Related Experiment Video
Updated: Jun 15, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Atrial premature complex burden as a risk stratification predictor of paroxysmal atrial fibrillation and embolic
Jin Un Kim1, Alice Snell1, Peter Kabunga1
1Department of Cardiology, Darent Valley Hospital, Dartford, United Kingdom.
Insights
High atrial premature complex (APC) burden, detected via 14-day monitoring, strongly predicts occult paroxysmal atrial fibrillation (pAF) and embolic strokes. APC burden may serve as a surrogate marker for risk stratification in cryptogenic stroke patients.
Area of Science:
- Cardiology
- Neurology
- Medical Monitoring
Background:
- Investigating cryptogenic stroke aetiology is challenging.
- Occult paroxysmal atrial fibrillation (pAF) is a likely contributor but often missed by standard monitoring.
- Atrial premature complexes (APC) are markers of atrial myopathy and predictors of AF.
Purpose of the Study:
- To assess the association between APC burden and pAF using 14-day ambulatory cardiac monitoring.
- To determine if APC burden can serve as a surrogate marker for risk stratification in cryptogenic stroke patients.
Main Methods:
- Retrospective data collection from April 2022 to October 2023.
- Inclusion of adults (≥18 years) with confirmed or suspected stroke/TIA undergoing 14-day cardiac monitoring (Zio XT®).
- Exclusion of patients with 100% atrial fibrillation (AF) burden.
Main Results:
- 454 patients included; 29 diagnosed with pAF.
- APC runs >20 associated with a 270% increased odds of pAF (OR: 3.70).
- High APC burden correlated strongly with embolic strokes, with increased odds (OR: 3.65) for APC runs >20.
Conclusions:
- APC burden is strongly associated with embolic strokes, mirroring pAF aetiology.
- High APC burden may be a useful surrogate marker for risk stratification in cryptogenic stroke.
- APC identification is important for diagnostic and therapeutic considerations in cryptogenic stroke patients.
Introduction:
Investigating the aetiology of cryptogenic stroke is challenging. Occult paroxysmal atrial fibrillation (pAF) is likely a significant contributor, but is often missed by standard 24 h cardiac monitoring. Atrial premature complexes (APC) are markers of atrial myopathy and predictors of AF. We employ 14-day ambulatory cardiac monitoring as a novel monitoring modality to assess the association between APC burden and pAF. In the absence of pAF detection, APC burden may be a useful surrogate marker for risk stratification in patients with embolic stroke.
Methods:
We retrospectively collected data from April 2022 to October 2023 on adults (≥18 years) with confirmed or suspected stroke or transient ischemic attack (TIA) who underwent 14-day cardiac monitoring using Zio XT® (iRhythm Technologies, UK). Patients with 100 % atrial fibrillation (AF) burden were excluded.
Results:
A total of 454 patients (male: 268, 59 %; median age: 67 years [IQR: 56-76]) were included. 29 were diagnosed with pAF. In adjusted analysis, APC runs >20 was associated with a 270 % increase in the odds of pAF (OR: 3.70, 95 % CI: 1.47-9.36, p < 0.01), with APC runs >110 showing the strongest association (OR: 7.71, 95 % CI: 2.49-23.86, p = 0.04). High APC burden showed a strong correlation with radiologically embolic appearing strokes with increasing strength of association with higher APC run counts [APC runs >20 was associated with 265 % increased odds of embolic stroke (OR: 3.65, 95 % CI: 2.06-6.46, p < 0.01)]. Age and hypertension were significant predictors of pAF, while obesity and smoking were not significant.
Discussion:
The presence and burden of APC run are strongly associated with embolic strokes. High APC burden displays similar aetiological stroke presentation to those with pAF. This appears to be distinct from those with low APC burden, where the majority had alternative identified aetiology. This is likely due to downstream consequences of atrial myopathy. In the absence of pAF, APC identification may be important in the diagnostic and therapeutic considerations of cryptogenic stroke patients.
Related Concept Videos
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:28Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
01:28Mechanism of Cardiac Arrhythmias
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...