This Article Full Text Full Text (PDF) All Versions of this Article: 39/6/e91    most recent STROKEAHA.107.509778v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Haft, J. I. Search for Related Content PubMed PubMed Citation Articles by Haft, J. I. Pubmed/NCBI databases Medline Plus Health Information Atrial Fibrillation High Blood Pressure Stroke

(Stroke. 2008;39:e91.)
© 2008 American Heart Association, Inc.

Letters to the Editor

Echocardiographic Findings That May Help Identify Occult Intermittent Atrial Fibrillation in Hypertensive Patients at Risk for a Second (or First) Ischemic Stroke

Department of Cardiology, Hackensack University Medical Center, Hackensack, New Jersey

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

In their review, Liao et al¹ found that Holter or event monitoring of patients after ischemic stroke identified 5% to 7% with intermittent atrial fibrillation not present on the admission ECG. They suggest that such monitoring is justified even if the yield is only 1 in 20. We recently studied the records of 827 patients with ischemic stroke and identified risk factors for atrial fibrillation in this population that might narrow the number of ischemic stroke patients requiring prolonged monitoring and might also be valuable in identifying patients with occult atrial fibrillation before their first stroke.

Of the 827 patients, 20.4% had atrial fibrillation on their admission ECG, another 7.5% were documented to have atrial fibrillation during the stroke admission and an additional 5.8% had atrial fibrillation on another admission before or after the stroke admission. Persistent atrial fibrillation (on all available ECGs after admission for stroke) was present in 149 patients (53.4% of atrial fibrillation patients) and intermittent atrial fibrillation (normal sinus rhythm on admission ECG or normal sinus rhythm occurring after atrial fibrillation noted on admission ECG) in 130 patients (46.6% of patients with atrial fibrillation). Hypertension was present in 86.7% of the atrial fibrillation patients and 77.5% of the patients without documented atrial fibrillation (P<0.01).

On review of the available echocardiographic findings in 233 hypertensive patients with atrial fibrillation and in 296 hypertensive patients with no documented atrial fibrillation, we found left atrial enlargement (4.0 cm) in 93.7% of the hypertensive . . . [Full Text of this Article]