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Irregularity and lack of p waves in short tachycardia episodes predict atrial fibrillation and ischemic stroke

Johnson, Linda S.B. LU ; Persson, Anders P. LU ; Wollmer, Per LU ; Juul-Möller, Steen LU ; Juhlin, Tord LU and Engström, Gunnar LU (2018) In Heart Rhythm 15(6). p.805-811
Abstract

Background: Atrial fibrillation (AF) is defined as an irregular supraventricular tachycardia (SVT) without p waves, with duration >30 seconds. Whether AF characteristics during short SVT episodes predict AF and stroke is not known. Objective: The purpose of this study was to determine whether irregularity and lack of p waves, alone or in combination, during short SVT episodes increase the risk of incident AF and ischemic stroke. Methods: The population-based Malmö Diet and Cancer study includes 24-hour ECG screening of 377 AF-free individuals (mean age 64.5 years; 43% men) who were prospectively followed for >13 years. There were 65 AF events and 25 ischemic stroke events during follow-up. Subjects with an SVT episode ≥5 beats... (More)

Background: Atrial fibrillation (AF) is defined as an irregular supraventricular tachycardia (SVT) without p waves, with duration >30 seconds. Whether AF characteristics during short SVT episodes predict AF and stroke is not known. Objective: The purpose of this study was to determine whether irregularity and lack of p waves, alone or in combination, during short SVT episodes increase the risk of incident AF and ischemic stroke. Methods: The population-based Malmö Diet and Cancer study includes 24-hour ECG screening of 377 AF-free individuals (mean age 64.5 years; 43% men) who were prospectively followed for >13 years. There were 65 AF events and 25 ischemic stroke events during follow-up. Subjects with an SVT episode ≥5 beats were identified, and the longest SVT episode was assessed for irregularity and lack of p waves. The association between SVT classification and AF and stroke was assessed using multivariable adjusted Cox regression. Results: The incidence of AF increased with increasing abnormality of the SVTs. The risk-factor adjusted hazard ratio for AF was 4.95 (95% confidence interval 2.06–11.9; P <.0001) for those with short irregular SVTs (<70 beats) without p waves. The incidence of ischemic stroke was highest in the group with regular SVT episodes without p waves (hazard ratio 14.2; 95% confidence interval 3.76–57.6; P <.0001, adjusted for age and sex). Conclusion: Characteristics of short SVT episodes detected at 24-hour ECG screening are associated with incident AF and ischemic stroke. Short irregular SVTs without p waves likely represent early stages of AF or atrial myopathy. Twenty-four–hour ECG could identify subjects suitable for primary prevention efforts.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Atrial fibrillation, Epidemiology, p Wave, Risk factor, Stroke, Supraventricular tachycardia
in
Heart Rhythm
volume
15
issue
6
pages
7 pages
publisher
Elsevier
external identifiers
  • pmid:29448015
  • scopus:85047155708
ISSN
1547-5271
DOI
10.1016/j.hrthm.2018.02.011
language
English
LU publication?
yes
id
7eea5db4-9da8-41f4-98d3-92c21ef3c310
date added to LUP
2019-05-17 15:26:57
date last changed
2021-05-11 04:48:20
@article{7eea5db4-9da8-41f4-98d3-92c21ef3c310,
  abstract     = {<p>Background: Atrial fibrillation (AF) is defined as an irregular supraventricular tachycardia (SVT) without p waves, with duration &gt;30 seconds. Whether AF characteristics during short SVT episodes predict AF and stroke is not known. Objective: The purpose of this study was to determine whether irregularity and lack of p waves, alone or in combination, during short SVT episodes increase the risk of incident AF and ischemic stroke. Methods: The population-based Malmö Diet and Cancer study includes 24-hour ECG screening of 377 AF-free individuals (mean age 64.5 years; 43% men) who were prospectively followed for &gt;13 years. There were 65 AF events and 25 ischemic stroke events during follow-up. Subjects with an SVT episode ≥5 beats were identified, and the longest SVT episode was assessed for irregularity and lack of p waves. The association between SVT classification and AF and stroke was assessed using multivariable adjusted Cox regression. Results: The incidence of AF increased with increasing abnormality of the SVTs. The risk-factor adjusted hazard ratio for AF was 4.95 (95% confidence interval 2.06–11.9; P &lt;.0001) for those with short irregular SVTs (&lt;70 beats) without p waves. The incidence of ischemic stroke was highest in the group with regular SVT episodes without p waves (hazard ratio 14.2; 95% confidence interval 3.76–57.6; P &lt;.0001, adjusted for age and sex). Conclusion: Characteristics of short SVT episodes detected at 24-hour ECG screening are associated with incident AF and ischemic stroke. Short irregular SVTs without p waves likely represent early stages of AF or atrial myopathy. Twenty-four–hour ECG could identify subjects suitable for primary prevention efforts.</p>},
  author       = {Johnson, Linda S.B. and Persson, Anders P. and Wollmer, Per and Juul-Möller, Steen and Juhlin, Tord and Engström, Gunnar},
  issn         = {1547-5271},
  language     = {eng},
  month        = {06},
  number       = {6},
  pages        = {805--811},
  publisher    = {Elsevier},
  series       = {Heart Rhythm},
  title        = {Irregularity and lack of p waves in short tachycardia episodes predict atrial fibrillation and ischemic stroke},
  url          = {http://dx.doi.org/10.1016/j.hrthm.2018.02.011},
  doi          = {10.1016/j.hrthm.2018.02.011},
  volume       = {15},
  year         = {2018},
}