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Supraventricular Runs in 7-Day Holter Monitoring Are Related to Increased Incidence of Atrial Fibrillation in a 3-Year Follow-Up of Cryptogenic Stroke Patients Free from Arrhythmia in a 24 h-Holter

1
Department of Cardiology, Medical University of Silesia, 40-635 Katowice, Poland
2
Upper-Silesian Medical Center, Department of Neurology, 40-635 Katowice, Poland
3
Upper-Silesian Medical Center, Department of Cardiology, 40-635 Katowice, Poland
4
Department of Neurology, Medical University of Silesia, 40-635 Katowice, Poland
*
Author to whom correspondence should be addressed.
Academic Editor: Andy Wessels
J. Cardiovasc. Dev. Dis. 2021, 8(7), 81; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd8070081
Received: 1 June 2021 / Revised: 29 June 2021 / Accepted: 13 July 2021 / Published: 19 July 2021
Introduction: Silent atrial fibrillation (AF) is a common cause of cryptogenic ischemic stroke (CIS). The 24-h-Holter is insufficient to reveal an occult arrhythmic cause of stroke and the strategy to select the patients for long-term monitoring is missing. Objectives: The aim of the study was to evaluate 7-day-Holter monitoring to identify cases with the arrhythmic cause of stroke in CIS patients in whom 24-h-Holter was free from arrhythmia, and to assess the relation between supraventricular (SV) runs in baseline Holter and the incidence of AF in a 3-year follow-up period. Methods: 78 patients (aged 60 ± 9 years, 45 males) with CIS and no arrhythmic findings in 24-h-Holter were enrolled. All patients had 7-day-Holter monitoring after stroke and were followed up for 36 months, and then 7-day Holter was repeated. We assessed SV runs (≥5 QRS) in the initial 7-day Holter and analyzed the relation of the findings with clinical characteristics of novel AF episodes revealed early after stroke and during a 3-year follow-up. Results: Baseline 7-day-Holter revealed SV runs in 36% of patients and AF in 9% of cases. During a 3-year follow-up, 8 additional cases were confirmed, both in standard care and in repeated Holter (a total of 19% of AF cases). There was no difference with regard to CHADS2VASc score (3.6 ± 1.1 vs. 3.4 ± 1.5; p = NS) and left atrium parameters between patients with SV runs and the non-arrhythmic group. Patients with SV runs had a higher incidence of AF both after stroke and in a 3-year follow-up (46% vs. 4%, RR 11.6, p < 0.001). In 8 cases, patent foramen ovale was detected during follow-up. Conclusions: A strategy of baseline 7-day-Holter monitoring after stroke allows for disclosing SV runs in every third case and AF in 9% of stroke survivors. Patients with SV runs have a higher incidence of AF (RR 11.6, p < 0.001) and should be considered for extended continuous ECG monitoring. View Full-Text
Keywords: atrial fibrillation; cryptogenic ischemic stroke; Holter ECG; supraventricular arrhythmia; SV runs atrial fibrillation; cryptogenic ischemic stroke; Holter ECG; supraventricular arrhythmia; SV runs
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MDPI and ACS Style

Kułach, A.; Dewerenda, M.; Majewski, M.; Lasek-Bal, A.; Gąsior, Z. Supraventricular Runs in 7-Day Holter Monitoring Are Related to Increased Incidence of Atrial Fibrillation in a 3-Year Follow-Up of Cryptogenic Stroke Patients Free from Arrhythmia in a 24 h-Holter. J. Cardiovasc. Dev. Dis. 2021, 8, 81. https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd8070081

AMA Style

Kułach A, Dewerenda M, Majewski M, Lasek-Bal A, Gąsior Z. Supraventricular Runs in 7-Day Holter Monitoring Are Related to Increased Incidence of Atrial Fibrillation in a 3-Year Follow-Up of Cryptogenic Stroke Patients Free from Arrhythmia in a 24 h-Holter. Journal of Cardiovascular Development and Disease. 2021; 8(7):81. https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd8070081

Chicago/Turabian Style

Kułach, Andrzej, Milena Dewerenda, Michał Majewski, Anetta Lasek-Bal, and Zbigniew Gąsior. 2021. "Supraventricular Runs in 7-Day Holter Monitoring Are Related to Increased Incidence of Atrial Fibrillation in a 3-Year Follow-Up of Cryptogenic Stroke Patients Free from Arrhythmia in a 24 h-Holter" Journal of Cardiovascular Development and Disease 8, no. 7: 81. https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd8070081

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