Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation

Bjørn Strøier Larsen; Preman Kumarathurai; Julie Falkenberg; Olav W Nielsen; Ahmad Sajadieh

doi:10.1016/j.jacc.2015.05.018

Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation

Bjørn Strøier Larsen, Preman Kumarathurai, Julie Falkenberg, Olav W Nielsen, Ahmad Sajadieh

Department of Clinical Medicine

99 Citations (Scopus)

Abstract

BACKGROUND: Approximately 30% of ischemic strokes have an unknown cause. Increased atrial ectopy (AE) increases the risk of atrial fibrillation (AF), but the risk of stroke in patients with increased AE is unknown.

OBJECTIVES: This study aimed to examine whether increased AE and short atrial runs increase the risk of stroke beyond incident AF.

METHODS: Data were collected during a 15-year follow-up of the Copenhagen Holter Study cohort with 678 men and women between 55 and 75 years of age, with no earlier history of cardiovascular disease, stroke, or AF. Study subjects underwent 48-h ambulatory electrocardiography, fasting blood tests, and clinical examination. Excessive supraventricular ectopic activity (ESVEA) was defined as the presence of either ≥30 premature atrial contractions (PACs)/hour daily or any runs of ≥20 PACs.

RESULTS: Ninety-nine subjects (15%) demonstrated ESVEA. After adjusting for baseline risk factors, ESVEA was associated with ischemic stroke when censoring subjects at time of AF (hazard ratio [HR]: 1.96; 95% confidence interval [CI]: 1.10 to 3.49) or when modeling AF as a time-varying exposure (HR: 2.00; 95% CI: 1.16 to 3.45). Among subjects with ESVEA who developed a stroke, 14.3% had diagnosed AF before their stroke. The incidence of stroke in subjects with ESVEA and a CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score of ≥2 was 2.4% per year, comparable to the risk observed in AF. In day-to-day analysis, ESVEA was a consistent finding.

CONCLUSIONS: ESVEA was associated with an increased risk of ischemic stroke beyond manifest AF in this middle-aged and older population. Stroke was more often the first clinical presentation, rather than AF, in these study subjects.

Original language	English
Journal	Journal of the American College of Cardiology
Volume	66
Issue number	3
Pages (from-to)	232-41
Number of pages	10
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2015.05.018
Publication status	Published - 21 Jul 2015

Keywords

Aged
Arrhythmias, Cardiac
Atrial Fibrillation
Atrial Premature Complexes
Cohort Studies
Comorbidity
Denmark
Electrocardiography, Ambulatory
Female
Follow-Up Studies
Heart Atria
Heart Conduction System
Humans
Incidence
Ischemic Attack, Transient
Male
Middle Aged
Risk Assessment
Risk Factors
Stroke

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10.1016/j.jacc.2015.05.018

Cite this

@article{f120d9e8af7b4a81b12a3d2d973befdd,

title = "Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation",

abstract = "BACKGROUND: Approximately 30% of ischemic strokes have an unknown cause. Increased atrial ectopy (AE) increases the risk of atrial fibrillation (AF), but the risk of stroke in patients with increased AE is unknown.OBJECTIVES: This study aimed to examine whether increased AE and short atrial runs increase the risk of stroke beyond incident AF.METHODS: Data were collected during a 15-year follow-up of the Copenhagen Holter Study cohort with 678 men and women between 55 and 75 years of age, with no earlier history of cardiovascular disease, stroke, or AF. Study subjects underwent 48-h ambulatory electrocardiography, fasting blood tests, and clinical examination. Excessive supraventricular ectopic activity (ESVEA) was defined as the presence of either ≥30 premature atrial contractions (PACs)/hour daily or any runs of ≥20 PACs.RESULTS: Ninety-nine subjects (15%) demonstrated ESVEA. After adjusting for baseline risk factors, ESVEA was associated with ischemic stroke when censoring subjects at time of AF (hazard ratio [HR]: 1.96; 95% confidence interval [CI]: 1.10 to 3.49) or when modeling AF as a time-varying exposure (HR: 2.00; 95% CI: 1.16 to 3.45). Among subjects with ESVEA who developed a stroke, 14.3% had diagnosed AF before their stroke. The incidence of stroke in subjects with ESVEA and a CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score of ≥2 was 2.4% per year, comparable to the risk observed in AF. In day-to-day analysis, ESVEA was a consistent finding.CONCLUSIONS: ESVEA was associated with an increased risk of ischemic stroke beyond manifest AF in this middle-aged and older population. Stroke was more often the first clinical presentation, rather than AF, in these study subjects.",

keywords = "Aged, Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Premature Complexes, Cohort Studies, Comorbidity, Denmark, Electrocardiography, Ambulatory, Female, Follow-Up Studies, Heart Atria, Heart Conduction System, Humans, Incidence, Ischemic Attack, Transient, Male, Middle Aged, Risk Assessment, Risk Factors, Stroke",

