TOPLINE

Periodic repolarization dynamics (PRD), a novel ECG-derived biomarker reflecting sympathetic activity-associated oscillations in cardiac repolarization, independently predicted atrial fibrillation detected after ischemic stroke or transient ischemic attack (AFDAS) in patients with acute ischemic stroke. When combined with supraventricular premature complexes (SPC) frequency, PRD demonstrated superior discrimination compared with the clinical CHASE-LESS score alone.

METHODOLOGY

• Researchers conducted a single-center, prospective cohort study including 263 adults with acute ischemic stroke from the STROKE-CARD cohort between 2021 and 2023 in Innsbruck, Austria.
• All patients were in sinus rhythm at baseline without prior or current atrial fibrillation and underwent a standardized 30-minute high-resolution ECG within 5 days after acute ischemic stroke. Researchers assessed PRD, heart rate variability, and SPC per hour.
• AFDAS was identified through continuous in-hospital monitoring, follow-ups at 3 and 12 months, and a review of electronic health records. The median follow-up duration was 17 months.
• The CHASE-LESS score, a clinical risk model comprising coronary heart disease, heart failure, age, stroke severity, hyperlipidemia, diabetes, and prior stroke/transient ischemic attack, served as the comparator for AFDAS prediction.

TAKEAWAY

• AFDAS occurred in 9.5% of patients during follow-up, with patients who developed AFDAS having significantly higher PRD values than those without (P = .005).
• In multivariable analysis, PRD independently predicted AFDAS (hazard ratio [HR], 1.27; P = .037), alongside SPC frequency (HR, 1.02; P < .001).
• A model combining PRD and SPC per hour showed superior discrimination compared with the CHASE-LESS score alone (area under the curve, 0.82 vs 0.67; P = .005).
• Risk for AFDAS was classified based on PRD and SPC frequency; the negative predictive value of the low-risk group was 97.9%, and the positive predictive value of the high-risk group was 28.6%.

IN PRACTICE

"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," the authors wrote.

SOURCE

The study was led by Michael Schreinlechner, MD, and Daniel Pavluk, MD, University Clinic of Internal Medicine III/Cardiology and Angiology, Medical University Innsbruck, Austria. It was published online on August 20 in the Journal of the American Heart Association.

LIMITATIONS

The study was conducted at a single center with a small sample size, which may have limited the generalizability of the findings. AFDAS detection relied on clinical monitoring and follow-up rather than continuous long-term monitoring, potentially underestimating the true incidence. Additionally, PRD was measured only once and not repeated at follow-up and the exclusion of patients with severe stroke may have led to a selection bias.

DISCLOSURES

The study was funded by VASCage, Center on Clinical Stroke Research. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.