Published Online
on June 21, 2007

A more recent version of this article appeared on August 1, 2007

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Submitted on February 9, 2007
Accepted on February 20, 2007

Frequent Atrial Premature Beats Predict Paroxysmal Atrial Fibrillation in Stroke Patients. An Opportunity for a New Diagnostic Strategy

Dieter Wallmann MD; David Tüller MD; Kerstin Wustmann MD; Pascal Meier MD; Jörg Isenegger MD; Marcel Arnold MD; Heinrich P. Mattle MD; and Etienne Delacrétaz MD^*

From the Swiss Cardiovascular Center (D.W., D.T., K.W., P.M., E.D.), Bern, and the Departments of Internal Medicine (J.I.) and Neurology (M.A., H.P.M.), Inselspital, University of Bern, Switzerland.

^* To whom correspondence should be addressed. E-mail: etienne.delacretaz{at}insel.ch.

Background and Purpose--For patients having suffered ischemic stroke, the current diagnostic strategies often fail to detect atrial fibrillation as a potential cause of embolic events. The aim of the study was to identify paroxysmal atrial fibrillation in stroke patients. We hypothesized that patients with frequent atrial premature beats (APBs) recorded in 24-hour ECG will show more often atrial fibrillation when followed by repeated long-term ECG recordings than patients without or infrequent APBs.

Methods--127 patients with acute ischemic stroke and without known AF were enrolled in a prospective study to detect paroxysmal AF. Patients were stratified according to the number of APBs recorded in a 24-hour ECG (70 APBs versus <70 APBs). Subsequently, they all underwent serial 7-day event-recorder monitoring at 0, 3, and 6 months.

Results--Serial extended ECG monitoring identified AF in 26% of patients with frequent APBs but only in 6.5% when APBs were infrequent (P=0.0021). A multivariate analysis showed that the presence of frequent APBs in the initial 24-hour ECG was the only independent predictor of paroxysmal AF during follow-up (odds ratio 6.6, 95% confidence intervals 1.6 to 28.2, P=0.01).

Conclusions--In patients with acute ischemic stroke, frequent APBs (70/24 hours) are a marker for individuals who are at greater risk to develop or have paroxysmal AF. For such patients, we propose a diagnostic workup with repeated prolonged ECG monitoring to diagnose paroxysmal AF.

Key words: atrial fibrillation • embolic stroke • stroke prevention

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