From the Department of Neurology, Faculty of Medicine (E.M.A., D.F.B., M.A.T.), Department of Cardiology, Faculty of Medicine (E.A.), and Department of Radiology, Faculty of Medicine (K.K.O.), Hacettepe University, Ankara, Turkey; and National Magnetic Resonance Research Center, Bilkent University, Ankara, Turkey (A.C.H.).
Stroke. 2015 Mar;46(3):634-40. doi: 10.1161/STROKEAHA.114.006396. Epub 2015 Jan 29.
The widespread use of ambulatory cardiac monitoring has not only increased the detection of high-risk arrhythmias like persistent and paroxysmal atrial fibrillation (AF), but also made it possible to identify other aberrations such as short-lasting (<30 seconds) irregular runs of supraventricular tachycardia. Ischemic stroke phenotype might be helpful in understanding whether these nonsustained episodes play a similar role in stroke pathophysiology like their persistent and paroxysmal counterparts.
In a consecutive series of patients with ischemic stroke, we retrospectively determined clinical and imaging features associated with nonsustained AF (n=126), defined as <30-second-lasting supraventricular tachyarrhythmias with irregular RR interval on 24-hour Holter monitoring, and compared them to patients with persistent/paroxysmal AF (n=239) and no AF (n=246).
Patients with persistent/paroxysmal AF significantly differed from patients with nonsustained AF by a higher prevalence of female sex (odds ratio [95% confidence interval], 1.8 [1.1-2.9]), coronary artery disease (1.9 [1.1-3.0]), and embolic imaging features (2.7 [1.1-6.5]), and lower frequency of smoking (0.4 [0.2-0.8]) and hyperlipidemia (0.5 [0.3-0.8]). In contrast, patients with no AF were younger (0.5 [0.4-0.6] per decade) and more likely to be male (1.7 [1.0-2.8]) in comparison with nonsustained AF population. The prevalence of nonsustained AF was similar among cryptogenic and noncryptogenic stroke patients (32% versus 29%). Voxel-wise comparison of lesion probability maps revealed no significant difference between cryptogenic stroke patients with and without nonsustained AF.
Clinical features of patients with nonsustained AF exhibited an intermediary phenotype in between patients with persistent/paroxysmal AF and no AF. Furthermore, imaging features did not entirely resemble patterns observed in patients with longer durations of AF.
动态心脏监测的广泛应用不仅增加了对持续性和阵发性心房颤动（AF）等高危心律失常的检测，还使得识别其他心律失常成为可能，如短暂（<30 秒）的室上性心动过速不规则发作。缺血性脑卒中表型可能有助于了解这些非持续性发作在脑卒中病理生理学中是否发挥与持续性和阵发性发作相似的作用。
我们连续纳入了一系列缺血性脑卒中患者，回顾性确定了与非持续性 AF（n=126）相关的临床和影像学特征，定义为 24 小时动态 Holter 监测中 RR 间期不规则的<30 秒持续的室上性心动过速，并将其与持续性/阵发性 AF（n=239）和无 AF（n=246）患者进行比较。
持续性/阵发性 AF 患者与非持续性 AF 患者相比，女性比例更高（优势比[95%置信区间]，1.8[1.1-2.9]）、冠状动脉疾病（1.9[1.1-3.0]）和栓塞性影像学特征（2.7[1.1-6.5]）更常见，而吸烟（0.4[0.2-0.8]）和高血脂（0.5[0.3-0.8]）更少见。相比之下，非持续性 AF 患者比持续性 AF 患者更年轻（每十年减少 0.5[0.4-0.6]），且更可能为男性（1.7[1.0-2.8]）。隐匿性和非隐匿性脑卒中患者中非持续性 AF 的患病率相似（32%与 29%）。基于体素的病变概率图比较显示，有和无非持续性 AF 的隐匿性脑卒中患者之间没有明显差异。
非持续性 AF 患者的临床特征在持续性/阵发性 AF 患者和无 AF 患者之间呈现出中间表型。此外，影像学特征与持续性 AF 患者的模式不完全相似。
