Predictors of Atrial Fibrillation in Patients with Embolic Stroke of Unknown Etiology and Implantable Loop Recorders-Further Insights of the TRACK AF Study on the Role of ECG and Echocardiography.

Autor: Höwel D; Department of Cardiology, St. Marienhospital Vechta, Marienstr. 6-8, 49377 Vechta, Germany.; Department of Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany., Leitz P; Department of Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany., Frommeyer G; Department of Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany., Ritter MA; Department of Neurology, University Hospital Münster, 48149 Münster, Germany., Reinke F; Department of Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany., Füting A; Department of Medicine, Witten/Herdecke University, 58455 Witten, Germany., Reinsch N; Department of Medicine, Witten/Herdecke University, 58455 Witten, Germany., Eckardt L; Department of Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany., Kochhäuser S; Department of Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany.; Department of Internal Medicine/Cardiology, Marienhospital Osnabrück, 49074 Osnabrück, Germany., Dechering DG; Department of Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany.; Department of Internal Medicine/Cardiology, Marienhospital Osnabrück, 49074 Osnabrück, Germany.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2023 Oct 17; Vol. 12 (20). Date of Electronic Publication: 2023 Oct 17.
DOI: 10.3390/jcm12206566
Abstrakt: Aims -Electrocardiography (ECG) and echocardiographic left atrial (LA) parameters may be helpful to assess the risk of atrial fibrillation (AF) in embolic stroke of unknown etiology (ESUS) and could therefore guide intensity of ECG monitoring. Methods -1153 consecutive patients with ischemic stroke or transient ischemic attack (TIA) were analyzed. An internal loop recorder (ILR) was implanted in 104 consecutive patients with ESUS. Multiple morphologic P-wave parameters in baseline 12-channel ECG and echocardiographic LA parameters were measured and analyzed in patients with and without ILR-detected AF. Using logistic regression, we evaluated the predictive value of several ECG parameters and LA dimensions on the occurrence of AF. Results -In 20 of 104 (19%) patients, AF was diagnosed by ILR during a mean monitoring time of 575 (IQR 470-580) days. Patients with AF were significantly older (72 (67-75) vs. 60 (52-72) years; p = 0.001) and premature atrial contractions (PAC) were more frequently observed (40% vs. 2%; p < 0.001) during baseline ECG. All morphologic P-wave parameters did not show a significant difference between groups. There was a non-significant trend towards a larger LA volume index (31 (24-36) vs. 29 (25-37) mL/m 2 ; p = 0.09) in AF patients. Conclusions -Age and PAC are independently associated with incident AF in ESUS and could be used as markers for selecting patients that may benefit from more extensive rhythm monitoring or ILR implantation. In our consecutive cohort of patients with ESUS, neither morphological P-wave parameters nor LA size were predictive of AF.
Databáze: MEDLINE
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