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The Role of Electrocardiographic Markers for Predicting Atrial Fibrillation in Patients with Acute Ischemic Stroke:
Valerie Schütz1,2, Svetlana Dougoud3, Katja Bracher1
1Department of Neurology, University Hospital of Zurich, Neuroscience Center Zurich, University of Zurich, 8006 Zürich, Switzerland.
Insights
Advanced interatrial block (aIAB) on ECG predicts new atrial fibrillation (AF) in acute ischemic stroke (AIS) patients. This finding aids in identifying high-risk individuals for AF screening post-stroke.
Area of Science:
- Cardiology
- Neurology
- Electrocardiography
Background:
- P-wave abnormalities on ECG correlate with increased risk of acute ischemic stroke (AIS) and atrial fibrillation (AF).
- Identifying AF in AIS patients is crucial for stroke management and prevention.
Purpose of the Study:
- To evaluate pre-determined ECG criteria during sinus rhythm for predicting newly diagnosed atrial fibrillation (NDAF) in unselected AIS patients.
- To assess the diagnostic value of ECG markers for identifying patients who develop AF after hospital admission for AIS.
Main Methods:
- 12-lead ECGs were analyzed for P-wave alterations in 856 consecutive AIS patients without known AF.
- Patients underwent prolonged electrocardiographic monitoring for up to one year to detect NDAF.
- Univariable and multivariable logistic regression, AUC, and net reclassification index were used to assess ECG markers' predictive value.
Main Results:
- NDAF occurred in 10% of patients within 365 days.
- Advanced interatrial block (aIAB) and PR interval in lead II were associated with NDAF in univariable analysis.
- Only aIAB remained an independent predictor in multivariable analysis, improving NDAF prediction accuracy (AUC from 0.78 to 0.81).
Conclusions:
- Advanced interatrial block (aIAB) is a significant independent predictor of NDAF in AIS patients.
- aIAB demonstrates high inter-rater reliability and can refine diagnostic work-up for AF in AIS.
- ECG assessment for aIAB may help identify AIS patients requiring closer monitoring for AF.
Background And Aims:
P-wave abnormalities in the 12-lead electrocardiogram (ECG) have been associated with a higher risk of acute ischemic stroke (AIS) as well as atrial fibrillation (AF). This study aimed to assess pre-determined ECG criteria during sinus rhythm in unselected AIS patients and their value for predicting newly diagnosed atrial fibrillation (NDAF) after hospital admission.
Methods:
P-wave alterations were measured on 12-lead ECG on admission in all consecutively enrolled patients without known AF between October 2014 and 2017. The outcome of interest was NDAF, identified by prolonged electrocardiographic monitoring within one year after the index AIS. Univariable and multivariable logistic regression was applied to assess the magnitude and independence of the association between pre-selected ECG markers and NDAF. The discriminatory accuracy was evaluated with the area under the receiver operating characteristic curve (AUC), and the incremental prognostic value was estimated with the net reclassification index.
Results:
NDAF was detected in 87 (10%) of 856 patients during a follow-up of 365 days. Out of the pre-selected ECG parameters, advanced interatrial block (aIAB) and PR interval in lead II were independently associated with NDAF in univariable regression analysis. Only aIAB remained a significant predictor in multivariable analysis. Adding aIAB to the best-performing multivariable regression model improved the discriminatory accuracy to predict NDAF from an AUC of 0.78 (95%-CI 0.77-0.80) to 0.81 (95%-CI 0.80-0.83, p < 0.001).
Conclusion:
aIAB is independently and highly associated with NDAF in patients with AIS, has high inter-rater reliability, and therefore may be helpful to refine diagnostic work-up to search for AF in AIS.
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