Abstract
Atrial fibrillation (AF) is a major etiological factor of ischemic strokes (IS). Recent data suggested that subclinical, i.e. silent AF, assessed at the acute phase of stroke by Continuous ECG Monitoring (CEM) is frequent, and associated with a worse prognosis. The aim of our study was to investigate the incidence and determinants of silent AF in patients with acute IS. All consecutive patients admitted on the stroke unit of CHU DIJON for IS or TIA were prospectively enrolled from March to December 2012. Patients with a history of AF or who experienced symptomatic AF during their hospital stay were excluded. Silent AF was assessed by CEM for 24h after admission and defined as at least 1 episode >30 sec without p waves, and with irregular RR intervals. An echocardiography was performed at 2±1 d to measure left ventricular ejection fraction (LVEF) and left auricular (LA) dimensions. Among the 187 patients included, 19 (10%) developed silent AF. Patients with silent AF were markedly older (76 vs. 66 years, p<0.002), with lower creatinine levels (90 vs. 80 μmol/L, p=0.030) and were less often smokers (5 vs. 41% p=0.058) than patients without silent AF. They also showed a trend towards more frequent hypertension (79 vs. 58%, p=0.057) and a recent history of infection (16 vs. 5%, p=0.082). There was no difference for chronic treatments, NIHSS score on admission, maximal heart rate (HR) or diabetes. By backward multivariate analysis, only age remained an independent estimate of silent AF. For echocardiographic measurements, patients with silent AF showed a trend towards a larger indexed LA volume (37.4 vs. 30.8 ml/m 3 ), p=0.057) and LA diameter (23.2 vs. 20.8 mm/m 2 , p=0.059); LVEF was similar for the two groups (59 vs. 59%, p=0.582). This study demonstrated that silent AF detected by CEM is common and associated with older age. Further studies are needed to investigate the interest of systematical screening for silent AF for secondary prevention after ischemic stroke.
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