromboembolic events was also significantly higher in JB patients without a retrograde P wave (17.8%) versus controls (2.9%; P = 0.011).
Conclusions:
- Junctional bradycardia is associated with an increased risk of ischemic stroke.
- The absence of an identifiable retrograde P wave in JB patients is a significant risk factor for stroke.
- These findings suggest JB, particularly without retrograde P waves, should be considered a potential risk factor for thromboembolic events.
Background:
This study aimed to determine the risk of thromboembolic events in patients with junctional bradycardia(JB).
Methods:
We retrospectively reviewed electrocardiograms(ECGs) for 380,682 patients. Those with JB on an ECG at least twice over a ≥3-month interval were included for analysis. We additionally included 138 CHADS2 score-matched patients(age, 68.4 ± 15.7 years; male, 52.2%) in sinus rhythm as a control group. Between the JB patients(with or without retrograde P wave) and controls, we compared incidences of ischemic stroke and a composite of ischemic stroke, renal infarction, ischemic colitis, acute limb ischemia, and pulmonary embolism.
Results:
Among 380,682 patients (age, 47.6 ± 19.9 years; male, 49.3%), 69 patients (age, 68.5 ± 16.5 years; male, 50.7%) exhibited JB on an ECG at least twice over a ≥3-month interval; the overall prevalence of JB was 0.02%. The mean follow-up period was 27.2 ± 26.2 months. Forty-five patients (65.2%) in the JB group had no retrograde P wave. Ischemic stroke incidence was significantly higher in JB patients without a retrograde P wave than in controls (6/45 patients [13.3%] and 3/138 patients [2.2%], respectively; P = 0.007). The incidence of composite thromboembolic events was also significantly higher in JB patients without a retrograde P wave than in controls (8/45 patients [17.8%] and 4/138 patients [2.9%], respectively; P = 0.011). In a Cox proportional hazards model, JB patients without a P wave showed a greater incidence of stroke (hazard ratio, 8.89 [2.20-33.01], P = 0.007) than controls and JB patients with a P wave.
Conclusions:
Junctional bradycardia is potentially associated with ischemic stroke, particularly in the absence of an identifiable retrograde P wave.
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