Key result
Excessive supraventricular ectopy in acute ischemic stroke is linked to a ~3-fold higher AF detection.
Why the study?
Excessive supraventricular ectopic activity (ESVEA) is regarded as a risk marker for later atrial fibrillation detection after acute ischemic stroke, but its association with AF detection during follow-up was not fully established.
Does excessive supraventricular ectopic activity (ESVEA) predict atrial fibrillation detection and adverse clinical outcomes within 24 months in patients with acute ischemic stroke?
RCT (n=3,465)
Open-label
1:1
Yes
Does excessive supraventricular ectopic activity (ESVEA) predict atrial fibrillation detection and adverse clinical outcomes within 24 months in patients with acute ischemic stroke?
Answers are grounded in this paper and cite their sources.
Excessive supraventricular ectopic activity in the acute phase of ischemic stroke is strongly associated with subsequent atrial fibrillation detection, suggesting it may be a useful marker to select patients for prolonged ECG monitoring.
Background Excessive supraventricular ectopic activity (ESVEA) is regarded as a risk marker for later atrial fibrillation (AF) detection. Methods and Results The investigator‐initiated, prospective, open, multicenter MonDAFIS (Impact of Standardized Monitoring for Detection of Atrial Fibrillation in Ischemic Stroke) study randomized 3465 patients with acute ischemic stroke without known AF 1:1 to usual diagnostic procedures for AF detection or additive Holter monitoring in hospital for up to 7 days, analyzed in a core laboratory. Secondary study objectives include the comparison of recurrent stroke, myocardial infarction, major bleeding, and all‐cause death within 24 months in patients with ESVEA (defined as ectopic supraventricular beats ≥480/day or atrial runs of 10–29 seconds or both) versus patients with newly diagnosed AF versus patients without ESVEA or AF (non‐ESVEA/AF), randomized to the intervention group. Overall, 1435 (84.8%) of 1714 patients randomized to the intervention group had analyzable study ECG monitoring of at least 48 hours' duration within the first 72 hours of monitoring. ESVEA was detected in 363 (25.3%) patients, while AF was first detected in 48 (3.3%) patients. Within 24 months, AF was newly detected in 67 (18.5%) patients with ESVEA versus 60 (5.9%) patients without ESVEA/AF‐ ( P <0.001). The composite outcome at 24 months was not different between patients with ESVEA and patients without ESVEA/AF (15.2% versus 12.6%; P =0.242). All‐cause death was numerically higher in patients with ESVEA (6.6% versus 3.2%), but failed statistical significance ( P =0.433) in multivariate analysis (including age, heart failure, stroke severity, and creatinine at baseline). Conclusions ESVEA in the acute phase of ischemic stroke or transient ischemic attack is associated with AF detection during follow‐up and therefore may be used to select patients for prolonged ECG monitoring. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02204267.
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Hæusler et al. (2025) conducted an RCT in Acute ischemic stroke (n=3,465). Excessive supraventricular ectopic activity (ESVEA) vs. No ESVEA or atrial fibrillation was evaluated on Newly detected atrial fibrillation within 24 months (p=<0.001). Excessive supraventricular ectopic activity in acute ischemic stroke was associated with higher atrial fibrillation detection at 24 months compared to patients without it (18.5% vs 5.9%; P<0.001).
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