Excessive supraventricular ectopic activity is indicative of paroxysmal atrial fibrillation in patients with cerebral ischemia.

<h4>Background</h4>Detecting paroxysmal atrial fibrillation (PAF) in patients with cerebral ischemia is challenging. Frequent premature atrial complexes (PAC/h) and the longest supraventricular run on 24-h-Holter (SV-run(24 h)), summarised as excessive supraventricular ectopic activity (...

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Autores principales:	Mark Weber-Krüger, Klaus Gröschel, Meinhard Mende, Joachim Seegers, Rosine Lahno, Beatrice Haase, Cord-Friedrich Niehaus, Frank Edelmann, Gerd Hasenfuß, Rolf Wachter, Raoul Stahrenberg
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8394b80a2b104720b2f9245f91cad34c
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spelling	oai:doaj.org-article:8394b80a2b104720b2f9245f91cad34c2021-11-18T07:39:25ZExcessive supraventricular ectopic activity is indicative of paroxysmal atrial fibrillation in patients with cerebral ischemia.1932-620310.1371/journal.pone.0067602https://doaj.org/article/8394b80a2b104720b2f9245f91cad34c2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23840747/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Detecting paroxysmal atrial fibrillation (PAF) in patients with cerebral ischemia is challenging. Frequent premature atrial complexes (PAC/h) and the longest supraventricular run on 24-h-Holter (SV-run(24 h)), summarised as excessive supraventricular ectopic activity (ESVEA), may help selecting patients for extended ECG-monitoring, especially in combination with echocardiographic marker LAVI/a' (left atrial volume index/late diastolic tissue Doppler velocity).<h4>Methods</h4>Retrospective analysis from the prospective monocentric observational trial Find-AF (ISRCTN-46104198). Patients with acute stroke or TIA were enrolled at the University Hospital Göttingen, Germany. Those with sinus rhythm at presentation received 7-day Holter-monitoring. ESVEA was quantified in one 24-hour interval free from PAF. Echocardiographic parameters were assessed prospectively.<h4>Results</h4>PAF was detected in 23/208 patients (11.1%). The median was 4 [IQR 1; 22] for PAC/h and 5 [IQR 0; 9] for SV-run(24 h). PAF was more prevalent in patients with ESVEA: 19.6% vs. 2.8% for PAC/h >4 vs. ≤ 4 (p<0.001); 17.0% vs. 4.9% for SV-run(24 h >5) vs. ≤ 5 beats (p = 0.003). Patients with PAF showed more supraventricular ectopic activity: 29 PAC/h [IQR 9; 143] vs. 4 PAC/h [1]; [14] and longest SV-run(24 h = 10) [5]; [21] vs. 0 [0; 8] beats (both p<0.001). Both markers discriminated between the PAF- and the Non-PAF-group (area under receiver-operator-characteristics-curve 0.763 [95% CI 0.667; 0.858] and 0.716 [0.600; 0.832]). In multivariate analyses log(PAC/h) and log(SV-run(24 h)) were independently indicative of PAF. In Patients with PAC/h ≤ 4 and normal LAVI/a' PAF was excluded, whereas those with PAC/h >4 and abnormal LAVI/a' showed high PAF-rates.<h4>Conclusions</h4>ESVEA discriminated PAF from non-PAF beyond clinical factors including LAVI/a' in patients with cerebral ischemia. Normal LAVI/a'+PAC/h ≤ 4 ruled out PAF, while prevalence was high in those with abnormal LAVI/a'+PAC/h >4.Mark Weber-KrügerKlaus GröschelMeinhard MendeJoachim SeegersRosine LahnoBeatrice HaaseCord-Friedrich NiehausFrank EdelmannGerd HasenfußRolf WachterRaoul StahrenbergPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 6, p e67602 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Mark Weber-Krüger Klaus Gröschel Meinhard Mende Joachim Seegers Rosine Lahno Beatrice Haase Cord-Friedrich Niehaus Frank Edelmann Gerd Hasenfuß Rolf Wachter Raoul Stahrenberg Excessive supraventricular ectopic activity is indicative of paroxysmal atrial fibrillation in patients with cerebral ischemia.
