Ethem M Arsava1, Demet F Bas1, Enver Atalar1, Arzu C Has1, Kader K Oguz1, Mehmet A Topcuoglu1. 1. From the Department of Neurology, Faculty of Medicine (E.M.A., D.F.B., M.A.T.), Department of Cardiology, Faculty of Medicine (E.A.), and Department of Radiology, Faculty of Medicine (K.K.O.), Hacettepe University, Ankara, Turkey; and National Magnetic Resonance Research Center, Bilkent University, Ankara, Turkey (A.C.H.).
Abstract
BACKGROUND AND PURPOSE: The widespread use of ambulatory cardiac monitoring has not only increased the detection of high-risk arrhythmias like persistent and paroxysmal atrial fibrillation (AF), but also made it possible to identify other aberrations such as short-lasting (<30 seconds) irregular runs of supraventricular tachycardia. Ischemic stroke phenotype might be helpful in understanding whether these nonsustained episodes play a similar role in stroke pathophysiology like their persistent and paroxysmal counterparts. METHODS: In a consecutive series of patients with ischemic stroke, we retrospectively determined clinical and imaging features associated with nonsustained AF (n=126), defined as <30-second-lasting supraventricular tachyarrhythmias with irregular RR interval on 24-hour Holter monitoring, and compared them to patients with persistent/paroxysmal AF (n=239) and no AF (n=246). RESULTS: Patients with persistent/paroxysmal AF significantly differed from patients with nonsustained AF by a higher prevalence of female sex (odds ratio [95% confidence interval], 1.8 [1.1-2.9]), coronary artery disease (1.9 [1.1-3.0]), and embolic imaging features (2.7 [1.1-6.5]), and lower frequency of smoking (0.4 [0.2-0.8]) and hyperlipidemia (0.5 [0.3-0.8]). In contrast, patients with no AF were younger (0.5 [0.4-0.6] per decade) and more likely to be male (1.7 [1.0-2.8]) in comparison with nonsustained AF population. The prevalence of nonsustained AF was similar among cryptogenic and noncryptogenic stroke patients (32% versus 29%). Voxel-wise comparison of lesion probability maps revealed no significant difference between cryptogenic stroke patients with and without nonsustained AF. CONCLUSIONS: Clinical features of patients with nonsustained AF exhibited an intermediary phenotype in between patients with persistent/paroxysmal AF and no AF. Furthermore, imaging features did not entirely resemble patterns observed in patients with longer durations of AF.
BACKGROUND AND PURPOSE: The widespread use of ambulatory cardiac monitoring has not only increased the detection of high-risk arrhythmias like persistent and paroxysmal atrial fibrillation (AF), but also made it possible to identify other aberrations such as short-lasting (<30 seconds) irregular runs of supraventricular tachycardia. Ischemic stroke phenotype might be helpful in understanding whether these nonsustained episodes play a similar role in stroke pathophysiology like their persistent and paroxysmal counterparts. METHODS: In a consecutive series of patients with ischemic stroke, we retrospectively determined clinical and imaging features associated with nonsustained AF (n=126), defined as <30-second-lasting supraventricular tachyarrhythmias with irregular RR interval on 24-hour Holter monitoring, and compared them to patients with persistent/paroxysmal AF (n=239) and no AF (n=246). RESULTS:Patients with persistent/paroxysmal AF significantly differed from patients with nonsustained AF by a higher prevalence of female sex (odds ratio [95% confidence interval], 1.8 [1.1-2.9]), coronary artery disease (1.9 [1.1-3.0]), and embolic imaging features (2.7 [1.1-6.5]), and lower frequency of smoking (0.4 [0.2-0.8]) and hyperlipidemia (0.5 [0.3-0.8]). In contrast, patients with no AF were younger (0.5 [0.4-0.6] per decade) and more likely to be male (1.7 [1.0-2.8]) in comparison with nonsustained AF population. The prevalence of nonsustained AF was similar among cryptogenic and noncryptogenic strokepatients (32% versus 29%). Voxel-wise comparison of lesion probability maps revealed no significant difference between cryptogenic strokepatients with and without nonsustained AF. CONCLUSIONS: Clinical features of patients with nonsustained AF exhibited an intermediary phenotype in between patients with persistent/paroxysmal AF and no AF. Furthermore, imaging features did not entirely resemble patterns observed in patients with longer durations of AF.
Authors: Kanjana S Perera; Balakumar Swaminathan; Roland Veltkamp; Antonio Arauz; Sebastian Ameriso; Joan Marti-Fabregas; Marcel Arnold; Graeme J Hankey; Helmi Lutsep; Robert G Hart Journal: Eur Stroke J Date: 2018-01-24
Authors: Yizhao Ni; Kathleen Alwell; Charles J Moomaw; Daniel Woo; Opeolu Adeoye; Matthew L Flaherty; Simona Ferioli; Jason Mackey; Felipe De Los Rios La Rosa; Sharyl Martini; Pooja Khatri; Dawn Kleindorfer; Brett M Kissela Journal: PLoS One Date: 2018-02-14 Impact factor: 3.240