Snyman Salomé, Seder Elena, David-Muller Marc, Klein Victor, Doche Emilie, Suissa Laurent, Deharo Jean-Claude, Robinet-Borgomano Emmanuelle, Maille Baptiste
Stroke Unit, University Hospital of Marseille, La Timone 264, Rue Saint-Pierre, 13005 Marseille, France.
Rhythmology Unit, Cardiology Department, University Hospital of Marseille, La Timone 264, Rue Saint-Pierre, 13005 Marseille, France.
J Clin Med. 2022 Sep 28;11(19):5740. doi: 10.3390/jcm11195740.
High incidence of covert paroxysmal atrial fibrillation (CPAF) detected by an implantable cardiac monitor (ICM) is expected in embolic stroke of undetermined source (ESUS) patients. This study aimed to determine the CPAF rate in an ESUS cohort using ICMs and compare stroke characteristics of patients with CPAF to those with known or inpatient-diagnosed AF (KIDAF).
ESUS patients with ICMs were enrolled. ESUS diagnosis was defined as a non-lacunar stroke in the absence of symptomatic atherosclerotic stenosis (≥50%), no major-risk cardioembolic source, and no other specific cause. ESUS characteristics of patients with CPAF were compared to ESUS patients without CPAF and to KIDAF stroke patients.
During the median follow-up of 476 (371-615) days, CPAF was newly detected in 38/163 (23.31%) patients within 236 (115.50-510.75) days after the stroke. CPAF was independently associated to older age, coronaropathy, left atrial dilation, and atrial hyperexcitability, but not to stroke severity. Compared to KIDAF strokes, ESUS with CPAF had lower rates of proximal occlusion leading to milder clinical severity (NIHSS: 3.00 (1.00-8.25) vs. 14.50 (6.00-21.00)).
Our study revealed a high proportion of CPAF in ESUS. We highlight that CPAF is a distinct clinical entity compared to KIDAF based on differences in stroke characteristics and AF diagnosis temporality.
在不明来源栓塞性卒中（ESUS）患者中，预计可通过植入式心脏监测器（ICM）检测到隐匿性阵发性心房颤动（CPAF）的高发生率。本研究旨在确定使用ICM的ESUS队列中的CPAF发生率，并比较CPAF患者与已知或住院诊断为房颤（KIDAF）患者的卒中特征。
纳入植入ICM的ESUS患者。ESUS诊断定义为在无症状性动脉粥样硬化狭窄（≥50%）、无主要风险的心源性栓塞源且无其他特定病因的情况下发生的非腔隙性卒中。将CPAF患者的ESUS特征与无CPAF的ESUS患者以及KIDAF卒中患者进行比较。
在中位随访476（371 - 615）天期间，卒中后236（115.50 - 510.75）天内，163例患者中有38例（23.31%）新检测到CPAF。CPAF与老年、冠心病、左心房扩大和心房过度兴奋独立相关，但与卒中严重程度无关。与KIDAF卒中相比，伴有CPAF的ESUS近端闭塞率较低，导致临床严重程度较轻（美国国立卫生研究院卒中量表评分：3.00（1.00 - 8.25）对14.50（6.00 - 21.00））。
我们的研究显示ESUS中CPAF的比例很高。我们强调，基于卒中特征和房颤诊断时间性的差异，与KIDAF相比，CPAF是一种独特的临床实体。
