Lee Ji Hyun, Moon In Tae, Cho Youngjin, Kim Jun Yup, Kang Jihoon, Kim Beom Joon, Han Moon Ku, Oh Il Young, Bae Hee Joon
Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
J Clin Neurol. 2021 Apr;17(2):213-219. doi: 10.3988/jcn.2021.17.2.213.
An insertable cardiac monitor (ICM) has been demonstrated to be a useful tool for detecting subclinical atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS). This study aimed to identify the clinical predictors of AF in ESUS patients with ICMs.
We retrospectively selected consecutive patients with an ICM implanted for AF detection following ESUS. The primary endpoint was defined as any AF episode lasting for longer than 5 min. The atrial ectopic burden (AEB) was calculated as the percentage of the number of conducted QRS from atrial ectopy on Holter monitoring.
This study included 136 patients. AF lasting ≥5 min was detected in 20 patients (14.7%) during a median follow-up period of 6.6 months (interquartile range, 3.3-10.8 months). AF patients had a higher AEB (0.20% vs. 0.02%, <0.001) and a larger left atrial diameter (LAD, 41.0 mm vs. 35.3 mm, <0.001) than those without AF. The areas under the receiver operating characteristic curves were 0.795 and 0.816 for the LAD and log-transformed AEB, respectively, for the best cutoff values of 38.5 mm for LAD and 0.050% for AEB. AF lasting ≥5 min was detected in 34.6% (9/26) of patients with LAD ≥38.5 mm and AEB ≥0.050%, and in 0% (0/65) of those with LAD <38.5 mm and AEB <0.050%.
AF was detected in a significant proportion of ESUS patients during a 6.6-month follow-up. The LAD and AEB are good predictors of AF and might be useful for AF risk stratification in ESUS patients.
可植入式心脏监测器（ICM）已被证明是检测不明来源栓塞性卒中（ESUS）患者亚临床房颤（AF）的有用工具。本研究旨在确定植入ICM的ESUS患者发生房颤的临床预测因素。
我们回顾性选择了连续的因ESUS后植入ICM以检测房颤的患者。主要终点定义为任何持续超过5分钟的房颤发作。心房异位负荷（AEB）通过动态心电图监测中房性异位搏动下传的QRS波数量占总QRS波数量的百分比来计算。
本研究纳入了136例患者。在中位随访期6.6个月（四分位间距，3.3 - 10.8个月）内，20例患者（14.7%）检测到持续≥5分钟的房颤。房颤患者的AEB（0.20%对0.02%，<0.001）和左心房直径（LAD，41.0 mm对35.3 mm，<0.001）均高于无房颤患者。对于LAD和经对数转换的AEB，受试者工作特征曲线下面积分别为0.795和0.816，LAD的最佳截断值为38.5 mm，AEB的最佳截断值为0.050%。LAD≥38.5 mm且AEB≥0.050%的患者中，34.6%（9/26）检测到持续≥5分钟的房颤，而LAD<38.5 mm且AEB<0.050%的患者中，这一比例为0%（0/65）。
在6.6个月的随访期间，相当比例的ESUS患者检测到房颤。LAD和AEB是房颤的良好预测因素，可能有助于ESUS患者的房颤风险分层。
