Mark Weber-Krüger1, Constanze Lutz2, Antonia Zapf2, Raoul Stahrenberg2, Joachim Seegers2, Janin Witzenhausen2, Katrin Wasser2, Gerd Hasenfuß2, Klaus Gröschel2, Rolf Wachter2. 1. From the Clinic for Cardiology and Pneumology (M.W.-K., C.L., G.H., R.W.), Department of Medical Statistics (A.Z.), and Clinic for Neurology (J.W., K.W.), University of Göttingen; Clinic for Medicine I (R.S.), Helios Albert-Schweitzer-Kliniken Northeim; Clinic and Polyclinic for Medicine II (J.S.), University of Regensburg; Clinic and Polyclinic for Neurology (K.G.), University Medical Center of the Johannes Gutenberg-University Mainz; and Clinic and Polyclinic for Cardiology (R.W.), University of Leipzig, Germany. mark.weber-krueger@med.uni-goettingen.de. 2. From the Clinic for Cardiology and Pneumology (M.W.-K., C.L., G.H., R.W.), Department of Medical Statistics (A.Z.), and Clinic for Neurology (J.W., K.W.), University of Göttingen; Clinic for Medicine I (R.S.), Helios Albert-Schweitzer-Kliniken Northeim; Clinic and Polyclinic for Medicine II (J.S.), University of Regensburg; Clinic and Polyclinic for Neurology (K.G.), University Medical Center of the Johannes Gutenberg-University Mainz; and Clinic and Polyclinic for Cardiology (R.W.), University of Leipzig, Germany.
Abstract
OBJECTIVE: Prolonged ECG monitoring after stroke frequently reveals short paroxysmal atrial fibrillation (pAF) and supraventricular (SV) runs. The minimal duration of atrial fibrillation (AF) required to induce cardioembolism, the relevance of SV runs, and whether short pAF results from cerebral damage itself are currently being debated. We aimed to study the relevance of SV runs and short pAF detected by prolonged Holter ECG after cerebral ischemia during long-term follow-up. METHODS: Analysis is from the prospective Find-AF trial (ISRCTN46104198). We included patients with acute cerebral ischemia. Those without AF on admission received 7-day Holter ECG monitoring. We differentiated patients with AF on admission (AF-adm), with pAF (>30 seconds), with SV runs (>5 beats but <30 seconds in a 24-hour ECG interval), and without SV runs (controls). During follow-up, those with baseline pAF received another 7-day Holter ECG to examine AF persistence. RESULTS: A total of 254 of 281 initially included patients were analyzed (mean age 70.0 years, 45.3% female). Forty-three (16.9%) had AF-adm. A total of 211 received 7-day Holter ECG monitoring: 27 (12.8%) had pAF, 67 (31.8%) had SV runs, and 117 (55.5%) were controls. During a mean 3.7 years of follow-up, the SV runs group had more recurrent strokes (p = 0.04) and showed numerically more novel AF (12% vs 5%, p = 0.09) than the controls. Seventy-five percent of the patients with manifest pAF detected after cerebral ischemia still had AF during follow-up (50% paroxysmal, 50% persisting/permanent). CONCLUSIONS: Patients with cerebral ischemia and SV runs had more recurrent strokes and numerically more novel AF during follow-up and could benefit from further prolonged ECG monitoring. pAF detected after stroke is not a temporal phenomenon.
OBJECTIVE: Prolonged ECG monitoring after stroke frequently reveals short paroxysmal atrial fibrillation (pAF) and supraventricular (SV) runs. The minimal duration of atrial fibrillation (AF) required to induce cardioembolism, the relevance of SV runs, and whether short pAF results from cerebral damage itself are currently being debated. We aimed to study the relevance of SV runs and short pAF detected by prolonged Holter ECG after cerebral ischemia during long-term follow-up. METHODS: Analysis is from the prospective Find-AF trial (ISRCTN46104198). We included patients with acute cerebral ischemia. Those without AF on admission received 7-day Holter ECG monitoring. We differentiated patients with AF on admission (AF-adm), with pAF (>30 seconds), with SV runs (>5 beats but <30 seconds in a 24-hour ECG interval), and without SV runs (controls). During follow-up, those with baseline pAF received another 7-day Holter ECG to examine AF persistence. RESULTS: A total of 254 of 281 initially included patients were analyzed (mean age 70.0 years, 45.3% female). Forty-three (16.9%) had AF-adm. A total of 211 received 7-day Holter ECG monitoring: 27 (12.8%) had pAF, 67 (31.8%) had SV runs, and 117 (55.5%) were controls. During a mean 3.7 years of follow-up, the SV runs group had more recurrent strokes (p = 0.04) and showed numerically more novel AF (12% vs 5%, p = 0.09) than the controls. Seventy-five percent of the patients with manifest pAF detected after cerebral ischemia still had AF during follow-up (50% paroxysmal, 50% persisting/permanent). CONCLUSIONS:Patients with cerebral ischemia and SV runs had more recurrent strokes and numerically more novel AF during follow-up and could benefit from further prolonged ECG monitoring. pAF detected after stroke is not a temporal phenomenon.
Authors: Rolf Wachter; Mark Weber-Krüger; Gerhard F Hamann; Pawel Kermer; Jan Liman; Meinhard Mende; Joachim Seegers; Katrin Wasser; Sonja Gröschel; Timo Uphaus; Holger Poppert; Martin Köhrmann; Markus Zabel; Ulrich Laufs; Peter U Heuschmann; David Conen; Klaus Gröschel Journal: J Stroke Date: 2021-12-17 Impact factor: 6.967