RESUMEN

BACKGROUND: Covert atrial fibrillation (AF) is a major cause of cryptogenic stroke. This study investigated whether a dose-dependent relationship exists between the frequency of premature atrial contractions (PACs) and AF detection in patients with cryptogenic stroke using an insertable cardiac monitor (ICM). METHODS: We enrolled consecutive patients with cryptogenic stroke who underwent ICM implantation between October 2016 and September 2020 at 8 stroke centers in Japan. Patients were divided into 3 groups according to the PAC count on 24-hour Holter ECG: ≤200 (group L), >200 to ≤500 (group M), and >500 (group H). We defined a high AF burden as above the median of the cumulative duration of AF episodes during the entire monitoring period. We evaluated the association of the frequency of PACs with AF detection using log-rank trend test and Cox proportional hazard model and with high AF burden using logistic regression model, adjusting for age, sex, CHADS2 score. RESULTS: Of 417 patients, we analyzed 381 patients with Holter ECG and ICM data. The median age was 70 (interquartile range, 59.5-76.5), 246 patients (65%) were males, and the median duration of ICM recording was 605 days (interquartile range, 397-827 days). The rate of new AF detected by ICM was higher in groups with more frequent PAC (15.5%/y in group L [n=277] versus 44.0%/y in group M [n=42] versus 71.4%/y in group H [n=62]; log-rank trend P<0.01). Compared with group L, the adjusted hazard ratios for AF detection in groups M and H were 2.11 (95% CI, 1.24-3.58) and 3.23 (95% CI, 2.07-5.04), respectively, and the adjusted odds ratio for high AF burden in groups M and H were 2.57 (95% CI, 1.14-5.74) and 4.25 (2.14-8.47), respectively. CONCLUSIONS: The frequency of PACs was dose-dependently associated with AF detection in patients with cryptogenic stroke.

Asunto(s)

Fibrilación Atrial , Complejos Atriales Prematuros , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Masculino , Humanos , Anciano , Femenino , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/epidemiología , Fibrilación Atrial/complicaciones , Complejos Atriales Prematuros/diagnóstico , Complejos Atriales Prematuros/epidemiología , Complejos Atriales Prematuros/complicaciones , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular Isquémico/complicaciones , Electrocardiografía Ambulatoria

Asunto(s)

Fibrilación Atrial , Complejos Atriales Prematuros , Ablación por Catéter , Venas Pulmonares , Humanos , Venas Pulmonares/cirugía

RESUMEN

Background: The clinical importance of supraventricular run (SVR) is uncertain in the management of patients with previous cerebrovascular events. We aim to evaluate the role of SVRs in the development of future atrial fibrillation (AF) in patients diagnosed with ischemic stroke. Methods: We retrospectively evaluated patients who underwent 24-h Holter monitoring for the evaluation of possible AF after ischemic cerebrovascular events. The presence and duration of SVR were noted. Subsequent diagnosis of AF was searched in patients with sinus rhythm. Results: A total of 694 patients were included in the analysis. SVR was detected in 104 (14.9%) patients in the study group. Seventy-one (10.2%) patients were diagnosed with AF in the follow-up. SVRs were more prevalent among patients with AF (P < 0.001). The median atrial run duration was 5.96 (2.02-17.84) s in the AF absent group vs. 8.76 (3.78-17.62) s in the AF present group (P < 0.001). The best predictive cut-off duration of an atrial run was 8 s (sensitivity = 61.5% and specificity = 74.4%, Area Under Curve (AUC) = 0.708). Cox regression analysis showed that age (odds ratio [OR]: 1.03, 95% confidence interval [CI]: 1.00-1.060, P = 0.020), presence of short supraventricular run (OR: 2.53, 95% CI 1.40-4.57, P = 0.002), and left atrial diameter (OR: 1.13 95% CI: 1.07-1.19, P < 0.001) were the independent predictors of AF development in the follow-up. Conclusion: Age, left atrial diameter, and the presence of SVRs are associated with an increased risk of future AF after ischemic stroke. SVR duration may be an important parameter in risk stratification.

RESUMEN

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.

