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Electrocardiographic and Echocardiographic predictors of paroxysmal atrial fibrillation detected after ischemic stroke

Baturova, Maria A. LU ; Sheldon, Seth H.; Carlson, Jonas LU ; Brady, Peter A.; Lin, Grace; Rabinstein, Alejandro A.; Friedman, Paul A. and Platonov, Pyotr G. LU (2016) In BMC Cardiovascular Disorders 16(1).
Abstract

Background: Detection of atrial fibrillation after ischemic stroke is challenging due to its paroxysmal nature. We aimed to assess predictors of paroxysmal atrial fibrillation using non-invasive surface ECG and transthoracic echocardiography to select candidates for atrial fibrillation screening. Methods: Ischemic stroke patients without documented atrial fibrillation (n = 110, 67 ± 10 years, 40 female) and a control group of age- and gender-matched patients with history of paroxysmal atrial fibrillation prior to stroke (n = 55, 67 ± 10 years, 19 female) comprised the study sample. Using non-invasive ECG monitoring for three weeks, short episodes of paroxysmal atrial fibrillation were detected in 24 of 110 patients (22 %). The standard... (More)

Background: Detection of atrial fibrillation after ischemic stroke is challenging due to its paroxysmal nature. We aimed to assess predictors of paroxysmal atrial fibrillation using non-invasive surface ECG and transthoracic echocardiography to select candidates for atrial fibrillation screening. Methods: Ischemic stroke patients without documented atrial fibrillation (n = 110, 67 ± 10 years, 40 female) and a control group of age- and gender-matched patients with history of paroxysmal atrial fibrillation prior to stroke (n = 55, 67 ± 10 years, 19 female) comprised the study sample. Using non-invasive ECG monitoring for three weeks, short episodes of paroxysmal atrial fibrillation were detected in 24 of 110 patients (22 %). The standard 12-lead ECG with sinus rhythm at stroke onset was digitally processed and analyzed. Transthoracic echocardiography data were reviewed for these patients. Results: Atrial fibrillation history was independently associated with P terminal force in lead V 1 > 40 mm*ms (OR 4.04 95 % CI 1.34-12.14, p = 0.013) and left atrial volume index (OR 1.08 95 % CI 1.03-1.13, p = 0.002; for LAVI > 40 mL/m2 OR 6.40 95 % CL 1.47-27.91, p = 0.013). Among patients without atrial fibrillation history, no ECG characteristics were predictive of atrial fibrillation detected after stroke. Left atrial volume index remained an independent predictor of atrial fibrillation detected after stroke (OR 1.09 95 % CI 1.02-1.16, p = 0.017). A cutoff of <40 mL/m2 had an 84 % negative predictive value for ruling out atrial fibrillation on ambulatory monitoring with a sensitivity of 50 % and a specificity of 86 %. Conclusion: In a post hoc analysis, left atrial dilatation assessed by left atrial volume index independently predicted atrial fibrillation after stroke in patients without prior atrial fibrillation history, while the other clinical or ECG markers were not predictive of atrial fibrillation detected early after ischemic stroke. Trial registration: This study is a post hoc analysis from the prospective case-control study registered in December 2011, ClinicalTrials.gov ID: NCT01325545.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Atrial fibrillation, ECG, Ischemic stroke, Left atrial volume index
in
BMC Cardiovascular Disorders
volume
16
issue
1
publisher
BioMed Central
external identifiers
  • scopus:84993949440
  • wos:000386689700002
ISSN
1471-2261
DOI
10.1186/s12872-016-0384-2
language
English
LU publication?
yes
id
466addb3-ca73-4a17-990c-30f34f310e7a
date added to LUP
2016-11-21 08:05:09
date last changed
2017-08-06 05:13:44
@article{466addb3-ca73-4a17-990c-30f34f310e7a,
  abstract     = {<p>Background: Detection of atrial fibrillation after ischemic stroke is challenging due to its paroxysmal nature. We aimed to assess predictors of paroxysmal atrial fibrillation using non-invasive surface ECG and transthoracic echocardiography to select candidates for atrial fibrillation screening. Methods: Ischemic stroke patients without documented atrial fibrillation (n = 110, 67 ± 10 years, 40 female) and a control group of age- and gender-matched patients with history of paroxysmal atrial fibrillation prior to stroke (n = 55, 67 ± 10 years, 19 female) comprised the study sample. Using non-invasive ECG monitoring for three weeks, short episodes of paroxysmal atrial fibrillation were detected in 24 of 110 patients (22 %). The standard 12-lead ECG with sinus rhythm at stroke onset was digitally processed and analyzed. Transthoracic echocardiography data were reviewed for these patients. Results: Atrial fibrillation history was independently associated with P terminal force in lead V 1 &gt; 40 mm*ms (OR 4.04 95 % CI 1.34-12.14, p = 0.013) and left atrial volume index (OR 1.08 95 % CI 1.03-1.13, p = 0.002; for LAVI &gt; 40 mL/m<sup>2</sup> OR 6.40 95 % CL 1.47-27.91, p = 0.013). Among patients without atrial fibrillation history, no ECG characteristics were predictive of atrial fibrillation detected after stroke. Left atrial volume index remained an independent predictor of atrial fibrillation detected after stroke (OR 1.09 95 % CI 1.02-1.16, p = 0.017). A cutoff of &lt;40 mL/m<sup>2</sup> had an 84 % negative predictive value for ruling out atrial fibrillation on ambulatory monitoring with a sensitivity of 50 % and a specificity of 86 %. Conclusion: In a post hoc analysis, left atrial dilatation assessed by left atrial volume index independently predicted atrial fibrillation after stroke in patients without prior atrial fibrillation history, while the other clinical or ECG markers were not predictive of atrial fibrillation detected early after ischemic stroke. Trial registration: This study is a post hoc analysis from the prospective case-control study registered in December 2011, ClinicalTrials.gov ID: NCT01325545.</p>},
  articleno    = {209},
  author       = {Baturova, Maria A. and Sheldon, Seth H. and Carlson, Jonas and Brady, Peter A. and Lin, Grace and Rabinstein, Alejandro A. and Friedman, Paul A. and Platonov, Pyotr G.},
  issn         = {1471-2261},
  keyword      = {Atrial fibrillation,ECG,Ischemic stroke,Left atrial volume index},
  language     = {eng},
  month        = {11},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {BMC Cardiovascular Disorders},
  title        = {Electrocardiographic and Echocardiographic predictors of paroxysmal atrial fibrillation detected after ischemic stroke},
  url          = {http://dx.doi.org/10.1186/s12872-016-0384-2},
  volume       = {16},
  year         = {2016},
}