Yurtseven Ece, Ural Dilek, Karaüzüm Kurtuluş, Yılmaz İrem, Çelikyurt Yengi Umut, Hancı Kaan, Aktaş Müjdat, Sinan Ümit Yaşar, Küçükoğlu Serdar, Ağaçdiken Ağır Ayşen
Department of Cardiology, Faculty of Medicine, Koç University, İstanbul, Türkiye.
Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye.
Anatol J Cardiol. 2025 Aug 1;29(8):401-408. doi: 10.14744/AnatolJCardiol.2025.5026.
Nonsustained atrial fibrillation (NS-AF) lasting longer than 30 seconds on ambulatory electrocardiogram(ECG) monitoring is considered a potential risk factor for future persistent or permanent AF and stroke. However, the clinical significance of NS-AF episodes shorter than 30 seconds, as detected on 24-hour Holter monitoring, remains unclear, as does their potential impact on stroke risk.
A total of 6117 Holter recordings were analyzed after excluding patients with AF, valvular heart disease, and a history of thromboembolic events. A total of 133 patients with NS-AF lasting less than 30 seconds and 113 controls with no detected arrhythmias were included. Both groups were followed for a mean of 65.84 ± 6.38 months.
In 133 patients (2.17%), NS-AF episodes were detected. During follow-up, the stroke rate was significantly higher in the NS-AF group [21 (15.78%) vs. 5 (4.42%), P = .004]. After excluding 20 patients through propensity matching and adjusting for other risk factors, both NS-AF (OR = 3.930, 95% CI: 1.235-12.510, P = .021) and CHA2DS2-VA score (OR = 1.819, 95% CI: 1.204-2.748, P = .004) were identified as independent predictors of ischemic stroke. In the NS-AF group, the prevalence of stroke increased with advancing CHA2DS2-VA score. Furthermore, in the NS-AF group, a CHA2DS2-VA score ≥2 demonstrated a sensitivity of 85.7%, a specificity of 56.6%, a positive predictive value of 26.8%, and a negative predictive value of 95.5% for predicting stroke (area under the curve [AUC]: 0.76; 95% CI: 0.65-0.86.6; P < .001).
Stroke risk is increased in patients with NS-AF of less than 30 seconds detected on 24-hour ambulatory ECG monitoring with a CHA2DS2-VA score ≥2. Close follow-up should be considered for these patients to evaluate the need for anticoagulation.
动态心电图监测中持续时间超过30秒的非持续性房颤（NS-AF）被认为是未来发生持续性或永久性房颤及卒中的潜在危险因素。然而，24小时动态心电图监测检测到的持续时间短于30秒的NS-AF发作的临床意义及其对卒中风险的潜在影响仍不明确。
排除患有房颤、瓣膜性心脏病和有血栓栓塞事件病史的患者后，共分析了6117份动态心电图记录。纳入了133例NS-AF持续时间少于30秒的患者和113例未检测到心律失常的对照者。两组患者的平均随访时间为65.84±6.38个月。
在133例患者（2.17%）中检测到NS-AF发作。随访期间，NS-AF组的卒中发生率显著更高[21例（15.78%）对5例（4.42%），P = 0.004]。通过倾向匹配排除20例患者并调整其他危险因素后，NS-AF（比值比[OR]=3.930，95%置信区间[CI]：1.235 - 12.510，P = 0.021）和CHA2DS2-VA评分（OR = 1.819，95% CI：1.204 - 2.748，P = 0.004）均被确定为缺血性卒中的独立预测因素。在NS-AF组中，卒中患病率随CHA2DS2-VA评分的增加而升高。此外，在NS-AF组中，CHA2DS2-VA评分≥2对于预测卒中的敏感性为85.7%，特异性为56.6%，阳性预测值为26.8%，阴性预测值为95.5%（曲线下面积[AUC]：0.76；95% CI：0.65 - 0.866；P < 0.001）。
24小时动态心电图监测检测到的持续时间少于30秒且CHA2DS2-VA评分≥2的NS-AF患者卒中风险增加。对于这些患者应考虑密切随访以评估抗凝治疗的必要性。
