Abstract 2642: Prevalence and Importance of Cardiac Arrhythmias after Acute Ischemic Stroke

Abstract

Although heart rhythm monitoring following acute ischemic stroke is widely practiced, the prevalence of arrhythmia during the acute phase of ischemic stroke is debated. Several studies have claimed the potential threat of QT prolongation possibly leading to Torsades de Pointes ventricular tachycardia (VT) or ventricular fibrillation (VF). Furthermore, knowledge of the true rate of occult atrial fibrillation (AF) among ischemic stroke patients is sparse. 224 consecutive patients with acute ischemic stroke underwent daily 12-lead ECG during the first 5 days after hospital admission; as well as 24 hour Holter monitoring was performed in all patients. Patients with prior AF, established ischemic heart disease and heart failure were excluded. Patients were followed for 40 months for vital status. The mean age of the patients was 69 years. No patient had VT or VF. Previously unsuspected AF could be demonstrated in only 13 of 224 patients (6%). All 13 were detected by Holter monitoring, while nearly half were missed by ECG. During follow-up 53 (24 %) patients died. The presence of AF was significantly associated with mortality (log-rank p <0.0001; Figure ). In Cox analysis, patients with AF had an increased mortality compared to patients without AF (HR=2.44; [95 % CI, 1.00 – 6.00], P = 0.05) with adjustment for age and stroke severity and renal failure. The fear of serious ventricular arrhythmias in the acute phase of ischemic stroke appears to be groundless. However, new onset AF can be demonstrated in one of 20 patients with acute ischemic stroke and seems to be associated with an increased mortality during long-term follow-up.