Elevated periodic repolarization dynamics independently predicted newly detected atrial fibrillation after acute ischemic stroke (HR 1.27; 95% CI 1.03-1.44; p=0.037).
Cohort (n=263)
Does elevated periodic repolarization dynamics (PRD) predict newly detected atrial fibrillation after acute ischemic stroke?
Elevated periodic repolarization dynamics and supraventricular premature complex frequency significantly improve the prediction of newly detected atrial fibrillation after acute ischemic stroke compared to clinical risk scores alone.
Hazard Ratio: 1.27 (95% CI 1.03–1.44)
p-value: p=0.037
Abstract Background Periodic repolarization dynamics (PRD) is a novel ECG-derived biomarker reflecting sympathetic activity–associated oscillations in cardiac repolarization (1). We hypothesized that elevated PRD identifies patients after acute ischemic stroke (AIS) who are at increased risk of developing atrial fibrillation detected after stroke (AFDAS) (2). Methods Between February 22, 2021, and May 5, 2023, 263 patients with AIS from the STROKE-CARD II cohort were prospectively enrolled. All were in sinus rhythm at baseline without prior or current atrial fibrillation (AF). Within 5 days after AIS, patients underwent a standardized 30-minute high-resolution ECG to assess PRD, heart rate variability, and supraventricular premature complexes (SPCs/hour). AFDAS was identified through continuous in-hospital monitoring, 6-month follow-ups, and electronic health record review. The CHASE-LESS score served as the clinical risk model for AFDAS. Results During a median follow-up of 17 (IQR 14) months, AFDAS occurred in 25 of 263 patients (9.5%). Patients with AFDAS exhibited higher PRD values than those without (5.80 vs. 2.93 deg², p = 0.005; Picture 1). In multivariable Cox regression, PRD independently predicted AFDAS (HR 1.27, 95% CI 1.03–1.44, p = 0.037), alongside SPC frequency (HR 1.02, 95% CI 1.01–1.03, p 0.001). A model comprising PRD and SPC per hour showed better discrimination than the CHASE LESS score alone, with an AUC of 0.82 versus 0.67 respectively, p = 0.005 (Picture 2). Conclusions Increased PRD and SPC frequency independently predict AFDAS and significantly improved risk prediction compared to the clinical CHASE-LESS score.PRD in Patients with or without AFDASROC-Curves CHASE-LESS vs PRD + SPCs
Pavluk et al. (Mon,) conducted a cohort in acute ischemic stroke (AIS) (n=263). Periodic repolarization dynamics (PRD) was evaluated on atrial fibrillation detected after stroke (AFDAS) (HR 1.27, 95% CI 1.03-1.44, p=0.037). Elevated periodic repolarization dynamics independently predicted newly detected atrial fibrillation after acute ischemic stroke (HR 1.27; 95% CI 1.03-1.44; p=0.037).