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Risk of Stroke in Patients With Short-Run Atrial Tachyarrhythmia
Shinya Yamada1, Chin-Yu Lin1, Shih-Lin Chang2
1From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.).
Insights
Short-run atrial tachyarrhythmia (AT) significantly increases stroke risk. The CHA2DS2-VASc score aids in stratifying this risk, with age and premature atrial contraction burden being key factors in low-risk groups.
Area of Science:
- Cardiology
- Electrophysiology
- Stroke Prevention
Background:
- The association between short-run atrial tachyarrhythmia (AT) and stroke risk is not well-defined.
- Understanding this relationship is crucial for effective stroke risk stratification.
Purpose of the Study:
- To investigate the link between short-run AT and stroke incidence.
- To evaluate the utility of the CHA2DS2-VASc score in stratifying stroke risk in patients with short-run AT.
Main Methods:
- Analysis of 5342 subjects from a 24-hour Holter monitoring registry without prior atrial fibrillation or stroke.
- Short-run AT defined as supraventricular ectopic beats <5 seconds.
- Median follow-up of 9.0 years to assess new-onset stroke.
Main Results:
- 1595 subjects (29.8%) had short-run AT, exhibiting higher stroke rates (11.4% vs. 8.3%).
- CHA2DS2-VASc score demonstrated increased stroke rates with higher scores in AT patients.
- Age and premature atrial contraction burden independently predicted stroke in low-risk (CHA2DS2-VASc score 0 or 1) AT patients.
Conclusions:
- Short-run AT is an independent risk factor for stroke.
- The CHA2DS2-VASc score is valuable for stratifying stroke risk in patients with short-run AT.
- Identifying high-risk individuals within lower CHA2DS2-VASc score categories requires consideration of age and premature atrial contraction burden.
Background And Purpose:
The risk of stroke in patients with short-run atrial tachyarrhythmia (AT) remains unclear. This study aimed to investigate the relationship between short-run AT and the stroke and the use of the CHA2DS2-VASc score for the risk stratification.
Methods:
From the registry of 24-hour Holter monitoring, 5342 subjects without known atrial fibrillation or stroke were enrolled. Short-run AT was defined as episodes of supraventricular ectopic beats <5 seconds.
Results:
There were 1595 subjects (29.8%) with short-run AT. During the median follow-up period of 9.0 years, 494 subjects developed new-onset stroke. Patients with short-run AT had significantly higher stroke rates compared with patients without short-run AT (11.4% versus 8.3%; P<0.001). In patients with short-run AT, the number of strokes per 100 person-years for patients with CHA2DS2-VASc score of 0 and 1 were 0.23 and 0.67, respectively. However, the number of them for patients with CHA2DS2-VASc score of 2, 3, 4, and ≥5 were 1.62, 1.89, 1.30, and 2.91, respectively. In patients with CHA2DS2-VASc score of 0 or 1, age (>61 years old) and burden of premature atrial contractions (>25 beats/d) independently predicted the risk of stroke. In subgroup analyses, short-run AT patients were divided into 3 groups based on their CHA2DS2-VASc scores: low score (score of 0 [men] or 1 [women]; n=324), intermediate score (score of 1 [men] or 2 [women]; n=275), and high score (score of ≥2 [men] or ≥3 [women]; n=996). When compared with low score, intermediate and high scores were independent predictors for stroke (hazard ratio, 6.165; P<0.001 and hazard ratio, 8.577; P<0.001, respectively).
Conclusions:
Short-run AT increases the risk of stroke. Therefore, the CHA2DS2-VASc score could be used for the risk stratification. Age and burden of premature atrial contractions were independent predictors for stroke in patients with CHA2DS2-VASc score of 0 or 1.
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