Evaluation of predictors indicating paroxysmal atrial fibrillation in patients with acute ischemic strokes – The Find-AFRANDOMISED trial

M. Weber-Krüger (Göttingen)¹, A. Zapf (Hamburg)², E. Protsenko (Sande)³, J. Liman (Nürnberg)⁴, G. F. Hamann (Wiesbaden)⁵, P. Kermer (Sande)³, K. Wasser (Göttingen)⁶, T. Uphaus (Mainz)⁷, S. Gröschel (Mainz)⁸, K. Gröschel (Mainz)⁹, R. Wachter (Leipzig)^10
1Universitätsmedizin Göttingen Herzzentrum, Klinik für Kardiologie und Pneumologie Göttingen, Deutschland; ²Universitätsklinikum Hamburg-Eppendorf Zentrum für Experimentelle Medizin, Institut für Medizinische Biometrie und Epidemiologie Hamburg, Deutschland; ³Nordwest-Krankenhaus Sanderbusch Sande, Deutschland; ⁴Klinikum Nürnberg Neurologie Nürnberg, Deutschland; ⁵Wiesbaden, Deutschland; ⁶Universitätsmedizin Göttingen Klinik für Neurologie Göttingen, Deutschland; ⁷Universitätsmedizin der Johannes Gutenberg-Universität Mainz Klinik und Poliklinik für Neurologie Mainz, Deutschland; ⁸Universitätsmedizin der Johannes Gutenberg-Universität Mainz Mainz, Deutschland; ⁹Universitätsmedizin Mainz Klinik und Poliklinik für Neurologie Mainz, Deutschland; ¹⁰Universitätsklinikum Leipzig Klinik und Poliklinik für Kardiologie Leipzig, Deutschland

Background

Detecting concealed paroxysmal atrial fibrillation after stroke requires elaborate electrocardiographic monitoring. We evaluated previously established predictors to quantify the individual risk of detecting atrial fibrillation within six months in the Find-AF_RANDOMISED trial.

Methods

We analyzed 200 patients ≥ 60 years with acute ischemic strokes in the intervention arm of the Find-AF_RANDOMISED-trial (NCT01855035). Patients received three 10-day Holter-electrocardiograms within 6 months. Regression analyses and receiver-operator-characteristic analyses were used to select promising biomarkers and to assess predictive performance. We applied previously established cut-offs for most promising markers to determine those at a high risk of underlying atrial fibrillation.

Results

27/200 patients (13.5%) had atrial fibrillation after six months. The left atrial diameter, atrial premature beats, supraventricular runs and brain natriuretic peptide were associated with atrial fibrillation, whereas the established markers age and suspected stroke etiology were not. Atrial premature beats differentiated best between those with and without atrial fibrillation (area-under-the-curve = 0.75). Only brain natriuretic peptide ≥100pg/ml and supraventricular runs ≥20 beats independently predicted atrial fibrillation in multivariable models.

Conclusions

Supraventricular runs and brain natriuretic peptide were the most promising predictors to define a high risk of underlying atrial fibrillation after stroke in our study. Future screening strategies for atrial fibrillation in stroke patients should focus on these parameters rather than the suspected stroke etiology.