Asunto(s)

Fibrilación Atrial , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Masculino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Femenino , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Electrocardiografía , Accidente Cerebrovascular/etiología

RESUMEN

AIMS: Digital health can transform the management of atrial fibrillation (AF) and enable patients to take a central role in detecting symptoms and self-managing AF. There is a gap in understanding factors that support sustained use of digital health tools for patients with AF. This study identified predictors of Alivecor® KardiaMobile ECG monitor usage among patients with AF enrolled in the iPhone®Helping Evaluate Atrial fibrillation Rhythm through Technology (iHEART) randomized controlled trial. METHODS AND RESULTS: We analysed data from 105 English and Spanish-speaking adults with AF enrolled in the intervention arm of the iHEART trial. The iHEART intervention included smartphone-based electrocardiogram self-monitoring with Alivecor® KardiaMobile and triweekly text messages for 6 months. The primary outcome was use of Alivecor® categorized as: infrequent (≤5 times/week), moderate (>5 times and ≤11 times/week), and frequent (>11 times/week). We applied multinomial logistic regression modelling to characterize frequency and predictors of use. Of the 105 participants, 25% were female, 75% were White, and 45% were ≥65 years of age. Premature atrial contractions (PACs) [adjusted odds ratio (OR): 1.23, 1.08-1.40, P = 0.002] predicted frequent as compared to infrequent use. PACs (adjusted OR: 1.17, 95% confidence interval 1.06-1.30, P = 0.003), lower symptom burden (adjusted OR: 1.06, 1.01-1.11, P = 0.02), and less treatment concern (adjusted OR: 0.96, 0.93-0.99, P = 0.02) predicted moderate as compared to infrequent use. CONCLUSIONS: Frequent use of AliveCor® is associated with AF symptoms and potentially symptomatic cardiac events. Symptom burden and frequency should be measured and incorporated into analyses of future digital health trials for AF management.

Asunto(s)

Fibrilación Atrial , Envío de Mensajes de Texto , Adulto , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/terapia , Electrocardiografía , Femenino , Humanos , Teléfono Inteligente

RESUMEN

OBJECTIVE: To examine the association between polarity of atrial premature complexes (APCs) and stroke. DESIGN: A prospective study. SETTING AND PARTICIPANTS: A total of 11 092 participants in the Jichi Medical School cohort study were included after excluding patients with atrial fibrillation. We analysed stroke events in patients with (n=136) and without (n=10 956) APCs. With regard to polarity of APCs, patients were subcategorised into having (1) negative (n=39) or non-negative (n=97) P waves in augmented vector right (aVR), and (2) positive (n=28) or non-positive (n=108) P waves in augmented vector left (aVL). OUTCOME MEASURES: The primary endpoint was stroke. RESULTS: Patients with APCs were significantly older than those without APCs (64.1±9.2 vs 55.1±11.6 years, p<0.001). The mean follow-up period was 11.8±2.4 years. Stroke events were observed in patients with (n=13 events) and without (n=411 events) APCs. This difference was significant (log-rank 12.9, p<0.001); however, APCs were not an independent predictor of stroke after adjusting for age, sex, height, body mass index, current drinking, diabetes, systolic blood pressure, prior myocardial infarction, prior stroke and high-density lipoprotein-cholesterol (p=0.15). The incidence of stroke in patients with APCs and non-negative P wave in aVR was significantly higher than in patients without APCs (log-rank 20.1, p<0.001), and non-negative P wave in aVR was revealed to be an independent predictor of stroke (HR 1.84, 95% CI 1.02 to 3.30). The incidence of stroke in patients with APC with non-positive P wave in aVL was also significantly higher than in patients without APC (log-rank 15.3, p<0.001), and non-positive P wave in aVL was an independent predictor of stroke (HR 1.92, 95% CI 1.05 to 3.54). CONCLUSIONS: The presence of APCs with non-negative P wave in aVR or non-positive P wave in aVL on 12-lead ECG was associated with a higher risk of incident stroke.

