急性缺血性卒中患者的室上性异位活动过多与卒中后24个月内检测到心房颤动相关：MonDAFIS研究的预定义分析

Excessive Supraventricular Ectopic Activity in Patients With Acute Ischemic Stroke Is Associated With Atrial Fibrillation Detection Within 24 Months After Stroke: A Predefined Analysis of the MonDAFIS Study.

作者信息

Haeusler Karl Georg, Tütüncü Serdar, Fiessler Cornelia, Jawad-Ul-Qamar Muhammad, Kunze Claudia, Schurig Johannes, Dietzel Joanna, Krämer Michael, Petzold Gabor C, Royl Georg, Helberg Torsten, Thomalla Götz, Nabavi Darius G, Röther Joachim, Laufs Ulrich, Veltkamp Roland, Heuschmann Peter U, Kirchhof Paulus, Olma Manuel C, Endres Matthias

机构信息

Department of Neurology University of Ulm Ulm Germany.

Center for Stroke Research Berlin Charité-Universitätsmedizin Berlin Berlin Germany.

出版信息

J Am Heart Assoc. 2025 Jan 21;14(2):e034512. doi: 10.1161/JAHA.123.034512. Epub 2025 Jan 10.

DOI:10.1161/JAHA.123.034512

PMID:39791425

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12054430/

Abstract

BACKGROUND

Excessive supraventricular ectopic activity (ESVEA) is regarded as a risk marker for later atrial fibrillation (AF) detection.

METHODS AND RESULTS

The investigator-initiated, prospective, open, multicenter MonDAFIS (Impact of Standardized Monitoring for Detection of Atrial Fibrillation in Ischemic Stroke) study randomized 3465 patients with acute ischemic stroke without known AF 1:1 to usual diagnostic procedures for AF detection or additive Holter monitoring in hospital for up to 7 days, analyzed in a core laboratory. Secondary study objectives include the comparison of recurrent stroke, myocardial infarction, major bleeding, and all-cause death within 24 months in patients with ESVEA (defined as ectopic supraventricular beats ≥480/day or atrial runs of 10-29 seconds or both) versus patients with newly diagnosed AF versus patients without ESVEA or AF (non-ESVEA/AF), randomized to the intervention group. Overall, 1435 (84.8%) of 1714 patients randomized to the intervention group had analyzable study ECG monitoring of at least 48 hours' duration within the first 72 hours of monitoring. ESVEA was detected in 363 (25.3%) patients, while AF was first detected in 48 (3.3%) patients. Within 24 months, AF was newly detected in 67 (18.5%) patients with ESVEA versus 60 (5.9%) patients without ESVEA/AF- (<0.001). The composite outcome at 24 months was not different between patients with ESVEA and patients without ESVEA/AF (15.2% versus 12.6%; =0.242). All-cause death was numerically higher in patients with ESVEA (6.6% versus 3.2%), but failed statistical significance (=0.433) in multivariate analysis (including age, heart failure, stroke severity, and creatinine at baseline).

CONCLUSIONS

ESVEA in the acute phase of ischemic stroke or transient ischemic attack is associated with AF detection during follow-up and therefore may be used to select patients for prolonged ECG monitoring.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT02204267.

摘要

背景

室上性异位活动过度（ESVEA）被视为后期心房颤动（AF）检测的风险标志物。

方法与结果

由研究者发起的前瞻性、开放性、多中心MonDAFIS（缺血性卒中中心房颤动检测标准化监测的影响）研究，将3465例无已知AF的急性缺血性卒中患者按1:1随机分为AF检测的常规诊断程序组或在医院进行长达7天的附加动态心电图监测组，并在核心实验室进行分析。次要研究目标包括比较ESVEA患者（定义为异位室上性搏动≥480次/天或房性心动过速持续10 - 29秒或两者兼有）、新诊断AF患者与无ESVEA或AF患者（非ESVEA/AF）在24个月内复发性卒中、心肌梗死、大出血和全因死亡情况，这些患者被随机分配到干预组。总体而言，随机分配到干预组的1714例患者中，1435例（84.8%）在监测的前72小时内有可分析的研究心电图监测，持续时间至少48小时。363例（25.3%）患者检测到ESVEA，而48例（3.3%）患者首次检测到AF。在24个月内，67例（18.5%）ESVEA患者新检测到AF，而无ESVEA/AF患者中有60例（5.9%）新检测到AF（<0.001）。ESVEA患者和无ESVEA/AF患者在24个月时的复合结局无差异（15.2%对12.6%；P = 0.242）。ESVEA患者的全因死亡在数值上更高（6.6%对3.2%），但在多因素分析（包括年龄、心力衰竭、卒中严重程度和基线肌酐）中未达到统计学显著性（P = 0.433）。