Non-conducted premature atrial complexes: A new independent predictor of atrial fibrillation in cryptogenic stroke
Atrial fibrillation (AF) is the main cardiac cause of stroke, but it frequently remains undetected. In patients with cryptogenic stroke an Holter electrocardiogram (ECG) monitoring for AF is recommended. To evaluate the prognostic role of Non-Conducted Premature Atrial Complexes (ncPACs) recorded on...
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| Veröffentlicht in: | Journal of electrocardiology 2022-09, Vol.74, p.46-53 |
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| creator | Vetta, Giampaolo Parlavecchio, Antonio Caminiti, Rodolfo Crea, Pasquale Magnocavallo, Michele Della Rocca, Domenico Giovanni Lavalle, Carlo Vetta, Francesco Marano, Giovanni Ruggieri, Chiara Lofrumento, Francesca Dattilo, Giuseppe Ferraù, Ludovica Dell'Aera, Cristina Giammello, Fabrizio La Spina, Paolino Musolino, Rosa Fortunata Luzza, Francesco Carerj, Scipione Micari, Antonio Di Bella, Gianluca |
| description | Atrial fibrillation (AF) is the main cardiac cause of stroke, but it frequently remains undetected. In patients with cryptogenic stroke an Holter electrocardiogram (ECG) monitoring for AF is recommended.
To evaluate the prognostic role of Non-Conducted Premature Atrial Complexes (ncPACs) recorded on Holter ECG.
We prospectively enrolled consecutive patients admitted to the Stroke Unit of our hospital with a diagnosis of cryptogenic stroke between December 2018 and January 2020; all patients underwent 24-h Holter ECG monitoring during hospitalization. Two follow-up visits were scheduled, including a 24-h Holter ECG at 3 and 6 months to detect AF.
Among 112 patients, 58% were male with an average age of 72.2 ± 12.2 years. At follow-up, AF was diagnosed in 21.4% of the population. The baseline 24-h Holter ECG burden of ncPACs and Premature Atrial Complexes (PACs) was higher in patients with AF detected on follow-up (13.5 vs 2, p = 0.001; 221.5 vs 52; p = 0.01). ROC analysis showed that ncPACs had the best diagnostic accuracy in predicting AF (AUC:0.80; 95% CI 0.68–0.92). Cut-off value of ≥7 for ncPACs burden showed the highest accuracy with sensitivity of 62.5% and specificity 97.7% to predict AF onset at follow-up. Moreover, at multivariate Cox-proportional hazard analysis ncPACs burden ≥7 was a powerful independent predictor of AF onset (HR 12.4; 95% CI 4.8–32.8; p |
| doi_str_mv | 10.1016/j.jelectrocard.2022.07.071 |
| format | Article |
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To evaluate the prognostic role of Non-Conducted Premature Atrial Complexes (ncPACs) recorded on Holter ECG.
We prospectively enrolled consecutive patients admitted to the Stroke Unit of our hospital with a diagnosis of cryptogenic stroke between December 2018 and January 2020; all patients underwent 24-h Holter ECG monitoring during hospitalization. Two follow-up visits were scheduled, including a 24-h Holter ECG at 3 and 6 months to detect AF.
Among 112 patients, 58% were male with an average age of 72.2 ± 12.2 years. At follow-up, AF was diagnosed in 21.4% of the population. The baseline 24-h Holter ECG burden of ncPACs and Premature Atrial Complexes (PACs) was higher in patients with AF detected on follow-up (13.5 vs 2, p = 0.001; 221.5 vs 52; p = 0.01). ROC analysis showed that ncPACs had the best diagnostic accuracy in predicting AF (AUC:0.80; 95% CI 0.68–0.92). Cut-off value of ≥7 for ncPACs burden showed the highest accuracy with sensitivity of 62.5% and specificity 97.7% to predict AF onset at follow-up. Moreover, at multivariate Cox-proportional hazard analysis ncPACs burden ≥7 was a powerful independent predictor of AF onset (HR 12.4; 95% CI 4.8–32.8; p < 0.0001).
NcPACs burden ≥7 represents a new predictor of AF that could guide the screening of this arrhythmia in cryptogenic stroke patients.
