Non-conducted premature atrial complexes: A new independent predictor of atrial fibrillation in cryptogenic stroke.

Autor: Vetta G; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. Electronic address: giampaolo.vetta7@gmail.com., Parlavecchio A; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Caminiti R; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Crea P; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Magnocavallo M; Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, 00161 Rome, Italy; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX 78705, USA., Della Rocca DG; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX 78705, USA., Lavalle C; Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, 00161 Rome, Italy., Vetta F; Arrhythmology Unit, Paideia Hospital, 00191 Rome, Italy., Marano G; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Ruggieri C; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Lofrumento F; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Dattilo G; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Ferraù L; Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Dell'Aera C; Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Giammello F; Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., La Spina P; Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Musolino RF; Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Luzza F; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Carerj S; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Micari A; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Di Bella G; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Jazyk: angličtina
Zdroj: Journal of electrocardiology [J Electrocardiol] 2022 Sep-Oct; Vol. 74, pp. 46-53. Date of Electronic Publication: 2022 Jul 29.
DOI: 10.1016/j.jelectrocard.2022.07.071
Abstrakt: Introduction: 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.
Objective: To evaluate the prognostic role of Non-Conducted Premature Atrial Complexes (ncPACs) recorded on Holter ECG.
Methods: 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.
Results: 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).
Conclusions: NcPACs burden ≥7 represents a new predictor of AF that could guide the screening of this arrhythmia in cryptogenic stroke patients.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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