Asunto(s)

Fibrilación Atrial , Complejos Atriales Prematuros , Accidente Cerebrovascular , Adulto , Anciano , Fibrilación Atrial/epidemiología , Complejos Atriales Prematuros/epidemiología , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Vida Independiente , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología

RESUMEN

The clinical presentation,chest image and electrocardiogram of 4 cases of premature complex-induced chronic cough admitted in the First Affiliated Hospital of Guangzhou Medical University from March 2008 to February 2009,were retrospectively analyzed.And other 6 cases of premature complex-induced chronic cough were retrieved for literature review.In total 10 patients,there were 3 males and 7 females aged 58(36-74) years,with a disease duration of 10.5 (3.0,264.0) months.The main clinical presentations were chronic dry cough with post-sternal thump and premature beats as shown by auscultation and 24 h-electrocardiogram examination.Cough was relieved after the premature beats were controlled with the treatment of arrhythmia drugs or radiofrequency ablation.Premature complex-induced cough is rare but it should be considered when the chief complaint of patients with premature beat is chronic cough.

RESUMEN

BACKGROUND: The clinical significance of atrial premature complexes (APCs) during exercise is unclear. HYPOTHESIS: Frequent APCs during exercise provides prognostic information. METHODS: A total of 998 patients were divided into 2 groups based on the presence of frequent APCs during treadmill testing (>5 beats per stage): the FAPC group (n = 128) vs the non-FAPC group (n = 870). The primary outcome was new-onset atrial fibrillation or flutter (AF/AFL) during follow-up period (356.2 ± 131.1 days). RESULTS: Mean age was 56.0 ± 10.2 years in the FAPC group and 52.6 ± 12.0 years in the non-FAPC group (P = 0.001). Baseline electrocardiographic and echocardiographic findings were not significantly different between the 2 groups. During exercise, maximal heart rate did not differ between the 2 groups. Chronotropic incompetence was more prevalent in the FAPC group than in the non-FAPC group (P = 0.04). During follow-up, the FAPC group had a higher incidence of AF/AFL than did the non-FAPC group (7 patients [5.5%] vs 5 patients [0.6%]; P < 0.001). Treadmill-induced frequent APCs (adjusted hazard ratio [HR]: 15.23, 95% confidence interval: 4.59-50.56, P < 0.001), chronotropic incompetence (adjusted HR: 19.95, 95% CI: 6.02-66.10, P < 0.001), and palpitation as a reason for treadmill testing (adjusted HR: 5.72, 95% CI: 1.64-20.00, P = 0.01) were independent risk factors that predicted new-onset AF/AFL. CONCLUSIONS: Frequent APCs during treadmill testing was associated with development of AF/AFL in this study. Close monitoring for further AF/AFL development is needed in these patients.

Asunto(s)

Fibrilación Atrial/epidemiología , Aleteo Atrial/epidemiología , Complejos Atriales Prematuros/epidemiología , Ejercicio Físico , Potenciales de Acción , Adulto , Anciano , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Aleteo Atrial/diagnóstico , Aleteo Atrial/fisiopatología , Complejos Atriales Prematuros/diagnóstico , Complejos Atriales Prematuros/fisiopatología , Distribución de Chi-Cuadrado , Ecocardiografía , Electrocardiografía , Prueba de Esfuerzo , Femenino , Frecuencia Cardíaca , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Prevalencia , Pronóstico , Modelos de Riesgos Proporcionales , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Seúl/epidemiología , Factores de Tiempo