•AF is the main cardiac cause of stroke, frequently undetected.•ECG monitoring for AF screening is recommended in cryptogenic stroke patients.•Non-conducted premature atrial complexes represents a new predictor of AF onset.</description><identifier>ISSN: 0022-0736</identifier><identifier>EISSN: 1532-8430</identifier><identifier>DOI: 10.1016/j.jelectrocard.2022.07.071</identifier><identifier>PMID: 35964522</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Atrial fibrillation ; Atrial Fibrillation - complications ; Atrial Fibrillation - diagnosis ; Atrial premature complexes ; Electrocardiogram ; Electrocardiography ; Female ; Holter-monitoring ; Humans ; Ischemic Stroke ; Male ; Middle Aged ; Stroke ; Stroke - etiology</subject><ispartof>Journal of electrocardiology, 2022-09, Vol.74, p.46-53</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c310t-2e513f719a849393c4ee1101e6d3dc271993c5db97be082799a44a24939c85f63</citedby><cites>FETCH-LOGICAL-c310t-2e513f719a849393c4ee1101e6d3dc271993c5db97be082799a44a24939c85f63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jelectrocard.2022.07.071$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35964522$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vetta, Giampaolo</creatorcontrib><creatorcontrib>Parlavecchio, Antonio</creatorcontrib><creatorcontrib>Caminiti, Rodolfo</creatorcontrib><creatorcontrib>Crea, Pasquale</creatorcontrib><creatorcontrib>Magnocavallo, Michele</creatorcontrib><creatorcontrib>Della Rocca, Domenico Giovanni</creatorcontrib><creatorcontrib>Lavalle, Carlo</creatorcontrib><creatorcontrib>Vetta, Francesco</creatorcontrib><creatorcontrib>Marano, Giovanni</creatorcontrib><creatorcontrib>Ruggieri, Chiara</creatorcontrib><creatorcontrib>Lofrumento, Francesca</creatorcontrib><creatorcontrib>Dattilo, Giuseppe</creatorcontrib><creatorcontrib>Ferraù, Ludovica</creatorcontrib><creatorcontrib>Dell'Aera, Cristina</creatorcontrib><creatorcontrib>Giammello, Fabrizio</creatorcontrib><creatorcontrib>La Spina, Paolino</creatorcontrib><creatorcontrib>Musolino, Rosa Fortunata</creatorcontrib><creatorcontrib>Luzza, Francesco</creatorcontrib><creatorcontrib>Carerj, Scipione</creatorcontrib><creatorcontrib>Micari, Antonio</creatorcontrib><creatorcontrib>Di Bella, Gianluca</creatorcontrib><title>Non-conducted premature atrial complexes: A new independent predictor of atrial fibrillation in cryptogenic stroke</title><title>Journal of electrocardiology</title><addtitle>J Electrocardiol</addtitle><description>Atrial fibrillation (AF) is the main cardiac cause of stroke, but it frequently remains undetected. In patients with cryptogenic stroke an Holter electrocardiogram (ECG) monitoring for AF is recommended.
To evaluate the prognostic role of Non-Conducted Premature Atrial Complexes (ncPACs) recorded on Holter ECG.
We prospectively enrolled consecutive patients admitted to the Stroke Unit of our hospital with a diagnosis of cryptogenic stroke between December 2018 and January 2020; all patients underwent 24-h Holter ECG monitoring during hospitalization. Two follow-up visits were scheduled, including a 24-h Holter ECG at 3 and 6 months to detect AF.
Among 112 patients, 58% were male with an average age of 72.2 ± 12.2 years. At follow-up, AF was diagnosed in 21.4% of the population. The baseline 24-h Holter ECG burden of ncPACs and Premature Atrial Complexes (PACs) was higher in patients with AF detected on follow-up (13.5 vs 2, p = 0.001; 221.5 vs 52; p = 0.01). ROC analysis showed that ncPACs had the best diagnostic accuracy in predicting AF (AUC:0.80; 95% CI 0.68–0.92). Cut-off value of ≥7 for ncPACs burden showed the highest accuracy with sensitivity of 62.5% and specificity 97.7% to predict AF onset at follow-up. Moreover, at multivariate Cox-proportional hazard analysis ncPACs burden ≥7 was a powerful independent predictor of AF onset (HR 12.4; 95% CI 4.8–32.8; p < 0.0001).
NcPACs burden ≥7 represents a new predictor of AF that could guide the screening of this arrhythmia in cryptogenic stroke patients.
