Excessive supraventricular ectopic activity in ischemic stroke patients was associated with a higher rate of premature ventricular contractions compared to those without (factor 2.96; 95% CI 1.78-4.90).
RCT (n=5,411)
Does excessive supraventricular ectopic activity (ESVEA) increase premature ventricular contractions in ischemic stroke patients?
Excessive supraventricular ectopic activity is associated with a nearly 3-fold higher rate of premature ventricular contractions in ischemic stroke patients, although sustained ventricular arrhythmias remain rare.
Effect estimate: Factor 2.96 (95% CI 1.78 to 4.90)
Absolute Event Rate: 9.8% vs 1.2%
Abstract Background Arrhythmias in stroke patients are associated with a poor prognosis. Holter ECGs are useful to detect clinically relevant ones and can also be used to predict the risk of underlying paroxysmal arrhythmias, e.g. atrial fibrillation (AF). One of the most predictive parameters for AF is excessive supraventricular ectopic activity (ESVEA) 1. To date, analyses regarding comparable risk predictors for ventricular arrhythmias (VA) which are typically associated with increased mortality are lacking, although it is known that e.g. ESVEA is associated with a higher rate of all-cause death in stroke patients. We therefore aimed to compare the rate of VA in patients with AF, with and without ESVEA in patients registered for the randomized Find-AF 2 trial. Methods and Results Ischemic stroke patients 60 years of age fulfilling the inclusion and exclusion criteria for the randomized Find-AF 2 trial (NCT04371055) received 24-h-Screening-Holter ECGs prior to randomization2 . Holter-ECGs were performed using a 5-lead device and analyzed by the ECG core laboratory. The primary focus in analyzing Holter ECGs was the prompt detection of AF and the quantification of ESVEA prior to randomization. Secondly, Holter ECGs were re-analyzed regarding ventricular arrhythmias in AF patients and an equally large age-matched group of patients with and without ESVEA. We analyzed 24h-Holter-ECGs in 5411 patients (mean age 72.4±7.6 years, 41% female). 78 (1.4%) patients had AF, 1236 (23.5%) had ESVEA and 4068 (75.1%) had neither AF nor ESVEA. Only one patient (0.02%) had a sustained ventricular tachycardia, this patient also had ESVEA. We found no difference in the number of log-premature ventricular contractions (PVC)/h (-0.03, 95%CI -0.19 to 0.14, p=0.75) during periods of AF and sinus rhythm in 57 AF patients with at least one minute of both. The number of PVC/h for age-matched patients with AF, with and without ESVEA on a logarithmic scale is shown in Figure 1 (median IQR PVC/h is ESVEA-: 1.2 0.3-9,1, ESVEA+: 9.8 1.7-41.0, AF: 3.2 0.2-14.6). In a linear model with log(VPB/h +1) as the independent variable and sex, age and the three above mentioned groups as dependent variables, the number of PVCs/h was a factor 2.96 (95% CI 1.78 to 4.90) higher for ESVEA+ compared to ESVEA-, a factor 0.46 (95%CI 0.30 to 0.70) lower in females compared to males and increased by a factor of 1.36 (95% CI 1.04 to 1.77) with every decade in age. The number was comparable in AF and ESVEA- patients where the factor was 1.22 (95% CI 0.74 to 2.02). Conclusion Sustained ventricular arrhythmia in stroke patients are rare (1 in 5416 patients). ESVEA, age and male gender are associated with increased risk of premature ventricular contractions. Figure 1: Premature ventricular contractions in patients with AF, with and without excessive supraventricular activity. The horizontal lines show the geometric mean values.Figure 1
Uhe et al. (Sat,) conducted a rct in Ischemic stroke (n=5,411). Excessive supraventricular ectopic activity (ESVEA) vs. Without ESVEA was evaluated on Number of premature ventricular contractions (PVC)/h (Factor 2.96, 95% CI 1.78 to 4.90). Excessive supraventricular ectopic activity in ischemic stroke patients was associated with a higher rate of premature ventricular contractions compared to those without (factor 2.96; 95% CI 1.78-4.90).