Abstract
The characterization of onset scenarios of paroxysmal atrial fibrillation (pAF) has recently gained prominence to determine various underlying arrhythmogenic trigger mechanisms. It is hypothesized that there might be specific onset scenarios of pAF in patients with ischemic stroke, however, onset scenarios of pAF have not yet been systematically analysed in a broad patient population without pacemaker indication and especially those patients after ischemic stroke. Methods and Results: From a total of 20.546 consecutive ambulatory 24-hour-Holter-ECG-recordings, 668 episodes of pAF (lasting > 1 minute) were identified in 343 patients without previous stroke (155 females; 71±10years) and 35 pAF episodes in 20 patients after ischemic stroke (8 females; 67±15 years). The dominant portion of episodes of pAF was preceded by atrial ectopy [single atrial premature beats (APB), blocked APB, multiple APB, short atrial runs, short-long-short sequences] or heart rate alterations [bradycardia, tachycardia, sudden rate drop, ventricular premature beats (VPB)]. Almost one third of all pAF episodes were not preceded by either ectopy or heart rate alterations (i.e. sudden-onset pAF). There were no significant differences between patients with or without stroke regarding the distribution of pAF-onset patterns. Mean RR-interval during sinus-rhythm tended to be higher in patients after ischemic stroke (866±184ms vs 845±190ms; p=0.1) Conclusion: There are no significant differences regarding specific onset-scenarios of pAF patients after ischemic stroke and in patients without stroke. Interestingly, patients with stroke tended to have lower heart rates during sinus rhythm.
Published Version
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