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Anatomical and radiographic stroke topography predicts ventricular and atrial ectopic burden
1Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
Insights
Stroke location influences cardiac arrhythmias. Lesions in specific brain areas, like the basal ganglia or left hemisphere, are linked to increased premature atrial contractions (PACs) and premature ventricular contractions (PVCs).
Area of Science:
- Neurology
- Cardiology
- Medical Research
Background:
- Stroke can disrupt normal heart rhythms, leading to cardiac arrhythmias.
- The precise relationship between the location of a stroke and the severity of ectopic beats (arrhythmias) is not well understood.
Purpose of the Study:
- To investigate the association between specific stroke locations and the burden of premature ventricular contractions (PVCs) and premature atrial contractions (PACs).
Main Methods:
- Retrospective analysis of 103 patients with confirmed stroke and 24-hour Holter monitoring.
- Stroke topography was categorized by vascular territory, neuro-anatomical region, and hemisphere.
- Negative-binomial regression models were used to assess the relationship between stroke location and ectopic burden, adjusting for relevant clinical factors.
Main Results:
- PAC burden was significantly higher in anterior cerebral artery (ACA) and middle cerebral artery (MCA) strokes compared to posterior cerebral artery (PCA) strokes.
- PVC burden was elevated in strokes affecting the basal ganglia, cerebellum, and brainstem.
- Left-sided strokes showed a higher burden of both PVCs and PACs compared to right-sided or bilateral strokes.
- No significant difference in ectopic burden was observed between ischemic and hemorrhagic strokes.
Conclusions:
- The site of a brain stroke lesion is a significant factor in the development of cardiac atrial and ventricular ectopy post-stroke.
- Understanding these associations can inform risk stratification and management strategies for cardiac arrhythmias in stroke patients.
Background:
Stroke-related dysregulation can trigger cardiac arrhythmias, but the impact of stroke localization on ectopic burden is uncertain.
Objective:
To examine if stroke locations are associated with PVC/PAC burden.
Methods:
We retrospectively screened 150 consecutive adults admitted to a university hospital stroke service (2023-2025); 103 met inclusion criteria (radiologically confirmed stroke, 24-hour Holter monitoring, no pre-existing arrhythmia). Stroke topography was classified by vascular territory (ACA, MCA, PCA, multifocal, brainstem), neuro-anatomical region (frontal, temporal, parietal, occipital, basal ganglia, insula, cerebellum), and hemisphere. Stroke etiology (ischemic vs. hemorrhagic) was also examined. Negative-binomial models adjusted for age, sex, hypertension, and left ventricular function quantified associations as incidence rate ratios (IRR) between stroke location and ectopic burden. Results were significant if p < 0.05.
Results:
Mean age was 70.8 years; 54.9% male, 62.1% with hypertension; arrhythmias occurred in 11.7%. By vascular territory, PAC burden was higher in ACA than MCA strokes (IRR 12.50) and higher in MCA than PCA strokes (IRR 8.30); PVC burden did not differ across territories. By neuro-anatomical region, PVC burden was elevated in the basal ganglia, cerebellum, and brainstem versus cortical regions; PAC burden was lowest in the frontal lobe (IRR 0.17 vs. temporal, 0.03 vs. basal ganglia, 0.01 vs. cerebellum). By hemisphere, left-sided strokes had higher PVC burden than right (IRR 1.98) and bilateral (IRR 12.33), and higher PAC burden than right-sided strokes (IRR 13.69). Ischemic and hemorrhagic strokes did not differ in ectopic burden. Several estimates carried wide confidence intervals reflecting small subgroup sizes, and should be interpreted as preliminary conclusions.
Conclusions:
Post-stroke, cardiac atrial and venricular ectopy varies by the stroke lesion site in the brain.
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