Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015, 159(2):283-287 | DOI: 10.5507/bp.2015.019

Paroxysmal atrial fibrillation in young cryptogenic ischemic stroke: A 3-week ECG Holter monitoring study

Daniel Sanak^a, Martin Hutyra^b, Michal Kral^a, Andrea Bartkova^a, Jana Zapletalova^c, Marian Fedorco^b, Tomas Veverka^a, David Vindis^b, Tomas Dornak^a, Tomas Skala^b, David Skoloudik^d, Milos Taborsky^b, Petr Kanovsky^a

^a Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic

^b Department of Cardiology, University Hospital Olomouc

^c Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc

^d Department of Nursing, Faculty of Health Sciences, Palacky University Olomouc

Background: Atrial fibrillation is known very frequent cause of ischemic stroke. Undetected paroxysmal atrial fibrillation (PAF) is thus often considered a possible cause of cryptogenic ischemic stroke (CIS). The aim of this prospective study was to detect PAF using ECG Holter monitoring and determinate whether prolongation of the Holter monitoring to 3 weeks would increase the detection rates of PAF in young CIS patients ≤ 50 years.

Methods: The study set consisted of IS patients ≤ 50 years enrolled in the HISTORY (Heart and Ischemic STrOke Relationship studY) study (NCT01541163). CIS was defined according to the TOAST criteria including the absence of ultrasonographic or angiographic signs of atherosclerosis, vasculitis or dissection. Admission ECG, serum levels of high sensitive Troponin T (hs TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP), markers of thrombophilia, transoesophageal echocardiography (TEE) and 24-hour ECG-Holter monitoring were performed in all patients. In case of negative 24-h ECG Holter, an additional 3-weeks monitoring was done.

Results: Of the 105 enrolled patients ≤ 50 years, 95 (90%) were identified as cryptogenic (49 males, mean age 39.1 ± 8.2 years). All CIS patients had normal admission ECG. In total, PAF was detected in 9 (9.5%, 95% CI: 3.5% - 17.8%) patients; in two during 24-h ECG Holter and in seven during 3-weeks Holter monitoring. Patients with PAF had more frequently elevated admission hs TnT and NT-proBNP levels (P - 0.0001).

Conclusions: PAF was detected in 9.5% of young CIS patients and 3-weeks ECG Holter monitoring increased the detection rate.

Keywords: cryptogenic ischemic stroke, paroxysmal atrial fibrillation, ECG Holter monitoring, young stroke

Received: October 29, 2014; Accepted: April 14, 2015; Prepublished online: April 24, 2015; Published: June 28, 2015  Show citation