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Vol. 157. Issue 12.
Pages 555-560 (December 2021)
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Vol. 157. Issue 12.
Pages 555-560 (December 2021)
Original article
Atrial fibrillation predictors in patients with embolic stroke of undetermined source
Predictores de fibrilación auricular en pacientes con ictus embólico de origen indeterminado
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Javier Ramos-Maquedaa,
Corresponding author
, Cristina Navarro-Valverdeb, Irene Esteve-Ruizb, Mercedes Cabrera-Ramosa, Ricardo Rivera-Lópezc, Dolores García-Medinab, Ricardo Pavón-Jiménezb, Francisco Javier Molano-Casimirob
a Servicio de Cardiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Servicio de Cardiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
c Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
Article information
Abstract
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Tables (3)
Table 1. Main baseline characteristics of the total population and according to whether or not AF was detected during the follow-up.
Table 2. AF predictors in patients according to whether or not AF was detected during the follow-up.
Table 3. Univariate and multivariate analysis of the main AF predictors.
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Abstract
Background and objectives

Atrial fibrillation (AF) detection in patients with embolic stroke of underdetermined source (ESUS), entails a change of medical treatment and a significant decrease in the incidence of new strokes. It is necessary to determine which patients would benefit more from prolonged electrocardiographic monitoring. Our aim was to find electrocardiographic and echocardiographic AF predictors in patients with ESUS.

Methods

We performed a cohort study that included 95 consecutive patients admitted to the hospital because of an ESUS. An electrocardiogram, each subject in the study underwent a 24-h Holter-electrocardiogram (Holter-ECG) and an echocardiogram. A 2-year follow up was also conducted, with a 24-h Holter-ECG every three months for the first year, and every 6 months during the second one.

Results

During the follow-up, AF was detected in 11 patients (11.6%), with a detection rate of 3.2% at 6 months, 7.4% at 12 months, and 11.6% at 18 months as well as at 24 months. The variables that were independently related to AF detection included moderate or severe left atrium dilation (p = .02), interatrial advanced block (p = .04) and more than 1000 premature atrial beats on 24 h Holter-ECG (p = .01).

Conclusions

Moderate or severe atrial dilation, interatrial advanced block, and the presence of more than 1000 premature atrial beats on 24 h Holter-ECG behave as AF predictors in patients with ESUS.

Keywords:
Embolic stroke of undetermined source
Atrial fibrillation
Holter-electrocardiogram
Predictors
Resumen
Antecedentes y objetivos

En el accidente cerebrovascular embólico de origen indeterminado (ESUS), la detección de fibrilación auricular (FA) conlleva un cambio de tratamiento y una reducción drástica en la incidencia de nuevos ictus. Es necesario determinar qué pacientes se benefician en mayor medida de una monitorización electrocardiográfica prolongada. Nuestro objetivo fue la búsqueda de predictores electrocardiográficos y ecocardiográficos de FA en pacientes con ESUS.

Materiales y métodos

Se diseñó un estudio observacional de cohortes en el que se incluyeron 95 pacientes consecutivos que ingresaron por ESUS en un hospital terciario. A todos se les realizó un electrocardiograma (ECG), un Holter electrocardiograma (Holter-ECG) de 24 horas y un ecocardiograma durante el ingreso. Se realizó un seguimiento presencial durante dos años mediante Holter-ECG de 24 horas, trimestral durante el primer año y semestral durante el segundo.

Resultados

Durante el seguimiento, se detectó FA en 11 pacientes (11,6%), siendo la tasa detección del 3,2% a los 6 meses, 7,4% a los 12 meses, y 11,6% a los 18 y a los 24 meses. Las variables que se relacionaron de forma independiente con el desarrollo de FA fueron la dilatación en grado moderado o severo de la aurícula izquierda (AI) (p = 002), el bloqueo interauricular avanzado (BIA-A) (p = 0,04), y la presencia de más de 1000 extrasístoles auriculares (EA) en Holter-ECG de 24 horas (p = 0,01).

Conclusiones

La dilatación en un grado moderado o severo de AI, el BIA-A, y la presencia de más de 1000 EA en Holter-ECG de 24 horas se comportan como predictores independientes de FA en pacientes con ESUS.

Palabras clave:
Accidente cerebrovascular embólico de origen indeterminado
Fibrilación auricular
Holter-electrocardiograma
Predictores

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