频发房性期前收缩与不明原因脑卒中后房颤检出相关。

Higher Frequency of Premature Atrial Contractions Correlates With Atrial Fibrillation Detection after Cryptogenic Stroke.

机构信息

Department of Neurology, Osaka University Graduate School of Medicine, Japan (Y.S., K.T., Y.G., S.O., T.S., H.M.).

Department of Neurology (R.D.), Iwate Prefectural Central Hospital, Japan.

出版信息

Stroke. 2024 Apr;55(4):946-953. doi: 10.1161/STROKEAHA.123.044813. Epub 2024 Mar 4.

DOI:10.1161/STROKEAHA.123.044813

PMID:38436115

Abstract

BACKGROUND

Covert atrial fibrillation (AF) is a major cause of cryptogenic stroke. This study investigated whether a dose-dependent relationship exists between the frequency of premature atrial contractions (PACs) and AF detection in patients with cryptogenic stroke using an insertable cardiac monitor (ICM).

METHODS

We enrolled consecutive patients with cryptogenic stroke who underwent ICM implantation between October 2016 and September 2020 at 8 stroke centers in Japan. Patients were divided into 3 groups according to the PAC count on 24-hour Holter ECG: ≤200 (group L), >200 to ≤500 (group M), and >500 (group H). We defined a high AF burden as above the median of the cumulative duration of AF episodes during the entire monitoring period. We evaluated the association of the frequency of PACs with AF detection using log-rank trend test and Cox proportional hazard model and with high AF burden using logistic regression model, adjusting for age, sex, CHADS score.

RESULTS

Of 417 patients, we analyzed 381 patients with Holter ECG and ICM data. The median age was 70 (interquartile range, 59.5-76.5), 246 patients (65%) were males, and the median duration of ICM recording was 605 days (interquartile range, 397-827 days). The rate of new AF detected by ICM was higher in groups with more frequent PAC (15.5%/y in group L [n=277] versus 44.0%/y in group M [n=42] versus 71.4%/y in group H [n=62]; log-rank trend <0.01). Compared with group L, the adjusted hazard ratios for AF detection in groups M and H were 2.11 (95% CI, 1.24-3.58) and 3.23 (95% CI, 2.07-5.04), respectively, and the adjusted odds ratio for high AF burden in groups M and H were 2.57 (95% CI, 1.14-5.74) and 4.25 (2.14-8.47), respectively.

CONCLUSIONS

The frequency of PACs was dose-dependently associated with AF detection in patients with cryptogenic stroke.

摘要

背景

隐匿性心房颤动（AF）是引起隐源性卒中的主要原因。本研究使用植入式心脏监测仪（ICM）调查了隐匿性卒中患者频发房性期前收缩（PACs）与 AF 检测之间是否存在剂量依赖性关系。

方法

我们连续纳入了 2016 年 10 月至 2020 年 9 月期间在日本 8 个卒中中心接受 ICM 植入术的隐匿性卒中患者。根据 24 小时动态心电图 Holter 的 PAC 计数，将患者分为 3 组：≤200 次/组（L 组）、＞200~≤500 次/组（M 组）和＞500 次/组（H 组）。我们将高 AF 负荷定义为整个监测期间 AF 发作累积持续时间的中位数以上。我们使用对数秩趋势检验和 Cox 比例风险模型评估 PAC 频率与 AF 检测之间的关系，使用逻辑回归模型评估与高 AF 负荷之间的关系，调整年龄、性别、CHADS 评分。

结果

在 417 例患者中，我们分析了 381 例具有 Holter ECG 和 ICM 数据的患者。中位年龄为 70 岁（四分位距 59.5-76.5），246 例（65%）为男性，ICM 记录的中位时间为 605 天（四分位距 397-827 天）。ICM 检测到新的 AF 的发生率在 PAC 更频繁的组中更高（L 组为 15.5%/年[277 例]，M 组为 44.0%/年[42 例]，H 组为 71.4%/年[62 例]；对数秩趋势<0.01）。与 L 组相比，M 组和 H 组 AF 检测的校正后风险比分别为 2.11（95%CI，1.24-3.58）和 3.23（95%CI，2.07-5.04），M 组和 H 组高 AF 负荷的校正后比值比分别为 2.57（95%CI，1.14-5.74）和 4.25（2.14-8.47）。