Document Detail

Unexpected low prevalence of atrial fibrillation in cryptogenic ischemic stroke: a prospective study.
MedLine Citation:
PMID:  20454840     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Ischemic stroke is a frequent pathology with high rate of recurrence and significant morbidity and mortality. There are several causes of stroke, affecting prognosis, outcomes, and management, but in many cases, the etiology remains undetermined. We hypothesized that atrial fibrillation was involved in this pathology but underdiagnosed by standard methods. The aim of the study was to determine the incidence of atrial fibrillation in cryptogenic ischemic stroke by using continuous monitoring of the heart rate over several months. The secondary objective was to test the value of atrial vulnerability assessment in predicting spontaneous atrial fibrillation.
METHODS AND RESULTS: We prospectively enrolled 24 patients under 75 years of age, 15 men and 9 women of mean age 49 years, who within the last 4 months had experienced cryptogenic stroke diagnosed by clinical presentation and brain imaging and presumed to be of cardioembolic mechanism. All causes of stroke were excluded by normal 12-lead ECG, 24-h Holter monitoring, echocardiography, cervical Doppler, hematological, and inflammatory tests. All patients underwent electrophysiological study. Of the patients, 37.5% had latent atrial vulnerability, and 33.3% had inducible sustained arrhythmia. Patients were secondarily implanted with an implantable loop recorder to look for spontaneous atrial fibrillation over a mean follow-up interval of 14.5 months. No sustained arrhythmia was found. Only one patient had non-significant episodes of atrial fibrillation.
CONCLUSION: In this study, symptomatic atrial fibrillation or AF with fast ventricular rate has not been demonstrated by the implantable loop recorder in patients under 75 years with unexplained cerebral ischemia. The use of this device should not be generalized in the systematic evaluation of these patients. In addition, this study attests that the assessment of atrial vulnerability is poor at predicting spontaneous arrhythmia in such patients.
Fanny Dion; Denis Saudeau; Isabelle Bonnaud; Patrick Friocourt; Armel Bonneau; Philippe Poret; Bruno Giraudeau; Sandra Régina; Laurent Fauchier; Dominique Babuty
Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2010-05-08
Journal Detail:
Title:  Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing     Volume:  28     ISSN:  1572-8595     ISO Abbreviation:  J Interv Card Electrophysiol     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-13     Completed Date:  2010-12-08     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  9708966     Medline TA:  J Interv Card Electrophysiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  101-7     Citation Subset:  IM    
Service de Cardiologie B, pôle Coeur, Thorax, Vaisseaux, hôpital Trousseau, Tours University, CHRU de Tours, 37044, Tours Cedex 9, France.
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MeSH Terms
Atrial Fibrillation / complications*,  epidemiology*
Biological Markers / blood
Brain Ischemia / epidemiology*,  etiology*
Electrocardiography / methods
Electrocardiography, Ambulatory
Electrophysiologic Techniques, Cardiac
Middle Aged
Ultrasonography, Doppler
Reg. No./Substance:
0/Biological Markers

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