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Total atrial conduction time to predict occult atrial fibrillation after cryptogenic stroke

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Abstract

Background

Insertable cardiac monitor (ICM) increases the detection rate of occult atrial fibrillation (AF) after cryptogenic stroke. The aim of this study was to evaluate the prognostic significance of total atrial conduction time (TACT) assessed by tissue Doppler imaging (PA-TDI interval) to predict AF presence in patients with cryptogenic stroke.

Methods

Ninety patients (57.7 ± 12.3 years, 48 % women) after acute cryptogenic stroke and ICM implantation were prospective recruited at four centers for continuous rhythm monitoring. In all patients, TACT was measured by PA-TDI interval via echocardiography. Patients were followed up (331 ± 186 days) for detection of AF (defined by episode lasting ≥30 s).

Results

AF was detected in 16 patients (18 %) during follow-up (331 ± 186 days). The median period to AF detection was 30 days (q1–q3; 16–62 days). Patients who exhibited occult AF were characterized by significantly longer PA-TDI intervals (154.7 ± 12.6 vs. 133.9 ± 9.5 ms, p < 0.0001). The cut-off value of PA-TDI interval at 145 ms demonstrated sensitivity and specificity for AF detection of 93.8 and 90.5 %, respectively. In multivariate analysis, CHA2DS2–VASc score (HR 1.96 per 1 point, p < 0.01) and longer PA-TDI interval (HR 4.05 per 10 ms, p < 0.0001) were independent predictors of occult AF.

Conclusion

Our data suggest that measurement of TACT could help to predict future AF detection in patients with cryptogenic stroke. The clinical importance of prolonged rhythm monitoring or indication of direct anticoagulation therapy after cryptogenic stroke based on TACT should be further investigated.

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Abbreviations

AF:

Atrial fibrillation

CT:

Computer tomography

ECG:

Electrocardiogram

DWI:

Diffusion weighted image

ICM:

Insertable cardiac monitor

LAD:

Left atrial diameter

LV-EF:

Left ventricular systolic ejection fraction

MRI:

Magnetic resonance imaging

Pmax:

Maximum P-wave duration

TACT:

Total atrial conduction time

TDI:

Tissue Doppler imaging

TOAST:

Trial of Org 10 172 in Acute Stroke Treatment

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Authors and Affiliations

  1. Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiac Arrhythmia Service, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, 40225, Düsseldorf, Germany

    Patrick Müller, Christian Blockhaus, Dimitrios Dimitroulis, Shazia Afzal, Dong-In Shin, Malte Kelm & Hisaki Makimoto

  2. Cardiovascular Center, St. Josef Hospital Bochum, Ruhr-University Bochum, Bochum, Germany

    Vladimir Ivanov, Kaffer Kara & Andreas Mügge

  3. Department of Cardiology, Katholisches Klinikum Essen, University of Witten/Herdecke, Essen, Germany

    Oliver Klein-Wiele

  4. Division of Electrophysiology, Heart Center Dresden, University of Dresden, Dresden, Germany

    Mathias Forkmann & Christopher Piorkowski

Authors
  1. Patrick Müller
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  2. Vladimir Ivanov
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Correspondence to Patrick Müller.

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All authors declare no conflict of interest.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000(5). Informed consent was obtained from all patients for being included in this study.

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This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

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Müller, P., Ivanov, V., Kara, K. et al. Total atrial conduction time to predict occult atrial fibrillation after cryptogenic stroke. Clin Res Cardiol 106, 113–119 (2017). https://doi.org/10.1007/s00392-016-1029-2

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  • DOI: https://doi.org/10.1007/s00392-016-1029-2

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