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Electrocardiographic markers of incident atrial fibrillation in patients with cryptogenic stroke
Session:
CO 13- Atrial fibrilation
Speaker:
Sara Couto Pereira
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.3 Atrial Fibrillation - Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sara Couto Pereira; Arminda Veiga; José Ferro; Fausto j. Pinto; Catarina Fonseca; Ana g. Almeida
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong>Prolonged screening of AF in patients (pts) with cryptogenic stroke is recommended and electrocardiographic markers of atrial remodeling, like p-wave dispersion, have been described in literature.Electrocardiographic changes in pts with cryptogenic stroke to predict AF in the follow up are not well-established.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose:</strong> To identify ECG predictors of AF in a subset of pts with cryptogenic stroke. </span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong> Prospective single-center study that included consecutive pts admitted with cryptogenic stroke. A surface 12-lead ECG was performed at admission, recorded at 25 mm/second and 10 mV/cm with commercially available imaging system. P-wave analysis of maximum (P max) and minimum (P min) duration, p-wave dispersion (PWD, defined as the difference between the P max and P min, being abnormal if>40 msec) and amplitude were evaluated by a two independent operator. P-wave axis was determined by an automated mode available in the equipment. ROC curve was analyzed to determine the optimal cut-off values. </span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong>We enrolled 105 pts (55.2% males), with mean age of 68.18±8.83 years, 79% had hypertension, 18.1% had diabetes, 44.8% with dyslipidemia, 21% current smokers. </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">During follow up period, 18 pts (17.1%) developed AF. We found that only PWD (AUC 0.706, IC95%: 0.564-0.848, p=0.006) and P-wave axis (AUC 0.715, IC95%: 0.870-0.860, p=0.004) were strong predictors of AF (figure 1). PWD cut-off of 47.50 presented a sensitivity of 77.8% and specificity of 59.8% and P-wave axis cut off value of 75.50 had a specificity of 95.4%. Age (p=0.032) and current smoking (p=0.014) were associated with occurrence of AF during the follow up. </span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong>PWD and P-wave axis predicted incident AF in this subset of pts with cryptogenic stroke. The ECG may be a toll to identify pts at risk of developing AF, although larger studies are needed to confirm these results.</span></span></span></p>
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