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Published on: February 26, 2013
Excessive supraventricular activity and risk of atrial fibrillation in patients with cryptogenic ischaemic stroke
Milan Maretta1, Miloš Šimurda2, Norbert Leško3
1Department of Neurology, P.J. Safarik University, Kosice, Slovakia. milan.maretta@gmail.com.
Insights
Prolonged Holter monitoring effectively detects atrial fibrillation (AF) in cryptogenic stroke patients. Frequent supraventricular activity predicts AF development, aiding early diagnosis and stroke prevention.
Area of Science:
- Cardiology
- Neurology
- Medical Diagnostics
Background:
- Atrial fibrillation (AF) is a primary cause of ischemic stroke, necessitating efficient screening methods.
- Current AF screening is time-consuming, highlighting the need for improved diagnostic markers.
- Cryptogenic Ischemic Stroke (CIS) patients, particularly those with Embolic Stroke of Unknown Source (ESUS), require thorough AF evaluation.
Purpose of the Study:
- To assess the effectiveness of prolonged inpatient Holter monitoring for AF detection in CIS patients.
- To evaluate early inpatient Holter monitoring's efficacy in diagnosing AF in ESUS-related CIS.
- To determine if excessive supraventricular activity correlates with AF detection in this patient cohort.
Main Methods:
- Included 48 consecutive patients with documented cerebral or cerebellar infarction.
- Diagnostic work-up involved neuroimaging, vascular ultrasound, ECG, transthoracic echocardiography, and 24-hour Holter monitoring.
- Patients without identified stroke cause underwent prolonged 14-day event Holter monitoring; supraventricular ectopic activity was quantified.
Main Results:
- AF was detected in 7 out of 48 patients (14.6%) using prolonged 14-day Holter monitoring.
- Patients diagnosed with new-onset AF exhibited a significantly higher burden of supraventricular ectopic activity (SVES, pairs, runs).
- Increased hourly SVES, SV pairs, and SV runs were significantly associated with AF detection (p < 0.022; p < 0.043; p < 0.022).
Conclusions:
- Prolonged ECG Holter monitoring significantly increases AF detection rates in patients with CIS-ESUS.
- Frequent supraventricular ectopic activity serves as a predictor for AF development in these patients.
- This approach improves the diagnostic process for AF in cryptogenic stroke patients.
Introduction:
Atrial fibrillation (AF) is one of the leading causes of ischaemic stroke. However, screening for AF is often time-consuming in clinical practice. Therefore, the determination of an appropriate marker to detect the presence of AF would improve the diagnostic process.
Objective:
The aim of the current study was to evaluate the efficacy of prolonged and early inpatient event Holter monitoring in the detection of AF in patients with ESUS-related cryptogenic ischaemic stroke (CIS), and to determine the possible relationship between excessive supraventricular activity and AF detection.
Material And Methods:
All consecutive patients with documented cerebral or cerebellar infarction were included. The diagnostic work-up included brain neuroimaging (CT/MRI), ultrasound of the carotid and vertebral arteries, admission ECG followed by 24 hours of Holter monitoring, and transthoracic echocardiography. The 24-hour Holter ECG was analysed, and supraventricular ectopic activity (supraventricular extrasystoles, runs and pairs of supraventricular extrasystoles) was recorded in all patients. If these examinations did not reveal the cause of ischaemic stroke, the patients underwent subsequent prlonged 14-day event Holter recorder monitoring.
Results:
We included 48 patients (mean age 69.9 ± 8.5 years, 60.4% men) who had been diagnosed with CIS. Of these 48 patients, atrial fibrillation was detected in seven (14.6%) during the prolonged 14-day Holter event monitoring. Patients with newly diagnosed atrial fibrillation had a higher burden of supraventricular ectopic activity. The number of supraventricular extrasystoles (SVES) per hour, as well as the number of SV pairs and SV runs, was significantly higher in patients with new onset AF (p < 0.022; p < 0.043; p < 0.022).
Conclusions:
In our study, we confirmed that prolonged ECG event Holter monitoring in patients with CIS-ESUS subtype led to a higher rate of AF detection. Likewise, frequent supraventricular ectopic activity predicted the development of AF.
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