RESUMEN

Aims: Early identification of patients who could benefit from early re-intervention after catheter ablation is highly warranted. Our aim was to investigate the association between post-procedural burden of supraventricular ectopic complexes (SVEC) and the risk of long-term atrial fibrillation (AF) recurrence. Methods and results: A total of 125 patients undergoing catheter ablation for AF were included. Patients underwent 7-day Holter recordings immediately post-procedural. The number of SVEC in post-procedural Holter recordings was categorized into quartiles: 0-72, 73-212, 213-782 and ≥ 783 SVEC/day. Long-term AF recurrence was defined as a combined endpoint of AF ≥ 1 min during follow-up Holter recordings, cardioversion or hospitalization for AF after a 3-month blanking period and within 24 months of follow-up. High post-procedural supraventricular ectopy burden was associated with an increased risk of long-term AF recurrence in a dose-dependent manner (≥ 783 SVEC: HR 4.6 [1.9-11.5], P < 0.001) irrespective of AF recurrence during the blanking period or other risk factors. In patients with early AF recurrence < 90 days after catheter ablation ectopy burden was also highly predictive of long-term AF recurrence (SVEC ≥ 213: HR 3.0 [1.3-6.7], P = 0.007). Correspondingly, patients with early AF recurrence but low ectopy burden remained at low risk of long-term AF recurrence after the blanking period. Conclusion: Our results indicate that post-procedural ectopy burden is highly associated with long-term AF recurrence and could be a potent risk marker for selection of patients for early re-ablation. Development of future ablation risk stratification and strategies should include focus on post-procedural ectopy burden.

Asunto(s)

Fibrilación Atrial/cirugía , Complejos Atriales Prematuros/etiología , Ablación por Catéter/efectos adversos , Potenciales de Acción , Adulto , Anciano , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Complejos Atriales Prematuros/diagnóstico , Complejos Atriales Prematuros/fisiopatología , Electrocardiografía Ambulatoria , Femenino , Frecuencia Cardíaca , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Recurrencia , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

Cardiac arrhythmias are a common problem in the neurological intensive care unit and represent a major cause of ischemic stroke. Significant arrhythmias are most likely to occur in elderly patients. In this review, we focus on three arrhythmias: premature beats, atrial fibrillation, and QT prolongation. The goal of this review is to provide a current concept of diagnosis and acute management of arrhythmias in the neurological intensive care unit.

Asunto(s)

Anciano , Humanos , Arritmias Cardíacas , Fibrilación Atrial , Complejos Atriales Prematuros , Complejos Cardíacos Prematuros , Cuidados Críticos , Diagnóstico , Unidades de Cuidados Intensivos , Accidente Cerebrovascular , Complejos Prematuros Ventriculares

RESUMEN

AIMS: Severe hypokalaemia can aggravate arrhythmia tendency and prognosis, but less is known about risk of mild hypokalaemia, which is a frequent finding. We examined the associations between mild hypokalaemia and ambulatory cardiac arrhythmias and their prognosis. METHODS AND RESULTS: Subjects from the cohort of the 'Copenhagen Holter Study' (n = 671), with no history of manifest cardiovascular (CV) disease or stroke, were studied. All had laboratory tests and 48-h ambulatory electrocardiogram (ECG) recording. The median follow-up was 6.3 years. p-Potassium was inversely associated with frequency of premature ventricular complexes (PVCs) especially in combination with diuretic treatment (r = -0.22, P = 0.015). Hypokalaemia was not associated with supraventricular arrhythmias. Subjects at lowest quintile of p-potassium (mean 3.42, range 2.7-3.6 mmol/L) were defined as hypokalaemic. Cardiovascular mortality was higher in the hypokalaemic group (hazard ratio and 95% confidence intervals: 2.62 (1.11-6.18) after relevant adjustments). Hypokalaemia in combination with excessive PVC worsened the prognosis synergistically; event rates: 83 per 1000 patient-year in subjects with both abnormalities, 10 and 15 per 1000 patient-year in those with one abnormality, and 3 per 1000 patient-year in subjects with no abnormality. One variable combining hypokalaemia with excessive supraventricular arrhythmias gave similar results in univariate analysis, but not after multivariate adjustments. CONCLUSION: In middle-aged and elderly subjects with no manifest heart disease, mild hypokalaemia is associated with increased rate of ventricular but not supraventricular arrhythmias. Hypokalaemia interacts synergistically with increased ventricular ectopy to increase the risk of adverse events.