description	<h4>Background</h4>Detecting paroxysmal atrial fibrillation (PAF) in patients with cerebral ischemia is challenging. Frequent premature atrial complexes (PAC/h) and the longest supraventricular run on 24-h-Holter (SV-run(24 h)), summarised as excessive supraventricular ectopic activity (ESVEA), may help selecting patients for extended ECG-monitoring, especially in combination with echocardiographic marker LAVI/a' (left atrial volume index/late diastolic tissue Doppler velocity).<h4>Methods</h4>Retrospective analysis from the prospective monocentric observational trial Find-AF (ISRCTN-46104198). Patients with acute stroke or TIA were enrolled at the University Hospital Göttingen, Germany. Those with sinus rhythm at presentation received 7-day Holter-monitoring. ESVEA was quantified in one 24-hour interval free from PAF. Echocardiographic parameters were assessed prospectively.<h4>Results</h4>PAF was detected in 23/208 patients (11.1%). The median was 4 [IQR 1; 22] for PAC/h and 5 [IQR 0; 9] for SV-run(24 h). PAF was more prevalent in patients with ESVEA: 19.6% vs. 2.8% for PAC/h >4 vs. ≤ 4 (p<0.001); 17.0% vs. 4.9% for SV-run(24 h >5) vs. ≤ 5 beats (p = 0.003). Patients with PAF showed more supraventricular ectopic activity: 29 PAC/h [IQR 9; 143] vs. 4 PAC/h [1]; [14] and longest SV-run(24 h = 10) [5]; [21] vs. 0 [0; 8] beats (both p<0.001). Both markers discriminated between the PAF- and the Non-PAF-group (area under receiver-operator-characteristics-curve 0.763 [95% CI 0.667; 0.858] and 0.716 [0.600; 0.832]). In multivariate analyses log(PAC/h) and log(SV-run(24 h)) were independently indicative of PAF. In Patients with PAC/h ≤ 4 and normal LAVI/a' PAF was excluded, whereas those with PAC/h >4 and abnormal LAVI/a' showed high PAF-rates.<h4>Conclusions</h4>ESVEA discriminated PAF from non-PAF beyond clinical factors including LAVI/a' in patients with cerebral ischemia. Normal LAVI/a'+PAC/h ≤ 4 ruled out PAF, while prevalence was high in those with abnormal LAVI/a'+PAC/h >4.
format	article
author	Mark Weber-Krüger Klaus Gröschel Meinhard Mende Joachim Seegers Rosine Lahno Beatrice Haase Cord-Friedrich Niehaus Frank Edelmann Gerd Hasenfuß Rolf Wachter Raoul Stahrenberg
author_facet	Mark Weber-Krüger Klaus Gröschel Meinhard Mende Joachim Seegers Rosine Lahno Beatrice Haase Cord-Friedrich Niehaus Frank Edelmann Gerd Hasenfuß Rolf Wachter Raoul Stahrenberg
author_sort	Mark Weber-Krüger
title	Excessive supraventricular ectopic activity is indicative of paroxysmal atrial fibrillation in patients with cerebral ischemia.
title_short	Excessive supraventricular ectopic activity is indicative of paroxysmal atrial fibrillation in patients with cerebral ischemia.
title_full	Excessive supraventricular ectopic activity is indicative of paroxysmal atrial fibrillation in patients with cerebral ischemia.
title_fullStr	Excessive supraventricular ectopic activity is indicative of paroxysmal atrial fibrillation in patients with cerebral ischemia.
title_full_unstemmed	Excessive supraventricular ectopic activity is indicative of paroxysmal atrial fibrillation in patients with cerebral ischemia.
title_sort	excessive supraventricular ectopic activity is indicative of paroxysmal atrial fibrillation in patients with cerebral ischemia.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/8394b80a2b104720b2f9245f91cad34c
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Excessive supraventricular ectopic activity is indicative of paroxysmal atrial fibrillation in patients with cerebral ischemia.

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