Risk of Stroke in Patients With Short-Run Atrial Tachyarrhythmia

Shinya Yamada; Chin-Yu Lin; Shih-Lin Chang; Tze-Fan Chao; Yenn-Jiang Lin; Li-Wei Lo; Fa-Po Chung; Yu-Feng Hu; Ta-Chuan Tuan; Jo-Nan Liao; Abigail Louise D Te; Yao-Ting Chang; Ting-Yung Chang; Cheng-I Wu; Satoshi Higa; Shih-Ann Chen

doi:10.1161/STROKEAHA.117.018475

Risk of Stroke in Patients With Short-Run Atrial Tachyarrhythmia

Stroke. 2017 Dec;48(12):3232-3238. doi: 10.1161/STROKEAHA.117.018475. Epub 2017 Nov 16.

Authors

Affiliations

¹ From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.).
² From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (S.Y., C.-Y.L., S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., A.L.D.T., Y.-T.C., T.-Y.C., C.-I.W., S.-A.C.); Department of Cardiovascular Medicine, Fukushima Medical University, Japan (S.Y.); Institution of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (S.-L.C., T.-F.C., Y.-J.L., L.-W.L., F.-P.C., Y.-F.H., T.-C.T., J.-N.L., S.-A.C.); Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan (C.-Y.L.); and Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.). [email protected].

PMID: 29146875
DOI: 10.1161/STROKEAHA.117.018475

Abstract

Background and purpose: The risk of stroke in patients with short-run atrial tachyarrhythmia (AT) remains unclear. This study aimed to investigate the relationship between short-run AT and the stroke and the use of the CHA₂DS₂-VASc score for the risk stratification.

Methods: From the registry of 24-hour Holter monitoring, 5342 subjects without known atrial fibrillation or stroke were enrolled. Short-run AT was defined as episodes of supraventricular ectopic beats <5 seconds.

Results: There were 1595 subjects (29.8%) with short-run AT. During the median follow-up period of 9.0 years, 494 subjects developed new-onset stroke. Patients with short-run AT had significantly higher stroke rates compared with patients without short-run AT (11.4% versus 8.3%; P<0.001). In patients with short-run AT, the number of strokes per 100 person-years for patients with CHA₂DS₂-VASc score of 0 and 1 were 0.23 and 0.67, respectively. However, the number of them for patients with CHA₂DS₂-VASc score of 2, 3, 4, and ≥5 were 1.62, 1.89, 1.30, and 2.91, respectively. In patients with CHA₂DS₂-VASc score of 0 or 1, age (>61 years old) and burden of premature atrial contractions (>25 beats/d) independently predicted the risk of stroke. In subgroup analyses, short-run AT patients were divided into 3 groups based on their CHA₂DS₂-VASc scores: low score (score of 0 [men] or 1 [women]; n=324), intermediate score (score of 1 [men] or 2 [women]; n=275), and high score (score of ≥2 [men] or ≥3 [women]; n=996). When compared with low score, intermediate and high scores were independent predictors for stroke (hazard ratio, 6.165; P<0.001 and hazard ratio, 8.577; P<0.001, respectively).

Conclusions: Short-run AT increases the risk of stroke. Therefore, the CHA₂DS₂-VASc score could be used for the risk stratification. Age and burden of premature atrial contractions were independent predictors for stroke in patients with CHA₂DS₂-VASc score of 0 or 1.

Keywords: CHA2DS2-VASc score; risk stratification; short-run atrial tachyarrhythmia; stroke.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Atrial Fibrillation / complications
Atrial Fibrillation / epidemiology
Electrocardiography, Ambulatory
Endpoint Determination
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Retrospective Studies
Risk Assessment
Risk Factors
Stroke / epidemiology*
Stroke / etiology*
Tachycardia / complications*
Tachycardia / epidemiology*
Tachycardia, Ectopic Atrial / complications
Tachycardia, Ectopic Atrial / epidemiology