Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan,
Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
Cerebrovasc Dis. 2020;49(2):144-150. doi: 10.1159/000505958. Epub 2020 Feb 5.
To determine whether frequent premature atrial contractions (PAC) predict atrial fibrillation (AF) in cryptogenic stroke patients, we analyzed the association between frequent PACs in 24-h Holter electrocardiogram recording and AF detected by insertable cardiac monitoring (ICM).
We retrospectively analyzed a database of 66 consecutive patients with cryptogenic stroke who received ICM implantation between October 2016 and March 2018 at 5 stroke centers. We included the follow-up data until June 2018 in this analysis. We defined frequent PACs as the upper quartile of the 66 patients. We analyzed the association of frequent PACs with AF detected by ICM.
Frequent PACs were defined as >222 PACs per a 24-h period. The proportion of patients with newly detected AF by ICM was higher in patients with frequent PACs than those without (50% [8/16] vs. 22% [11/50], p < 0.05). Frequent PACs were associated with AF detection and time to the first AF after adjustment for CHADS2 score after index stroke, high plasma -B-type natriuretic peptide (BNP; >100 pg/mL) or serum -N-terminal pro-BNP levels (>300 pg/mL), and large left atrial diameter (≥45 mm).
High frequency of PACs in cryptogenic stroke may be a strong predictor of AF detected by ICM.
为了明确频发房性早搏（PAC）是否能预测隐源性卒中患者的心房颤动（AF），我们分析了 24 小时动态心电图记录中频发 PAC 与植入式心脏监测仪（ICM）检测到的 AF 之间的相关性。
我们回顾性分析了 2016 年 10 月至 2018 年 3 月期间在 5 家卒中中心接受 ICM 植入的 66 例隐源性卒中连续患者的数据库。在此分析中，我们纳入了截至 2018 年 6 月的随访数据。我们将频发 PAC 定义为 66 例患者中第 75 百分位数以上的 PAC。我们分析了频发 PAC 与 ICM 检测到的 AF 之间的相关性。
频发 PAC 定义为 24 小时内超过 222 次 PAC。与无频发 PAC 的患者相比，有频发 PAC 的患者通过 ICM 新检测到 AF 的比例更高（50%[8/16]比 22%[11/50]，p<0.05）。在调整了卒中后 CHADS2 评分、高血浆 B 型利钠肽（BNP；>100 pg/mL）或血清 N-末端 pro-BNP 水平（>300 pg/mL）以及左心房内径（≥45 mm）后，频发 PAC 与 AF 检测和首次 AF 时间相关。
隐源性卒中患者 PAC 频发可能是 ICM 检测到 AF 的一个强有力预测因子。
