What is the clinical evidence from this study?

Study design: Observational. Population: Acute ischemic stroke or transient ischemic attack (n=133). Intervention: Right vagus nerve cross-sectional area. Primary outcome: Presence of atrial fibrillation (OR 0.33, 95% CI 0.12-0.91, p=0.03).

November 3, 2021Open Access

Cross-sectional area of the vagus nerve on carotid duplex ultrasound and atrial fibrillation in acute stroke: A retrospective analysis

Key Result

Smaller right vagus nerve cross-sectional area on carotid ultrasonography was an independent predictor of atrial fibrillation in patients with acute ischemic stroke or transient ischemic attack (OR 0.33).

Study Design

Type

Observational (n=133)

Blinding

Single-blind

Multicenter

Structured PICO

Population

133 adult patients (median age 74 years, 39.1% female) with acute ischemic stroke or transient ischemic attack, evaluated retrospectively during their hospital stay.

Exposure

Measurement of vagus nerve cross-sectional area (CSA) using carotid duplex ultrasonography

Outcome

Presence of atrial fibrillation (AF) defined as irregular RR intervals and absence of P waves for >30 s in ECG, ECG monitoring, or Holter ECG during hospital stay, or a history of AF diagnosis

Smaller right vagus nerve cross-sectional area measured by carotid ultrasonography is an independent predictor of atrial fibrillation in patients with acute ischemic stroke or transient ischemic attack.

Main Result

Odds Ratio: 0.33 (95% CI 0.12–0.91)

p-value: p=0.03

Limitations

Retrospective and cross-sectional design
Lack of follow-up assessments after discharge
Single-center study with a small patient population
Inability to fully determine the duration of in-hospital ECG monitoring
Patient population was not entirely uniform

Abstract

INTRODUCTION: The autonomic nervous system, including the vagus nerve, is associated with the development of atrial fibrillation (AF). However, the association between the cross-sectional area (CSA) of the vagus nerve on ultrasound and the presence of AF has not been fully clarified. This study investigated the association between vagus nerve CSA and the presence of AF in patients with acute stroke. METHODS: We retrospectively reviewed 150 consecutive patients with ischemic stroke or transient ischemic attack. Vagus nerve CSA was evaluated by carotid ultrasonography on the axial view at the thyroid gland level. Univariate and multivariable analyses were performed to examine the association between vagus nerve CSA and AF. RESULTS: = 0.03). However, there was no significant difference in median left vagus nerve CSA. Multivariable logistic regression analysis revealed that log transformed and quintiled brain natriuretic peptide level (odds ratio OR, 5.03; 95% confidence interval CI, 2.43-10.40) and right vagus nerve CSA (OR, 0.33; 95% CI, 0.12-0.91) were independent predictors of AF. DISCUSSION/CONCLUSION: Smaller right vagus nerve CSA in carotid ultrasonography was an independent predictor of AF in patients with ischemic stroke or transient ischemic attack, suggesting that patients with small right vagus nerve CSA should be closely monitored for development of AF.

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