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Excessive supraventricular ectopic activity and future onset of atrial fibrillation in patients with cryptogenic stroke

      Highlights

      • More PACs and longer LSVR are linked to future AF in patients with cryptogenic stroke.
      • Atrial ectopy showed a 12-fold risk of new AF after controlling for confounding.
      • Excessive atrial ectopy appears as a risk factor for future development of AF.

      Abstract

      Objectives

      Although evidence has shown the association of excessive supraventricular ectopic activity (ESVEA) with future development of atrial fibrillation (AF), this relationship is not yet fully understood. This study examines whether ESVEA can predict the future onset of AF, in patients presenting with cryptogenic stroke.

      Materials and Methods

      A retrospective cohort of 124 non-AF, consecutive patients, hospitalized for cryptogenic stroke between 2014 and 2015, was retrieved. 24-h inpatient monitoring with Holter was employed to reveal ESVEA, defined as the presence of more than 20 premature atrial complexes per hour (PACs/h) on average, or a more than 5 s duration of the longest supraventricular run (LSVR). After a median follow-up period of 5.2 years, the patients were examined for AF.

      Results

      From initial 124 patients, 12 died and one was lost during follow-up. For the total of 111 patients finally included, the median age was 56 years and 25.2% were females. The overall baseline median CHA2DS2-VASc score was 3. AF was found in 13 (11.71%) patients. Patients who were finally diagnosed with AF had a significantly higher number of PACs/h and a longer median LSVR duration at baseline (16.67 vs. 0.21, p < 0.001 and 3 vs. 0 s, p < 0.001, respectively). The presence of ESVEA was also significantly more frequent among AF patients (46.15%, 95%CI: 17.78%–74.22%) compared to non-AF ones (6.1%, 95%CI: 1.3%–10.7%, p < 0.001).

      Conclusions

      Excessive atrial ectopy, detected with 24 h inpatient Holter monitoring, is a significant indicator of future development of AF in patients presenting originally with a cryptogenic stroke.

      Keywords

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