Abstract
Background: The widespread use of ambulatory cardiac monitoring has not only increased the detection rate of chronic or paroxysmal atrial fibrillation (AF), but also made it possible to identify other aberrations such as short lasting (<30 secs) irregular runs of non-sustained supraventricular tachycardia (NS-SVT). Despite their resemblance to AF, these rhythms cannot be classified as paroxysmal AF due to their non-sustained nature. Furthermore, it is currently unclear whether they play a similar role in stroke pathophysiology like their chronic and paroxysmal counterparts. In this study, we determined prevalence of NS-SVT/AF in various subtypes of ischemic stroke and compared imaging features associated with these arrhythmias to imaging findings in chronic AF. Methods: This was a retrospective analysis of ischemic stroke patients admitted to a tertiary care center over 2 years. SVTs lasting <30 secs with an irregular RR interval on 24 hour holter were classified as NS-SVT/AF. MRI and angiographic features suggestive of embolism were determined in all patients. Statistical analyses were performed to compare clinical characteristics of patients with and without NS-SVT/AF. Imaging data was analyzed for prevalence of embolic patterns in patients with NS-SVT/AF and chronic AF. Results: The study population consisted of 370 patients. Patients with NS-SVT/AF (n=89) were older (p<0.01), more likely to be female (p=0.03) and had more commonly a history of hypertension (p=0.02). The distribution of stroke subtypes and specifically the prevalence of cryptogenic strokes did not significantly differ among both groups (p=0.15 and p=0.53, respectively). Patients with cryptogenic stroke and NS-SVT/AF had less commonly chronic embolic lesions (p=0.03) and angiographic evidence of abrupt-cut off or recanalization (p=0.09) compared to patients with chronic AF. Conclusions: The clinical characteristics of patients with NS-SVT/AF differ from patients without these arrhythmias, yet prevalence of NS-SVT/AF is similar among various stroke subtypes. More importantly, imaging characteristics do not entirely resemble patterns observed in patients with chronic AF. Further studies are needed to clarify the role of NS-SVT/AF in ischemic stroke.
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