Abstract
Background and objectivesAtrial fibrillation is a known risk factor for cryptogenic stroke and therefore requires early detection and prompt management. We investigated predictors of stroke recurrence in patients with cryptogenic stroke and concomitant non-sustained atrial tachycardia but not atrial fibrillation.Subjects and methodsWe investigated 390 patients (219 men, mean age 67 ± 12 years) diagnosed with stroke and non-sustained atrial tachycardia on 24-h Holter monitoring and recorded the total number of atrial premature contractions identified by the Holter monitor. Multiple atrial premature contractions were defined as atrial premature contractions > 34 beats/day. We analyzed the rates of 5-year freedom from stroke recurrence or atrial fibrillation and investigated independent predictors of stroke recurrence and undiagnosed atrial fibrillation.ResultsThe mean follow-up period was 35 ± 21 months, and the overall stroke recurrence rate was 9.0%. Kaplan–Meier survival analysis revealed that the rate of freedom from stroke recurrence was significantly lower in patients with multiple atrial premature contractions. Also, the patients with multiple atrial premature contractions had higher cumulative incidence rate of new-onset AF (p = 0.019). Multivariate analysis showed that multiple atrial premature contractions (hazard ratio 2.49, 95% confidence interval 1.05–5.88, p = 0.038), cigarette smoking status (hazard ratio 2.66, 95% confidence interval 1.15–6.17, p = 0.022), and the left atrial volume index (hazard ratio 1.05, 95% confidence interval 1.01–1.09, p = 0.020) were significantly associated with stroke recurrence in patients with cryptogenic stroke. However, these factors were not statistically significant predictors of future onset of atrial fibrillation.ConclusionsMultiple atrial premature contractions were significantly correlated with an increased left atrial volume index, which could predict future onset of atrial fibrillation and stroke recurrence. This study showed that multiple atrial premature contractions predict stroke recurrence in patients with cryptogenic stroke without atrial fibrillation.
Highlights
Atrial fibrillation (AF) is a well-known risk factor for cerebral infarction; AF is often diagnostically challenging owing to its paroxysmal or asymptomatic clinical presentation [1,2,3]
Kaplan– Meier survival analysis revealed that the rate of freedom from stroke recurrence was significantly lower in patients with multiple atrial premature contractions
Multivariate analysis showed that multiple atrial premature contractions, cigarette smoking status, and the left atrial volume index were significantly associated with stroke recurrence in patients with cryptogenic stroke
Summary
Atrial fibrillation (AF) is a well-known risk factor for cerebral infarction; AF is often diagnostically challenging owing to its paroxysmal or asymptomatic clinical presentation [1,2,3]. The clinical presentation and sequelae of cerebral infarction are more severe in patients with AF; early detection of AF significantly improves patients’ prognosis and reduces overall health care costs [6]. We investigated the predictors of stroke recurrence in patients with cryptogenic stroke and concomitant NSAT but not AF. Atrial fibrillation is a known risk factor for cryptogenic stroke and requires early detection and prompt management. We investigated predictors of stroke recurrence in patients with crypto‐ genic stroke and concomitant non-sustained atrial tachycardia but not atrial fibrillation
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