Ischemic stroke phenotype in patients with nonsustained atrial fibrillation

Date
2015
Advisor
Instructor
Source Title
Stroke
Print ISSN
0039-2499
Electronic ISSN
Publisher
Lippincott Williams and Wilkins
Volume
46
Issue
3
Pages
634 - 640
Language
English
Type
Article
Journal Title
Journal ISSN
Volume Title
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.

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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
Citation
Published Version (Please cite this version)