Available online 29 July 2022
Highlights•AF is the main cardiac cause of stroke, frequently undetected.
•ECG monitoring for AF screening is recommended in cryptogenic stroke patients.
•Non-conducted premature atrial complexes represents a new predictor of AF onset.
AbstractIntroductionAtrial fibrillation (AF) is the main cardiac cause of stroke, but it frequently remains undetected. In patients with cryptogenic stroke an Holter electrocardiogram (ECG) monitoring for AF is recommended.
ObjectiveTo evaluate the prognostic role of Non-Conducted Premature Atrial Complexes (ncPACs) recorded on Holter ECG.
MethodsWe prospectively enrolled consecutive patients admitted to the Stroke Unit of our hospital with a diagnosis of cryptogenic stroke between December 2018 and January 2020; all patients underwent 24-h Holter ECG monitoring during hospitalization. Two follow-up visits were scheduled, including a 24-h Holter ECG at 3 and 6 months to detect AF.
ResultsAmong 112 patients, 58% were male with an average age of 72.2 ± 12.2 years. At follow-up, AF was diagnosed in 21.4% of the population. The baseline 24-h Holter ECG burden of ncPACs and Premature Atrial Complexes (PACs) was higher in patients with AF detected on follow-up (13.5 vs 2, p = 0.001; 221.5 vs 52; p = 0.01). ROC analysis showed that ncPACs had the best diagnostic accuracy in predicting AF (AUC:0.80; 95% CI 0.68–0.92). Cut-off value of ≥7 for ncPACs burden showed the highest accuracy with sensitivity of 62.5% and specificity 97.7% to predict AF onset at follow-up. Moreover, at multivariate Cox-proportional hazard analysis ncPACs burden ≥7 was a powerful independent predictor of AF onset (HR 12.4; 95% CI 4.8–32.8; p < 0.0001) .
ConclusionsNcPACs burden ≥7 represents a new predictor of AF that could guide the screening of this arrhythmia in cryptogenic stroke patients.
KeywordsAtrial fibrillation
Atrial premature complexes
Electrocardiogram
Stroke
Holter-monitoring
AbbreviationsESCEuropean Society of Cardiology
MACEsMajor Adverse Cardiovascular Events
LAViLeft Atrial Volume Index
LVEFLeft Ventricle Ejection Fraction
ncPACsnon conducted Premature Atrial Complexes
nsSVTnon-sustained Supraventricular Tachycardia
nsVTnon-sustained Ventricular Tachycardia
PACsPremature Atrial Complexes
PVCsPremature Ventricular Complexes
ROCReceiver Operating Characteristic
SVTsustained Supraventricular Tachycardia
TIATransient Ischemic Attack
VTsustained Ventricular Tachycardia
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