•AF is the main cardiac cause of stroke, frequently undetected.•ECG monitoring for AF screening is recommended in cryptogenic stroke patients.•Non-conducted premature atrial complexes represents a new predictor of AF onset.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial premature complexes</subject><subject>Electrocardiogram</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Holter-monitoring</subject><subject>Humans</subject><subject>Ischemic Stroke</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Stroke</subject><subject>Stroke - etiology</subject><issn>0022-0736</issn><issn>1532-8430</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkMlKBDEQhoMozri8ggRPXnrM0qs3cQfRi55DJqmWjN1Jm6Rd3t40M4pHoUig6vtr-RE6pmRBCS1PV4sVdKCid0p6vWCEsQWpUtAtNKcFZ1mdc7KN5iRVMlLxcob2QlgRQhpWsV0040VT5gVjc-QfnM2Us3pUETQePPQyjh6wjN7IDivXDx18QjjD59jCBzZWwwDpsXGitVHReezaH0Frlt50nYzG2QRj5b-G6F7AGoVDWvkVDtBOK7sAh5t_Hz1fXz1d3Gb3jzd3F-f3meKUxIxBQXlb0UbWecMbrnIAmu6HUnOtWCqkXKGXTbUEUrOqaWSeSzaxqi7aku-jk3Xfwbu3EUIUvQkK0m4W3BgEqwjL66LIJ_RsjSrvQvDQisGbXvovQYmYPBcr8ddzMXkuSJWCJvHRZs647EH_Sn9MTsDlGoB07bsBL4IyYFUyz6eWQjvznznfgbSbPA</recordid><startdate>202209</startdate><enddate>202209</enddate><creator>Vetta, Giampaolo</creator><creator>Parlavecchio, Antonio</creator><creator>Caminiti, Rodolfo</creator><creator>Crea, Pasquale</creator><creator>Magnocavallo, Michele</creator><creator>Della Rocca, Domenico Giovanni</creator><creator>Lavalle, Carlo</creator><creator>Vetta, Francesco</creator><creator>Marano, Giovanni</creator><creator>Ruggieri, Chiara</creator><creator>Lofrumento, Francesca</creator><creator>Dattilo, Giuseppe</creator><creator>Ferraù, Ludovica</creator><creator>Dell'Aera, Cristina</creator><creator>Giammello, Fabrizio</creator><creator>La Spina, Paolino</creator><creator>Musolino, Rosa Fortunata</creator><creator>Luzza, Francesco</creator><creator>Carerj, Scipione</creator><creator>Micari, Antonio</creator><creator>Di Bella, Gianluca</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202209</creationdate><title>Non-conducted premature atrial complexes: A new independent predictor of atrial fibrillation in cryptogenic stroke</title><author>Vetta, Giampaolo ; Parlavecchio, Antonio ; Caminiti, Rodolfo ; Crea, Pasquale ; Magnocavallo, Michele ; Della Rocca, Domenico Giovanni ; Lavalle, Carlo ; Vetta, Francesco ; Marano, Giovanni ; Ruggieri, Chiara ; Lofrumento, Francesca ; Dattilo, Giuseppe ; Ferraù, Ludovica ; Dell'Aera, Cristina ; Giammello, Fabrizio ; La Spina, Paolino ; Musolino, Rosa Fortunata ; Luzza, Francesco ; Carerj, Scipione ; Micari, Antonio ; Di Bella, Gianluca</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c310t-2e513f719a849393c4ee1101e6d3dc271993c5db97be082799a44a24939c85f63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial premature complexes</topic><topic>Electrocardiogram</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Holter-monitoring</topic><topic>Humans</topic><topic>Ischemic Stroke</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Stroke</topic><topic>Stroke - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vetta, Giampaolo</creatorcontrib><creatorcontrib>Parlavecchio, Antonio</creatorcontrib><creatorcontrib>Caminiti, Rodolfo</creatorcontrib><creatorcontrib>Crea, Pasquale</creatorcontrib><creatorcontrib>Magnocavallo, Michele</creatorcontrib><creatorcontrib>Della Rocca, Domenico Giovanni</creatorcontrib><creatorcontrib>Lavalle, Carlo</creatorcontrib><creatorcontrib>Vetta, Francesco</creatorcontrib><creatorcontrib>Marano, Giovanni</creatorcontrib><creatorcontrib>Ruggieri, Chiara</creatorcontrib><creatorcontrib>Lofrumento, Francesca</creatorcontrib><creatorcontrib>Dattilo, Giuseppe</creatorcontrib><creatorcontrib>Ferraù, Ludovica</creatorcontrib><creatorcontrib>Dell'Aera, Cristina</creatorcontrib><creatorcontrib>Giammello, Fabrizio</creatorcontrib><creatorcontrib>La Spina, Paolino</creatorcontrib><creatorcontrib>Musolino, Rosa