Asunto(s)

Hipopotasemia/complicaciones , Vida Independiente , Complejos Prematuros Ventriculares/etiología , Factores de Edad , Anciano , Complejos Atriales Prematuros/etiología , Complejos Atriales Prematuros/mortalidad , Complejos Atriales Prematuros/fisiopatología , Biomarcadores/sangre , Dinamarca , Supervivencia sin Enfermedad , Diuréticos/uso terapéutico , Electrocardiografía Ambulatoria , Femenino , Humanos , Hipopotasemia/sangre , Hipopotasemia/diagnóstico , Hipopotasemia/tratamiento farmacológico , Hipopotasemia/mortalidad , Estimación de Kaplan-Meier , Modelos Lineales , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Potasio/sangre , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Factores de Riesgo , Índice de Severidad de la Enfermedad , Taquicardia Supraventricular/etiología , Taquicardia Supraventricular/mortalidad , Taquicardia Supraventricular/fisiopatología , Factores de Tiempo , Complejos Prematuros Ventriculares/diagnóstico , Complejos Prematuros Ventriculares/mortalidad , Complejos Prematuros Ventriculares/fisiopatología

RESUMEN

AIMS: There is preliminary evidence for a link between obstructive sleep apnoea (OSA) and arrhythmias such as paroxysmal atrial fibrillation (PAF) and sudden cardiac death but underlying mechanisms remain largely unknown. METHODS AND RESULTS: In this interventional crossover study, we evaluated whether intrathoracic pressure changes, induced by simulated OSA, trigger premature cardiac beats, and alter measures of ventricular repolarization [QTc and Tpeak-to-Tend (TpTec) intervals] in patients with PAF. 12-Lead-electrocardiograms were recorded continuously in 44 patients, while simulating obstructive apnoea (Mueller manoeuvre, MM), obstructive hypopnoea (inspiration through a threshold load, ITH), end-expiratory central apnoea (AP), and during normal breathing (NB) in randomized order. The prevalence of OSA in these 44 patients was assessed by a sleep study. Atrial premature beats (APBs) occurred more frequently during MM (55% of patients) and ITH (32%), but not during AP (14%), compared with NB (9%) (P < 0.001, P = 0.006 and P = 0.688, respectively). Mueller manoeuvre led to a significant prolongation of QTc and TpTec intervals (+17.3 ms, P < 0.001 and +4.3 ms, P = 0.005). Inspiration through a threshold load significantly increased QTc (+9.6 ms, P < 0.001) but not TpTec. End-expiratory central apnoea did not alter QTc and TpTec intervals. According to the sleep study, 56% of patients had OSA (apnoea hypopnoea index ≥5). CONCLUSION: Simulated OSA induces APBs which may be important in patients with PAF, because the majority of episodes of PAF has been shown to be triggered by APBs. Simulated OSA leads to a significant prolongation of ventricular repolarization.

Asunto(s)

Fibrilación Atrial/etiología , Fibrilación Atrial/fisiopatología , Presión , Mecánica Respiratoria , Apnea Obstructiva del Sueño/fisiopatología , Tórax/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Apnea Obstructiva del Sueño/complicaciones

RESUMEN

BACKGROUND AND PURPOSE: Many ischemic strokes or transient ischemic attacks are labeled cryptogenic but may have undetected atrial fibrillation (AF). We sought to identify those most likely to have subclinical AF. METHODS: We prospectively studied patients with cryptogenic stroke or transient ischemic attack aged ≥55 years in sinus rhythm, without known AF, enrolled in the intervention arm of the 30 Day Event Monitoring Belt for Recording Atrial Fibrillation After a Cerebral Ischemic Event (EMBRACE) trial. Participants underwent baseline 24-hour Holter ECG poststroke; if AF was not detected, they were randomly assigned to 30-day ECG monitoring with an AF auto-detect external loop recorder. Multivariable logistic regression assessed the association between baseline variables (Holter-detected atrial premature beats [APBs], runs of atrial tachycardia, age, and left atrial enlargement) and subsequent AF detection. RESULTS: Among 237 participants, the median baseline Holter APB count/24 h was 629 (interquartile range, 142-1973) among those who subsequently had AF detected versus 45 (interquartile range, 14-250) in those without AF (P<0.001). APB count was the only significant predictor of AF detection by 30-day ECG (P<0.0001), and at 90 days (P=0.0017) and 2 years (P=0.0027). Compared with the 16% overall 90-day AF detection rate, the probability of AF increased from <9% among patients with <100 APBs/24 h to 9% to 24% in those with 100 to 499 APBs/24 h, 25% to 37% with 500 to 999 APBs/24 h, 37% to 40% with 1000 to 1499 APBs/24 h, and 40% beyond 1500 APBs/24 h. CONCLUSIONS: Among older cryptogenic stroke or transient ischemic attack patients, the number of APBs on a routine 24-hour Holter ECG was a strong dose-dependent independent predictor of prevalent subclinical AF. Those with frequent APBs have a high probability of AF and represent ideal candidates for prolonged ECG monitoring for AF detection. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00846924.

