Abstract
Background: Atrial fibrillation (AF) – be it permanent or paroxysmal – is the most frequent and most effectively treatable cause of stroke. However, when paroxysmal, even electrocardiography for 24 hours (24h-ECG) misses AF in more than 50% of cases. We assessed whether extended Poincare analysis of ECG R-R intervals (EPA) can help to identify electrocardiographic remodeling suggestive of paroxysmal AF (PAF). Methods: Twenty-nine patients with previously diagnosed PAF were re-assessed by 24h-ECG using conventional analysis and EPA based on a previously trained algorithm considering among other ratios of R-R interval duration, number of premature atrial complexes, approximate entropy, and standard deviation of Poincare plots-axes. 24h-ECG from 21 healthy subjects without a history of AF served as negative, and 9 patients with permanent AF as positive controls. Results: PAF during 24h-ECG was detected in 4 out of 29 (14%) patients with a history of PAF by conventional analysis. EPA classified ECGs of these and 22 additional patients with a history of PAF, i.e. a total 90%, as suggestive of PAF. All patients with permanent AF were identified by both tools. EPA additionally classified the ECG in 4 out of 21 control subjects as suggestive of PAF. Conclusions: Extended Poincare analysis in patients with a history of PAF is more sensitive to electrocardiographic abnormalities than is conventional 24h- ECG analysis. These findings warrant prospective studies of EPA in patients with a high likelihood of PAF, i.e. with stroke of undetermined origin.
Highlights
One fifth of all strokes are caused by atrial fibrillation (AF) [1,2]
Extended Poincaré analysis in patients with a history of paroxysmal AF (PAF) is more sensitive to electrocardiographic abnormalities than is conventional 24h- ECG analysis
Relative to standard ECG, 24h-ECG doubles the detection rate of PAF but still misses about one third of cases later identified by ambulatory 7-day ECG and up to 44% of cases detected by long-term event recorders [7]
Summary
One fifth of all strokes are caused by atrial fibrillation (AF) [1,2]. As in up to one third of cases AF is intermittent, appropriate diagnosis - and treatment - is frequently missed [4]. Diagnosis of paroxysmal AF (PAF) is estimated to be missed in more than 50% of patients [5,6]. The number of patients needed to screen to detect one case of PAF has been calculated to be 20 [8]. Atrial fibrillation (AF) – be it permanent or paroxysmal – is the most frequent and most effectively treatable cause of stroke. When paroxysmal, even electrocardiography for 24 hours (24h-ECG) misses AF in more than 50% of cases. We assessed whether extended Poincaré analysis of ECG R-R intervals (EPA) can help to identify electrocardiographic remodeling suggestive of paroxysmal AF (PAF)
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