Young Patients with Unknown Stroke and Little P Wave in ECG
Yi-He Chen1, Yan-Yan Chen2, Wei-Jian Huang1
1Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University.
Insights
Two young patients experienced atrial fibrillation/flutter with stroke due to electrical-mechanical atrial dysfunction. This suggests underlying fibrotic atrial cardiomyopathy in low-risk patients.
Area of Science:
- Cardiology
- Electrophysiology
- Neurology
Background:
- Atrial fibrillation and atrial flutter are common arrhythmias.
- Cerebral embolism is a serious complication, typically associated with higher stroke risk factors.
Observation:
- Two young patients presented with atrial fibrillation/flutter complicated by cardiogenic cerebral embolism.
- Electrophysiological studies revealed extensive low-voltage zones or electrical silence in the atria.
- Echocardiography demonstrated impaired atrial mechanical function.
Findings:
- Electrical-mechanical dysfunction of the atria was identified as the cause of embolic events.
- This occurred in patients considered at very low risk for stroke.
- Idiopathic, fibrotic atrial cardiomyopathy is proposed as the underlying pathology.
Implications:
- This finding highlights a potential mechanism for stroke in specific low-risk patient populations.
- It suggests the need for further investigation into atrial cardiomyopathy in young patients with these arrhythmias.
- Understanding this link may lead to revised risk stratification and treatment strategies.
Abstract:
Here we report two young patients with atrial fibrillation/atrial flutter complicated with cardiogenic cerebral embolism. Electrophysiological study revealed a large area of low-voltage zone or area of electric silence in both sides of the atrium during restoration of sinus rhythm, and the echocardiogram showed loss of mechanical function of the atrium. The electrical-mechanical dysfunction of the atrium was considered to be the cause of embolic event in this type of patient who was "very low" stroke risk atrial fibrillation or atrial flutter. The idiopathic, fibrotic atrial cardiomyopathy may be underlying in these patients.
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