Dion Fanny, Saudeau Denis, Bonnaud Isabelle, Friocourt Patrick, Bonneau Armel, Poret Philippe, Giraudeau Bruno, Régina Sandra, Fauchier Laurent, Babuty Dominique
Service de Cardiologie B, pôle Coeur, Thorax, Vaisseaux, hôpital Trousseau, Tours University, CHRU de Tours, 37044, Tours Cedex 9, France.
J Interv Card Electrophysiol. 2010 Aug;28(2):101-7. doi: 10.1007/s10840-010-9485-5. Epub 2010 May 8.
Ischemic stroke is a frequent pathology with high rate of recurrence and significant morbidity and mortality. There are several causes of stroke, affecting prognosis, outcomes, and management, but in many cases, the etiology remains undetermined. We hypothesized that atrial fibrillation was involved in this pathology but underdiagnosed by standard methods. The aim of the study was to determine the incidence of atrial fibrillation in cryptogenic ischemic stroke by using continuous monitoring of the heart rate over several months. The secondary objective was to test the value of atrial vulnerability assessment in predicting spontaneous atrial fibrillation.
We prospectively enrolled 24 patients under 75 years of age, 15 men and 9 women of mean age 49 years, who within the last 4 months had experienced cryptogenic stroke diagnosed by clinical presentation and brain imaging and presumed to be of cardioembolic mechanism. All causes of stroke were excluded by normal 12-lead ECG, 24-h Holter monitoring, echocardiography, cervical Doppler, hematological, and inflammatory tests. All patients underwent electrophysiological study. Of the patients, 37.5% had latent atrial vulnerability, and 33.3% had inducible sustained arrhythmia. Patients were secondarily implanted with an implantable loop recorder to look for spontaneous atrial fibrillation over a mean follow-up interval of 14.5 months. No sustained arrhythmia was found. Only one patient had non-significant episodes of atrial fibrillation.
In this study, symptomatic atrial fibrillation or AF with fast ventricular rate has not been demonstrated by the implantable loop recorder in patients under 75 years with unexplained cerebral ischemia. The use of this device should not be generalized in the systematic evaluation of these patients. In addition, this study attests that the assessment of atrial vulnerability is poor at predicting spontaneous arrhythmia in such patients.
缺血性中风是一种常见疾病，复发率高，发病率和死亡率显著。中风有多种病因，会影响预后、结局和治疗，但在许多情况下，病因仍不明确。我们推测心房颤动与这种疾病有关，但通过标准方法诊断不足。本研究的目的是通过连续数月监测心率来确定隐源性缺血性中风中心房颤动的发生率。次要目的是测试心房易损性评估在预测自发性心房颤动方面的价值。
我们前瞻性纳入了24例75岁以下患者，其中15例男性和9例女性，平均年龄49岁，这些患者在过去4个月内经历了经临床表现和脑成像诊断为隐源性中风，并推测为心源性栓塞机制。通过正常的12导联心电图、24小时动态心电图监测、超声心动图、颈部多普勒检查、血液学和炎症检查排除了所有中风病因。所有患者均接受了电生理研究。其中37.5%的患者存在潜在心房易损性，33.3%的患者可诱发出持续性心律失常。随后为患者植入植入式环路记录器，以在平均14.5个月的随访期内寻找自发性心房颤动。未发现持续性心律失常。只有1例患者出现非显著性心房颤动发作。
在本研究中，植入式环路记录器未在75岁以下不明原因脑缺血患者中证实有症状性心房颤动或心室率快的心房颤动。在对这些患者进行系统评估时，不应普遍使用该设备。此外，本研究证明，在此类患者中，心房易损性评估在预测自发性心律失常方面效果不佳。
