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Published on: February 26, 2013
Burden of Premature Atrial Complexes and Risk of Recurrent Stroke and Death in Patients with Mild to Moderate
Michala Herskind Sejr1, Ole May1, Dorte Damgaard2
1Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark.
Insights
High numbers of premature atrial complexes (PACs) and short atrial fibrillation (AF) runs did not increase stroke or death risk in patients recently experiencing ischemic stroke or transient ischemic attack (TIA). Further research is needed to understand PACs and AF
Area of Science:
- Cardiology
- Neurology
- Clinical Electrophysiology
Background:
- Premature atrial complexes (PACs) are increasingly recognized as a potential precursor to atrial fibrillation (AF).
- Current guidelines do not recommend anticoagulation for patients with high PAC burden despite suspected stroke risk.
- This study investigates the association between PACs, short AF runs, and adverse cardiovascular outcomes.
Purpose of the Study:
- To determine if a high burden of PACs or brief AF episodes (under 30 seconds) predict recurrent ischemic stroke, transient ischemic attack (TIA), or death.
- To analyze data from a large cohort of patients with acute ischemic stroke or TIA without prior AF diagnosis.
- To assess the risk associated with these arrhythmias in a post-stroke/TIA population.
Main Methods:
- A 48-hour continuous electrocardiogram (ECG) was performed within one week of ischemic stroke or TIA.
- Premature atrial complexes (PACs) were quantified as the mean number per hour.
- Cox Regression analysis was employed to calculate hazard ratios for adverse events, with follow-up data from national registries.
Main Results:
- The study included 1507 patients (60% ischemic stroke, 40% TIA), with 98.7% experiencing mild to moderate events.
- No significant association was found between PAC burden quartiles and the risk of recurrent stroke/TIA or death.
- Nonsustained atrial fibrillation (AF) episodes lasting less than 30 seconds were also not linked to an increased risk of stroke/TIA or death.
Conclusions:
- In patients with recent ischemic stroke or TIA, neither a high burden of PACs nor brief AF episodes (<30 seconds) were associated with an increased risk of recurrent stroke/TIA or death.
- These findings suggest that current anticoagulation guidelines may not need revision based solely on PAC burden or short AF runs in this patient group.
- Further investigation is warranted to fully elucidate the role of PACs and short AF runs in cardiovascular risk stratification.
Background:
Premature atrial complexes (PACs) meet increased attention as a potential intermediary between sinus rhythm and atrial fibrillation (AF). Patients with even high numbers of PACs do not fulfill current guidelines for oral anticoagulation treatment though an associated stroke risk is suspected.
Objective:
We aimed to determine whether a high number of PACs or runs of AF less than 30 seconds in 2-day continuous electrocardiogram (ECG) recording was associated with risk of recurrent ischemic stroke/transient ischemic attack (TIA) or death in a large cohort of patients with acute ischemic stroke or TIA and no prior AF.
Methods:
We performed 48 hours continuous ECG recording within 1 week after ischemic stroke/TIA. PACs were reported as mean number of PACs per hour. Patients were followed in Danish Stroke Registry, Danish Civil Registration System, and Danish National Patient Registry. Cox Regression analysis was used to calculate hazard ratios.
Results:
We included 1507 patients with TIA (40%) or ischemic stroke (60%), of which 98.7% had mild to moderate strokes. Mean age was 72.9 (7.8) years, 43.4% were females. Follow-up was 2.3 (1.3) years. Hazard ratio for recurrent stroke/TIA or death did not differ between quartiles of PAC burden, nor did any of the 2 components of this composite endpoint. Nonsustained AF less than 30 seconds was not associated with higher risk of recurrent stroke/TIA or death.
Conclusions:
In a large cohort of patients with recent ischemic stroke or TIA, burden of PACs or nonsustained AF less than 30 seconds were not associated to higher risk of recurrent stroke/TIA or death.
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