Abstract W P182: Left Atrial Volume as a Clinical Predictor for Atrial Fibrillation Detection in Cryptogenic Stroke: A Retrospective Analysis
Background: Detection of paroxysmal atrial fibrillation (PAF) after cryptogenic stroke has a major impact on secondary stroke prevention. Identifying clinical predictors to obtain a higher detection rate is necessary. There is an unclear association between left atrial enlargement (LAE) and PAF. Our goal was to determine the yield of 30-day Holter monitoring in patients with left atrial enlargement following acute ischemic stroke.
Methods: We retrospectively identified patients with acute ischemic stroke from November 2012 to June 2014 who had an echocardiogram done and a 30-day holter monitor on discharge. Demographics, medical history, clinical/laboratory data, echocardiographic features and holter monitor detected events were collected. Moderate to severe LAE was defined as left atrial volume index (LAVI) >35 cc/m2 on trans-thoracic echocardiogram. Patients were divided into two groups based on LAVI >35 cc/m2; thirty day holter monitoring results were retrieved in each group. Along with paroxysmal atrial fibrillation, detection of other supraventricular arrhythmias associated with subsequent development of PAF (i.e., supraventricular tachycardia (SVT) and atrial ectopy) was compared between the groups. Categorical variables were analyzed with Fischer’s exact test and continuous variables using independent sample T-test.
Results: 136 patients met our inclusion criteria, of which 76 (55.9%) completed 30 days of monitoring. Moderate to severe LAE was identified in 30 of 76 patients (39.5%). PAF was detected in 4 patients (5.3%). However, PAF was more likely in patients with LAE (13.3% vs 0%, p= 0.21). Detection of any PAF, SVT and atrial ectopy was more likely in patients with LAE (30% vs 6.5%, p= 0.009). Demographics, medical history, clinical and laboratory variables did not differ between patients with and without LAE.
Conclusions: In our cohort, the presence of LAE increased the yield of PAF on 30-day holter monitoring. Supraventricular arrhythmias historically associated with subsequent development of atrial fibrillation were more likely in ischemic stroke patients with LAE.
Author Disclosures: R.C. Martinez: None. A. Paoli: None. I. Iwuchukwu: None.
- © 2015 by American Heart Association, Inc.