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Periodic Repolarization Dynamics Predicts Newly Detected Atrial Fibrillation After Stroke
Key result
Elevated periodic repolarization dynamics predict ~27% higher risk of new AF after acute ischemic stroke.
- HR 1.27
- 95% CI 1.03-1.44
- P=0.037
- n=263
Why the study?
It was hypothesized that elevated periodic repolarization dynamics, an ECG biomarker of sympathetic activity-associated oscillations in cardiac repolarization, identifies acute ischemic stroke patients at increased risk for atrial fibrillation detected after stroke.
Does elevated periodic repolarization dynamics (PRD) predict newly detected atrial fibrillation in patients with acute ischemic stroke?
Study Design
Type
Cohort (n=263)
Structured PICO
Does elevated periodic repolarization dynamics (PRD) predict newly detected atrial fibrillation in patients with acute ischemic stroke?
P
Population
263 patients with acute ischemic stroke, in sinus rhythm without prior atrial fibrillation, followed for a median of 17 months.
E
Exposure
Assessment of Periodic repolarization dynamics (PRD) and supraventricular premature complexes (SVPCs) via standardized 30-minute high-resolution ECG within 5 days after acute ischemic stroke.
C
Comparator
Clinical risk model (CHASE-LESS score comprising coronary heart disease, heart failure, age, stroke severity, hyperlipidemia, diabetes, and prior stroke/transient ischemic attack).
O
Outcome
Atrial fibrillation detected after ischemic stroke or transient ischemic attack (AFDAS) identified through continuous in-hospital monitoring, 6-month follow-ups, and electronic health record review.hard clinical
Main Result
Hazard Ratio: 1.27 (95% CI 1.03–1.44)
p-value: p=0.037
Elevated periodic repolarization dynamics and supraventricular premature complex frequency independently predict newly detected atrial fibrillation after acute ischemic stroke, improving risk stratification over clinical scores alone.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The combination of PRD and SPC frequency was superior to a clinical score in predicting AFDAS. A simple risk classification based on PRD and SPC frequency further revealed a stepwise increase in AFDAS incidence and risk, with good negative and positive predictive values, supporting its potential use for targeted poststroke rhythm monitoring.”
Implication
May refine post-stroke AF risk stratification beyond clinical scores; hypothesis-generating and requires prospective validation.
Abstract
Background Periodic repolarization dynamics (PRD) is a novel ECG‐derived biomarker reflecting sympathetic activity‐associated oscillations in cardiac repolarization. We hypothesized that elevated PRD identifies patients after acute ischemic stroke who are at increased risk of developing atrial fibrillation detected after ischemic stroke or transient ischemic attack (AFDAS). Methods Between February 22, 2021 and May 5, 2023, 263 patients with acute ischemic stroke from the STROKE‐CARD cohort were prospectively enrolled. All patients were in sinus rhythm at baseline without prior or current atrial fibrillation. Within 5 days after acute ischemic stroke, patients underwent a standardized 30‐minute high‐resolution ECG to assess PRD, heart rate variability, and supraventricular premature complexes per hour. AFDAS was identified through continuous in‐hospital monitoring, 6‐month follow‐ups, and electronic health record review. The CHASE‐LESS score, a clinical score comprising coronary heart disease, heart failure, age, stroke severity, hyperlipidemia, diabetes, and prior stroke/transient ischemic attack, served as the clinical risk model for AFDAS. Results During a median follow‐up of 17 (interquartile range, 12–26) months, AFDAS occurred in 25 of 263 patients (9.5%). Patients with AFDAS exhibited higher PRD values than those without (5.80 versus 2.93 deg 2 , P =0.005). In multivariable Cox regression, PRD independently predicted AFDAS (hazard ratio [HR], 1.27 [95% CI, 1.03–1.44]; P =0.037), alongside supraventricular premature complexes frequency (HR, 1.02 [95% CI, 1.01–1.03]; P <0.001). A model comprising PRD and supraventricular premature complexes per hour showed better discrimination than the CHASE‐LESS score alone, with an area under the curve of 0.82 versus 0.67, respectively ( P =0.005). Conclusions Increased PRD and supraventricular premature complexes frequency independently predicted AFDAS and significantly improved risk prediction compared with the clinical CHASE‐LESS score.
Discussion
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Cite This Study
Schreinlechner et al. (2026) conducted a cohort in acute ischemic stroke (n=263). Periodic repolarization dynamics (PRD) vs. Lower PRD was evaluated on Atrial fibrillation detected after ischemic stroke or transient ischemic attack (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).