Frequent atrial premature beats predict paroxysmal atrial fibrillation in stroke patients : An opportunity for a new diagnostic strategy

• Published in: Stroke (1970) 2007-08, Vol.38 (8), p.2292-2294
• Main Authors: WALLMANN, Dieter, TÜLLER, David, WUSTMANN, Kerstin, MEIER, Pascal, ISENEGGER, Jörg, ARNOLD, Marcel, MATTLE, Heinrich P, DELACRETAZ, Etienne
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arrhythmia, Sinus - complications; Arrhythmia, Sinus - diagnosis; Arrhythmia, Sinus - physiopathology; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Biological and medical sciences; Brain Ischemia - etiology; Brain Ischemia - physiopathology; Brain Ischemia - prevention & control; Cardiac dysrhythmias; Cardiology. Vascular system; Electrocardiography - methods; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Heart; Heart Conduction System - physiopathology; Humans; Intracranial Embolism and Thrombosis - etiology; Intracranial Embolism and Thrombosis - physiopathology; Intracranial Embolism and Thrombosis - prevention & control; Male; Medical sciences; Middle Aged; Monitoring, Physiologic - methods; Nervous system (semeiology, syndromes); Neurology; Predictive Value of Tests; Prospective Studies; Stroke - etiology; Stroke - physiopathology; Stroke - prevention & control; Time Factors; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.107.485110

For patients having suffered ischemic stroke, the current diagnostic strategies often fail to detect atrial fibrillation as a potential cause of embolic events. The aim of the study was to identify paroxysmal atrial fibrillation in stroke patients. We hypothesized that patients with frequent atrial premature beats (APBs) recorded in 24-hour ECG will show more often atrial fibrillation when followed by repeated long-term ECG recordings than patients without or infrequent APBs. 127 patients with acute ischemic stroke and without known AF were enrolled in a prospective study to detect paroxysmal AF. Patients were stratified according to the number of APBs recorded in a 24-hour ECG (> or =70 APBs versus or = 70/24 hours) are a marker for individuals who are at greater risk to develop or have paroxysmal AF. For such patients, we propose a diagnostic workup with repeated prolonged ECG monitoring to diagnose paroxysmal AF.