Asunto(s)

Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Complejos Atriales Prematuros/diagnóstico , Ataque Isquémico Transitorio/etiología , Accidente Cerebrovascular/etiología , Anciano , Anciano de 80 o más Años , Electrocardiografía Ambulatoria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico

Asunto(s)

Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Taquicardia Ectópica de Unión/diagnóstico , Taquicardia Supraventricular/diagnóstico , Anciano , Estimulación Cardíaca Artificial , Ablación por Catéter , Diagnóstico Diferencial , Técnicas Electrofisiológicas Cardíacas , Femenino , Humanos , Valor Predictivo de las Pruebas , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia Ectópica de Unión/fisiopatología , Taquicardia Ectópica de Unión/cirugía , Taquicardia Supraventricular/fisiopatología , Taquicardia Supraventricular/cirugía , Resultado del Tratamiento , Procedimientos Innecesarios

RESUMEN

BACKGROUND: To characterize atrial ectopic activity in patients with cryptogenic ischemic stroke (CIS) or transient ischemic attack (TIA) and determine its prognostic significance. METHODS: Retrospective cohort study, in which 184 patients with CIS or TIA who had performed 24-hour Holter electrocardiogram were included. The median follow-up was 27.5 months. Baseline clinical and imagiologic characteristics, etiologic investigation results, and ischemic stroke and TIA recurrences information were collected. Number of atrial premature complexes (APCs) per hour was categorized as less than 10 APCs/hour, 10-30 APCs/hour, and more than 30 APCs/hour. RESULTS: Most of the patients had less than 10 APCs/hour (82.6%), 8.2% had 10-30 APCs/hour, and 9.2% had more than 30 APCs/hour. Patients with more than 30 APCs/hour had a greater median left atrium diameter than patients with 30 APCs/hour or less (42 mm vs. 38 mm; 95% confidence interval [CI], .50-7.00; P = .003). Annual recurrence rate of CIS or TIA was 2.9% in patients with less than 10 APCs/hour, 11.0% in 10-30 APCs/hour, and 22.6% in more than 30 APCs/hour (P = .001). More than 30 APCs/hour were independently associated with recurrence risk in multivariate survival analysis (hazard ratio, 3.40; 95% CI, 1.12-10.32; P = .030). CONCLUSIONS: In patients with CIS or TIA, frequent atrial ectopic activity (>30 APCs/h) was independently associated with increased risk of stroke or TIA recurrence. Further studies need to validate frequent atrial ectopic activity as a risk factor for recurrence in cryptogenic stroke and confirm its role as a predictor of occult atrial fibrillation.

Asunto(s)

Fibrilación Atrial/fisiopatología , Isquemia Encefálica/fisiopatología , Atrios Cardíacos/fisiopatología , Ataque Isquémico Transitorio/fisiopatología , Accidente Cerebrovascular/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Isquemia Encefálica/complicaciones , Electrocardiografía Ambulatoria , Femenino , Humanos , Ataque Isquémico Transitorio/complicaciones , Masculino , Persona de Mediana Edad , Pronóstico , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/complicaciones

