Available online 29 July 2022

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.

Atrial 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.

To evaluate the prognostic role of Non-Conducted Premature Atrial Complexes (ncPACs) recorded on Holter ECG.

We 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.

Among 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) .

NcPACs burden ≥7 represents a new predictor of AF that could guide the screening of this arrhythmia in cryptogenic stroke patients.

Atrial fibrillation

Atrial premature complexes

Electrocardiogram

Stroke

Holter-monitoring

European Society of Cardiology

Major Adverse Cardiovascular Events

Left Atrial Volume Index

Left Ventricle Ejection Fraction

non conducted Premature Atrial Complexes

non-sustained Supraventricular Tachycardia

non-sustained Ventricular Tachycardia

Premature Atrial Complexes

Premature Ventricular Complexes

Receiver Operating Characteristic

sustained Supraventricular Tachycardia

Transient Ischemic Attack

sustained Ventricular Tachycardia

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