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      Ischemic stroke phenotype in patients with nonsustained atrial fibrillation

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      Author
      Arsava, E. M.
      Bas, D. F.
      Atalar, Ergin
      Has, A. C.
      Oguz, K. K.
      Topcuoglu, M. A.
      Date
      2015
      Source Title
      Stroke
      Print ISSN
      0039-2499
      Publisher
      Lippincott Williams and Wilkins
      Volume
      46
      Issue
      3
      Pages
      634 - 640
      Language
      English
      Type
      Article
      Item Usage Stats
      136
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      117
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      Abstract
      Background and Purpose: The widespread use of ambulatory cardiac monitoring has not only increased the detection of high-risk arrhythmias like persistent and paroxysmal atrial fibrillation (AF), but also made it possible to identify other aberrations such as short-lasting (<30 seconds) irregular runs of supraventricular tachycardia. Ischemic stroke phenotype might be helpful in understanding whether these nonsustained episodes play a similar role in stroke pathophysiology like their persistent and paroxysmal counterparts. Methods: In a consecutive series of patients with ischemic stroke, we retrospectively determined clinical and imaging features associated with nonsustained AF (n=126), defined as <30-second-lasting supraventricular tachyarrhythmias with irregular RR interval on 24-hour Holter monitoring, and compared them to patients with persistent/paroxysmal AF (n=239) and no AF (n=246). Results: Patients with persistent/paroxysmal AF significantly differed from patients with nonsustained AF by a higher prevalence of female sex (odds ratio [95% confidence interval], 1.8 [1.1-2.9]), coronary artery disease (1.9 [1.1-3.0]), and embolic imaging features (2.7 [1.1-6.5]), and lower frequency of smoking (0.4 [0.2-0.8]) and hyperlipidemia (0.5 [0.3-0.8]). In contrast, patients with no AF were younger (0.5 [0.4-0.6] per decade) and more likely to be male (1.7 [1.0-2.8]) in comparison with nonsustained AF population. The prevalence of nonsustained AF was similar among cryptogenic and noncryptogenic stroke patients (32% versus 29%). Voxel-wise comparison of lesion probability maps revealed no significant difference between cryptogenic stroke patients with and without nonsustained AF. Conclusions: Clinical features of patients with nonsustained AF exhibited an intermediary phenotype in between patients with persistent/paroxysmal AF and no AF. Furthermore, imaging features did not entirely resemble patterns observed in patients with longer durations of AF.
      Keywords
      Ambulatory
      Atrial fibrillation
      Electrocardiography
      Magnetic resonance imaging
      Adult
      Aged
      Article
      Atherosclerosis
      Atrial fibrillation
      Brain ischemia
      Cerebrovascular accident
      Coronary artery disease
      Diabetes mellitus
      Female
      Holter monitoring
      Human
      Hyperlipidemia
      Hypertension
      Major clinical study
      Male
      Middle aged
      Persistent atrial fibrillation
      Phenotype
      Priority journal
      Retrospective study
      RR interval
      Smoking
      Stroke patient
      Supraventricular tachycardia
      Transient ischemic attack
      Very elderly
      Atrial fibrillation
      Brain ischemia
      Electrocardiography
      Pathophysiology
      Probability
      Procedures
      Tachycardia, Supraventricular
      Aged
      Aged, 80 and over
      Atrial Fibrillation
      Brain Ischemia
      Electrocardiography, Ambulatory
      Female
      Humans
      Male
      Middle Aged
      Phenotype
      Probability
      Retrospective Studies
      Stroke
      Tachycardia
      Supraventricular
      Permalink
      http://hdl.handle.net/11693/22347
      Published Version (Please cite this version)
      https://doi.org/10.1161/STROKEAHA.114.006396
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      • National Magnetic Resonance Research Center (UMRAM) 175
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