RESUMEN

BACKGROUND: Postoperative atrial fibrillation occurs in 20%-60% of patients after cardiac surgery. Recently, premature atrial contraction has been considered an initiator of atrial fibrillation. This study evaluated whether the frequency of premature atrial contractions predicts the occurrence of postoperative atrial fibrillation. METHODS: The subjects of this study were 70 patients with no history of atrial fibrillation who had undergone a 24-h Holter electrocardiogram before off-pump coronary artery bypass. Their records were reviewed and postoperative electrocardiograms and telemetry strips were analyzed for postoperative atrial fibrillation. RESULTS: Postoperative atrial fibrillation was documented in 22 (31.4%) patients. The frequency of preoperative premature atrial contractions was significantly higher in the postoperative atrial fibrillation group (4128 ± 7186 vs. 69 ± 221 beats/24 h, p < 0.001). The incidence of postoperative atrial fibrillation increased with the frequency of preoperative premature atrial contractions which occurred in 60% of patients in the upper 50th percentile group of preoperative premature atrial contractions. Multivariate logistic regression analysis revealed the upper 50th percentile group of preoperative premature atrial contractions (odds ratio = 67; 95% confidence interval: 5.51-838; p = 0.001) to be an independent predictor of postoperative atrial fibrillation. CONCLUSION: A high frequency of preoperative premature atrial contractions is a strong independent predictor of postoperative atrial fibrillation in off-pump coronary artery bypass.

Asunto(s)

Fibrilación Atrial/etiología , Complejos Atriales Prematuros/complicaciones , Puente de Arteria Coronaria Off-Pump/efectos adversos , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/diagnóstico , Complejos Atriales Prematuros/diagnóstico , Distribución de Chi-Cuadrado , Electrocardiografía Ambulatoria , Femenino , Humanos , Incidencia , Japón , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Estudios Retrospectivos , Factores de Riesgo , Telemetría , Resultado del Tratamiento

RESUMEN

BACKGROUND AND PURPOSE: Supraventricular premature beats (SPBs) may help to assess the risk of atrial fibrillation (AF) in patients with cryptogenic stroke and therefore guide therapy. METHODS: An internal loop recorder was implanted in consecutive patients with acute cryptogenic stroke. The occurrence and quantity of SPBs and short supraventricular runs (SVRs) in 24-hour ECG in patients with and without future AF were analyzed. We evaluated the relative risk of the upper quartile of SPB and SVR patients against the remainder and used binary logistic regression to evaluate a possible independent influence of SPBs and SVRs on AF occurrence. RESULTS: Twelve of 70 included patients (mean age, 59±13 years) experienced development of AF during a mean monitoring duration of 536±212 days. Patients with AF had a median of 22.8 SPBs/h versus 1.2 SPBs/h (P<0.0001) in patients without AF and a median of 0.7 SVRs/h (AF) versus 0 SVR/h (non-AF). Patients in the upper quartile of SPBs (>14.1/h) and SVRs (>0.2/h) demonstrated a relative risk of 4.0 (95% confidence interval, 1.1-14.6; P=0.04) and 6.9 (95% confidence interval, 1.8-26.7; P=0.005) for future AF, respectively. In binary logistic regression, SPBs (P=0.02) and SVRs (P=0.05) remained significant independent predictors for occurrence of AF. CONCLUSIONS: Numerous SPBs and SVRs demonstrated a high risk for future AF in patients with cryptogenic stroke.

Asunto(s)

Arritmias Cardíacas/fisiopatología , Fibrilación Atrial/fisiopatología , Complejos Atriales Prematuros/fisiopatología , Accidente Cerebrovascular/fisiopatología , Anciano , Fibrilación Atrial/terapia , Complejos Atriales Prematuros/terapia , Intervalos de Confianza , Electrocardiografía , Electrocardiografía Ambulatoria , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Curva ROC , Medición de Riesgo , Accidente Cerebrovascular/terapia

