Related Experiment Video
Updated: Aug 24, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
How is Ambulatory Electrocardiogram Predictive of Stroke in Atrial Fibrillation Patients?
1Affiliated Hospital of Putian University, No. 999 Dongzhen East Road, Licheng District, Putian, Fujian, China.
Insights
Atrial fibrillation burden did not significantly predict stroke risk in patients detected by Holter ECG. However, the CHA₂DS₂-VASc score remains a strong predictor of stroke in these patients.
Area of Science:
- Cardiology
- Neurology
- Clinical Research
Background:
- Atrial fibrillation (AF) is a major risk factor for stroke.
- The relationship between atrial fibrillation burden (AFB) and ischemic stroke risk requires further investigation.
- Optimizing anticoagulation strategies by combining AFB and CHA₂DS₂-VASc scores is a key research area.
Purpose of the Study:
- To evaluate if AF burden, measured by 24-hour Holter ECG, is associated with ischemic stroke risk.
- To determine the predictive value of AF burden and CHA₂DS₂-VASc score for thromboembolic outcomes.
Main Methods:
- A cohort study of 210 patients with AF detected by Holter ECG.
- AF burden quantified as the percentage of time in AF during monitoring.
- Comparison of AF burden and CHA₂DS₂-VASc scores between patients with and without thromboembolic events.
- Multivariate regression analysis to identify stroke predictors.
Main Results:
- Eighteen thromboembolic events occurred during a median follow-up of 11.39 months.
- Patients with ischemic stroke had higher CHA₂DS₂-VASc scores but not significantly higher AF burden.
- Higher CHA₂DS₂-VASc scores were associated with a significantly increased risk of ischemic stroke (HR, 15.17) after adjustment.
- CHA₂DS₂-VASc score > 4.5 demonstrated high predictive accuracy for future stroke (AUC 0.92).
Conclusions:
- AF burden measured by Holter ECG monitoring is not a significant independent predictor of subsequent stroke risk.
- The CHA₂DS₂-VASc score remains a robust and validated predictor of stroke risk in patients with AF detected by Holter ECG.
- Underlying risk factors captured by the CHA₂DS₂-VASc score may be more critical than AF burden for predicting stroke in this population.
Background:
Atrial fibrillation (AF) is a significant stroke risk factor. Further research is needed to clarify whether higher atrial fibrillation burden (AFB) link to the elevated risk of ischemic embolism, and how AF burden could combine with CHA2DS2-VASc score to improve the anticoagulation strategy. We aim to evaluate if the AF burden characterized using 24-hours Holter ECG monitoring is associated with the risk of ischemic stroke.
Methods:
This cohort study enrolled 210 Holter ECG monitoring detected atrial fibrillation patients. The burden of atrial fibrillation was defined as the percentage of time in atrial fibrillation during the monitoring period, and the AF burden and CHA2DS2-VASc score were compared between patients with and without thromboembolic outcomes. Multivariate regressions were conducted to estimate the predictors of thromboembolic outcomes.
Results:
Eighteen thromboembolic events occurred within a median follow-up of 11.39 months. Patients with ischemic stroke had higher CHA2DS2-VASc scores but not higher AF burden. After adjusting for age, hypertension, diabetes, anticoagulation, antithrombotic therapy, AF burden, and AF with higher CHA2DS2-VASc score was associated with increased risk for ischemic stroke (hazard ratio (HR), 15.17). CHA2DS2-VASc score > 4.5 was a predictor of significantly higher risk of future stroke (AUC 0.92).
Conclusions:
In Holter ECG monitoring detected AF, AF burden does not significantly impact the subsequent risk of stroke; whereas, CHA2DS2-VASc scoring is still a robust predictor of stroke risk. This may illustrate that once AF is detected from Holter ECG monitoring, underlying risk factors appear to be more predictive of subsequent stroke risk than atrial fibrillation burden.
Related Concept Videos
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...
01:25Dysrhythmias VI: Management of Dysrhythmias