Fortunata</creatorcontrib><creatorcontrib>Luzza, Francesco</creatorcontrib><creatorcontrib>Carerj, Scipione</creatorcontrib><creatorcontrib>Micari, Antonio</creatorcontrib><creatorcontrib>Di Bella, Gianluca</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of electrocardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vetta, Giampaolo</au><au>Parlavecchio, Antonio</au><au>Caminiti, Rodolfo</au><au>Crea, Pasquale</au><au>Magnocavallo, Michele</au><au>Della Rocca, Domenico Giovanni</au><au>Lavalle, Carlo</au><au>Vetta, Francesco</au><au>Marano, Giovanni</au><au>Ruggieri, Chiara</au><au>Lofrumento, Francesca</au><au>Dattilo, Giuseppe</au><au>Ferraù, Ludovica</au><au>Dell'Aera, Cristina</au><au>Giammello, Fabrizio</au><au>La Spina, Paolino</au><au>Musolino, Rosa Fortunata</au><au>Luzza, Francesco</au><au>Carerj, Scipione</au><au>Micari, Antonio</au><au>Di Bella, Gianluca</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Non-conducted premature atrial complexes: A new independent predictor of atrial fibrillation in cryptogenic stroke</atitle><jtitle>Journal of electrocardiology</jtitle><addtitle>J Electrocardiol</addtitle><date>2022-09</date><risdate>2022</risdate><volume>74</volume><spage>46</spage><epage>53</epage><pages>46-53</pages><issn>0022-0736</issn><eissn>1532-8430</eissn><abstract>Atrial fibrillation (AF) is the main cardiac cause of stroke, but it frequently remains undetected. In patients with cryptogenic stroke an Holter electrocardiogram (ECG) monitoring for AF is recommended.
To evaluate the prognostic role of Non-Conducted Premature Atrial Complexes (ncPACs) recorded on Holter ECG.
We prospectively enrolled consecutive patients admitted to the Stroke Unit of our hospital with a diagnosis of cryptogenic stroke between December 2018 and January 2020; all patients underwent 24-h Holter ECG monitoring during hospitalization. Two follow-up visits were scheduled, including a 24-h Holter ECG at 3 and 6 months to detect AF.
Among 112 patients, 58% were male with an average age of 72.2 ± 12.2 years. At follow-up, AF was diagnosed in 21.4% of the population. The baseline 24-h Holter ECG burden of ncPACs and Premature Atrial Complexes (PACs) was higher in patients with AF detected on follow-up (13.5 vs 2, p = 0.001; 221.5 vs 52; p = 0.01). ROC analysis showed that ncPACs had the best diagnostic accuracy in predicting AF (AUC:0.80; 95% CI 0.68–0.92). Cut-off value of ≥7 for ncPACs burden showed the highest accuracy with sensitivity of 62.5% and specificity 97.7% to predict AF onset at follow-up. Moreover, at multivariate Cox-proportional hazard analysis ncPACs burden ≥7 was a powerful independent predictor of AF onset (HR 12.4; 95% CI 4.8–32.8; p < 0.0001).
NcPACs burden ≥7 represents a new predictor of AF that could guide the screening of this arrhythmia in cryptogenic stroke patients.
•AF is the main cardiac cause of stroke, frequently undetected.•ECG monitoring for AF screening is recommended in cryptogenic stroke patients.•Non-conducted premature atrial complexes represents a new predictor of AF onset.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35964522</pmid><doi>10.1016/j.jelectrocard.2022.07.071</doi><tpages>8</tpages></addata></record> |
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| ispartof | Journal of electrocardiology, 2022-09, Vol.74, p.46-53 |
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| language | eng |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Aged Aged, 80 and over Atrial fibrillation Atrial Fibrillation - complications Atrial Fibrillation - diagnosis Atrial premature complexes Electrocardiogram Electrocardiography Female Holter-monitoring Humans Ischemic Stroke Male Middle Aged Stroke Stroke - etiology |
| title | Non-conducted premature atrial complexes: A new independent predictor of atrial fibrillation in cryptogenic stroke |
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