RESUMEN

Purpose To probe into the value of M-mode echocardiography and spectral Doppler echocardiography in diagnosing fetal atrial premature beats.Materials and Methods Echocardiography examinations were given to the seventy-three fetuses around 16-40 gestational weeks which were found suffering from fetal arrhythmia in the clinical examinations by using M-mode echocardiography and spectral Doppler. Thirty-two of them were screened out with fetal atrial premature beats, and their ultrasonic cardiograms were analyzed. The follow-up visits were later conducted.Results Among the thirty-two cases with fetal atrial premature beats, fourteen were attacked frequently, and the other eighteen were attacked accidentally. Two cases were documented with muscular ventricular septal defect. Apart from two missing cases, the rest thirty cases were found to be recovered from arrhythmia before or after birth in the follow-up visits. The disappearance rate of atrialpremature beats in the fetuses attacked frequently by the disease before birth was clearly lower than that in those attacked accidentally (P<0.05). Muscular ventricular septal defect in the two cases were found closed after birth. Conclusion M-mode echocardiography and spectral Doppler echocardiography, as non-invasive imagining techniques to take antenatal examination of fetal arrhythmia, have advantages such as reliable, direct, convenient and can be used repetitively, therefore can provide important information for clinical treatment and prognosis.

RESUMEN

Objective:To observe the feature of Lorenz plots of dual parasystole ,and explore its differential diagnosis significance .Methods :Lorenz plot data of seven patients diagnosed as dual parasystole was retrospectively analyzed . They were compared with those of single source premature beat ,dual premature beat and single source parasystole . Results :All case data were divided into six groups (seven cases in each group) ,its features were :group 1 [ (single source atrial premature beat (APB)] ,plots were characterized with three distribution and sinus rhythm located on 45° line ;group 2 (dual source APB) were five distribution with the same sinus rhythm location ,the points set before and after premature were located on its two sides ,the plot was symmetry ,slopes of line B were within 0~1 in group 1 and 2 and its slopes were no significant difference (P>0.05);group 3 was single source ventricular premature beat (VPB) ,show four distribution pattern ,sinus rhythm was located on 45° line ,the points set before and after prema-ture were almost parallel to X and Y axis ;group 4 ( dual source VPB) were in six distribution with the same sinus rhythm location ,its difference with single source VPB was the points set before and after premature were symme-try;slopes of line B all trends to 0 in group 3 and 4 ,their slope also no significant difference (P>0.05);Group 5 (single source parasystole ) was characterized as four distribution vertical to 45° line ,premature point set was vertical to 45° line ,point set before and after premature were vertical to axis X and Y respectively ;group 6 (dual parasysto-le) were seven distribution vertical to 45° line ,were similar to that of single source parasystole ,the difference was figure of group 6 was dual distribution ;slopes of line B were close to ∞ in group 5 and 6 ,and its difference were no significant (P>0.05) .The line B slopes in group 5 and 6 were significantly higher than those of group 1&2 [ (∞ ) vs .(4.78 ± 0.19)] ,and those of group 1&2 were significantly higher than those of group 3&4 (0.36 ± 0.06) ,P<0.01 all .Conclusion:There are significant difference in Lorenz plot features among single (dual) source atrial/ven-tricular premature beats ,single source parasystole and dual parasystole .Lorenz plot is helpful to differential diagno-sis of parasystole .

RESUMEN

Objective To evaluate the value of dual Doppler ultrasonography in the diagnosis of fetal atrial extrasystoles.Methods Seven thousands and thirteen fetuses were examined by fetal echocardiography.If fetal arrhythmias were found,information of pulsed wave Doppler signals in hepatic vein (HV) and descending aorta (DAo) using dual Doppler were colleted simultaneously.The detected times were compared between using general Doppler and dual Doppler in 20 cases.Results On dual Doppler examination,28 of the fetuses showed signals of atrial extrasystoles,14 fetuses atrial extrasystoles conducted to ventricle,8 fetuses atrial extrasystoles non-conducted to ventricle,6 fetuses with part of the extrasystoles conducted to ventricle and part of the extrasystoles non-conducted to ventricle.No case had congenital heart disease.Twenty-six fetuses with atrial extrasystole were converted to normal rhythm within the third trimester of pregnancy,and the others' were converted to normal rhythm during the first 3 days postnatally.The detected time of dual Doppler was shorter than that of general Doppler(P ＜0.05).Conclusions Dual Doppler ultrasonography of simultaneous recordings in HV and DAo is an easy,rapid method of assessing fetal atrial extrasystoles,which should allow precise diagnosis of atrial extrasystole.