author = "Larsen, {Bj{\o}rn Str{\o}ier} and Preman Kumarathurai and Julie Falkenberg and Nielsen, {Olav W} and Ahmad Sajadieh",

year = "2015",

month = jul,

day = "21",

doi = "10.1016/j.jacc.2015.05.018",

language = "English",

volume = "66",

pages = "232--41",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier",

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TY - JOUR

T1 - Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation

AU - Larsen, Bjørn Strøier

AU - Kumarathurai, Preman

AU - Falkenberg, Julie

AU - Nielsen, Olav W

AU - Sajadieh, Ahmad

PY - 2015/7/21

Y1 - 2015/7/21

N2 - BACKGROUND: Approximately 30% of ischemic strokes have an unknown cause. Increased atrial ectopy (AE) increases the risk of atrial fibrillation (AF), but the risk of stroke in patients with increased AE is unknown.OBJECTIVES: This study aimed to examine whether increased AE and short atrial runs increase the risk of stroke beyond incident AF.METHODS: Data were collected during a 15-year follow-up of the Copenhagen Holter Study cohort with 678 men and women between 55 and 75 years of age, with no earlier history of cardiovascular disease, stroke, or AF. Study subjects underwent 48-h ambulatory electrocardiography, fasting blood tests, and clinical examination. Excessive supraventricular ectopic activity (ESVEA) was defined as the presence of either ≥30 premature atrial contractions (PACs)/hour daily or any runs of ≥20 PACs.RESULTS: Ninety-nine subjects (15%) demonstrated ESVEA. After adjusting for baseline risk factors, ESVEA was associated with ischemic stroke when censoring subjects at time of AF (hazard ratio [HR]: 1.96; 95% confidence interval [CI]: 1.10 to 3.49) or when modeling AF as a time-varying exposure (HR: 2.00; 95% CI: 1.16 to 3.45). Among subjects with ESVEA who developed a stroke, 14.3% had diagnosed AF before their stroke. The incidence of stroke in subjects with ESVEA and a CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score of ≥2 was 2.4% per year, comparable to the risk observed in AF. In day-to-day analysis, ESVEA was a consistent finding.CONCLUSIONS: ESVEA was associated with an increased risk of ischemic stroke beyond manifest AF in this middle-aged and older population. Stroke was more often the first clinical presentation, rather than AF, in these study subjects.

AB - BACKGROUND: Approximately 30% of ischemic strokes have an unknown cause. Increased atrial ectopy (AE) increases the risk of atrial fibrillation (AF), but the risk of stroke in patients with increased AE is unknown.OBJECTIVES: This study aimed to examine whether increased AE and short atrial runs increase the risk of stroke beyond incident AF.METHODS: Data were collected during a 15-year follow-up of the Copenhagen Holter Study cohort with 678 men and women between 55 and 75 years of age, with no earlier history of cardiovascular disease, stroke, or AF. Study subjects underwent 48-h ambulatory electrocardiography, fasting blood tests, and clinical examination. Excessive supraventricular ectopic activity (ESVEA) was defined as the presence of either ≥30 premature atrial contractions (PACs)/hour daily or any runs of ≥20 PACs.RESULTS: Ninety-nine subjects (15%) demonstrated ESVEA. After adjusting for baseline risk factors, ESVEA was associated with ischemic stroke when censoring subjects at time of AF (hazard ratio [HR]: 1.96; 95% confidence interval [CI]: 1.10 to 3.49) or when modeling AF as a time-varying exposure (HR: 2.00; 95% CI: 1.16 to 3.45). Among subjects with ESVEA who developed a stroke, 14.3% had diagnosed AF before their stroke. The incidence of stroke in subjects with ESVEA and a CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score of ≥2 was 2.4% per year, comparable to the risk observed in AF. In day-to-day analysis, ESVEA was a consistent finding.CONCLUSIONS: ESVEA was associated with an increased risk of ischemic stroke beyond manifest AF in this middle-aged and older population. Stroke was more often the first clinical presentation, rather than AF, in these study subjects.

KW - Aged

KW - Arrhythmias, Cardiac

KW - Atrial Fibrillation

KW - Atrial Premature Complexes

KW - Cohort Studies

KW - Comorbidity

KW - Denmark

KW - Electrocardiography, Ambulatory

KW - Female

KW - Follow-Up Studies

KW - Heart Atria

KW - Heart Conduction System

KW - Humans

KW - Incidence

KW - Ischemic Attack, Transient

KW - Male

KW - Middle Aged

KW - Risk Assessment

KW - Risk Factors

KW - Stroke

U2 - 10.1016/j.jacc.2015.05.018

DO - 10.1016/j.jacc.2015.05.018

M3 - Journal article

C2 - 26184616

SN - 0735-1097

VL - 66

SP - 232

EP - 241

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 3