Atrial Ectopy and Short Atrial Runs Increase Stroke Risk Beyond Incident Atrial Fibrillation

Study Questions:

Is frequent atrial ectopic activity (FEA) an independent risk factor for stroke?


The subjects of this study were 678 individuals between the ages of 55 and 75 years with no history of heart disease or atrial fibrillation (AF). They were enrolled in the Copenhagen Holter Study in 1998-2000 and underwent a 48-hour Holter monitor recording. FEA was defined as ≥30 premature atrial complexes/hour or atrial tachycardia ≥20 beats in duration. Follow-up data were collected in 2013 (median follow-up 14.4 years). The primary endpoint was stroke.


FEA was present in 99 subjects (15%). The incidence of ischemic stroke was 21.5/1,000 person-years in the subjects with FEA and 7.4/1,000 person-years in the subjects without FEA. Seventy-seven subjects (11%) were diagnosed with AF during follow-up. After correction for multiple other risk factors including AF, FEA was independently associated with a twofold higher risk of stroke. The risk of stroke in subjects with FEA was related to the CHA2DS2-VASc score. The annual stroke risk in subjects with a CHA2DS2-VASc score ≥2 was 2.4%.


The authors concluded that FEA increases the risk of ischemic stroke independently of AF.


The most likely explanation for the association between FEA and ischemic stroke seemingly independent of AF is that FEA is associated with an increased risk of subclinical AF. There are two main clinical implications of this study: 1) anticoagulation is reasonable in patients with cryptogenic stroke and FEA, but no documented AF; and 2) periodic event monitors or an implantable loop recorder to look for subclinical AF is appropriate in individuals with FEA, particularly when the CHA2DS2-VASc score is ≥2.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Premature Complexes, Electrocardiography, Ambulatory, Risk, Risk Factors, Stroke, Tachycardia

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