Objective: To determine whether frequent premature atrial contractions (PAC) predict atrial fibrillation (AF) in cryptogenic stroke patients, we analyzed the association between frequent PACs in 24-h Holter electrocardiogram recording and AF detected by insertable cardiac monitoring (ICM). Methods: We retrospectively analyzed a database of 66 consecutive patients with cryptogenic stroke who received ICM implantation between October 2016 and March 2018 at 5 stroke centers. We included the follow-up data until June 2018 in this analysis. We defined frequent PACs as the upper quartile of the 66 patients. We analyzed the association of frequent PACs with AF detected by ICM. Results: Frequent PACs were defined as >222 PACs per a 24-h period. The proportion of patients with newly detected AF by ICM was higher in patients with frequent PACs than those without (50% [8/16] vs. 22% [11/50], p < 0.05). Frequent PACs were associated with AF detection and time to the first AF after adjustment for CHADS2 score after index stroke, high plasma ­B-type natriuretic peptide (BNP; >100 pg/mL) or serum ­N-terminal pro-BNP levels (>300 pg/mL), and large left atrial diameter (≥45 mm). Conclusion: High frequency of PACs in cryptogenic stroke may be a strong predictor of AF detected by ICM.

Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EJ, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996 Oct;27(10):1760–4.
Kimura K, Minematsu K, Yamaguchi T; Japan Multicenter Stroke Investigators’ Collaboration (J-MUSIC). Atrial fibrillation as a predictive factor for severe stroke and early death in 15,831 patients with acute ischaemic stroke. J Neurol Neurosurg Psychiatry. 2005 May;76(5):679–83.
EAFT (European Atrial Fibrillation Trial) Study Group. Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet. 1993 Nov;342(8882):1255–62.
Connolly SJ, Eikelboom J, Joyner C, Diener HC, Hart R, Golitsyn S, et al.; AVERROES Steering Committee and Investigators. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011 Mar;364(9):806–17.
Esato M, Chun YH, An Y, Ogawa H, Wada H, Hasegawa K, et al. Clinical Impact of Asymptomatic Presentation Status in Patients With Paroxysmal and Sustained Atrial Fibrillation: The Fushimi AF Registry. Chest. 2017 Dec;152(6):1266–75.
Hart RG, Catanese L, Perera KS, Ntaios G, Connolly SJ. Embolic Stroke of Undetermined Source: A Systematic Review and Clinical Update. Stroke. 2017 Apr;48(4):867–72.
Sanna T, Diener HC, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, et al.; CRYSTAL AF Investigators. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014 Jun;370(26):2478–86.
Cotter PE, Martin PJ, Ring L, Warburton EA, Belham M, Pugh PJ. Incidence of atrial fibrillation detected by implantable loop recorders in unexplained stroke. Neurology. 2013 Apr;80(17):1546–50.
Thijs VN, Brachmann J, Morillo CA, Passman RS, Sanna T, Bernstein RA, et al. Predictors for atrial fibrillation detection after cryptogenic stroke: results from CRYSTAL AF. Neurology. 2016 Jan;86(3):261–9.
Poli S, Diedler J, Härtig F, Götz N, Bauer A, Sachse T, et al. Insertable cardiac monitors after cryptogenic stroke—a risk factor based approach to enhance the detection rate for paroxysmal atrial fibrillation. Eur J Neurol. 2016 Feb;23(2):375–81.
Iwata T, Todo K, Yamagami H, Morimoto M, Hashimoto T, Doijiri R, et al. High detection rate of atrial fibrillation with insertable cardiac monitor implantation in patients with cryptogenic stroke diagnosed by magnetic resonance imaging. J Stroke Cerebrovasc Dis. 2019 Sep;28(9):2569–73.
Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993 Jan;24(1):35–41.
Toyoda K, Okumura K, Hashimoto Y, Ikeda T, Komatsu T, Hirano T, et al. Identification of Covert Atrial Fibrillation in Cryptogenic Ischemic Stroke: Current Clinical Practice in Japan. J Stroke Cerebrovasc Dis. 2016 Aug;25(8):1829–37.
Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001 Jun;285(22):2864–70.
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al.; Authors/Task Force Members; Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016 Aug;18(8):891–975.
Hamatani Y, Ogawa H, Takabayashi K, Yamashita Y, Takagi D, Esato M, et al. Left atrial enlargement is an independent predictor of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Sci Rep. 2016 Aug;6(1):31042.
Package ‘rms’. https://cran.r-project.org/web/packages/rms/rms.pdf. Accessed 27 May 2016.
Engström G, Hedblad B, Juul-Möller S, Tydén P, Janzon L. Cardiac arrhythmias and stroke: increased risk in men with high frequency of atrial ectopic beats. Stroke. 2000 Dec;31(12):2925–9.
Wallmann D, Tüller D, Wustmann K, Meier P, Isenegger J, Arnold M, et al. Frequent atrial premature beats predict paroxysmal atrial fibrillation in stroke patients: an opportunity for a new diagnostic strategy. Stroke. 2007 Aug;38(8):2292–4.
Todo K, Moriwaki H, Saito K, Naritomi H. Frequent premature atrial contractions in stroke of undetermined etiology. Eur Neurol. 2009;61(5):285–8.
Goda T, Sugiyama Y, Ohara N, Ikegami T, Watanabe K, Kobayashi J, et al. P-Wave Terminal Force in Lead V1 Predicts Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2017 Sep;26(9):1912–5.
Okada Y, Shibazaki K, Kimura K, Iguchi Y, Miki T. Brain natriuretic peptide as a predictor of delayed atrial fibrillation after ischaemic stroke and transient ischaemic attack. Eur J Neurol. 2010 Feb;17(2):326–31.
Fujii S, Shibazaki K, Kimura K, Sakai K, Aoki J. A simple score for predicting paroxysmal atrial fibrillation in acute ischemic stroke. J Neurol Sci. 2013 May;328(1-2):83–6.
Maggioni AP, Latini R, Carson PE, Singh SN, Barlera S, Glazer R, et al.; Val-HeFT Investigators. Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT). Am Heart J. 2005 Mar;149(3):548–57.
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