Heart Ar­rhythmias in Young Patients with Cryptogenic Ischemic Stroke


Authors: D. Šaňák 1;  M. Hutyra 2;  M. Král 1;  History Study Group *
Authors‘ workplace: Komplexní cerebrovaskulární centrum, Neurologická klinika LF UP a FN Olomouc 1;  1. interní klinika – kardiologická LF UP a FN Olomouc 2
Published in: Cesk Slov Neurol N 2015; 78/111(6): 669-674
Category: Original Paper
doi: 10.14735/amcsnn2015669

*HISTORY study group: T. Veverka, A. Bárt­ková, A. Kunčarová, T. Dorňák, D. Franc, P. Kaňovský (Neurologická klinika LF UP a FN Olomouc), M. Fedorco, J. Galuzska, D. Vindiš, T. Skála, M. Táborský (1. interní klinika – kardiologická LF UP a Olomouc), E. Čecháková, Z. Tüdös, M. Černá, M. Köcher, (Radiologická klinika LF UP a FN Olomouc), J. Úlehlová, L. Slavík (Hemato-onkologická klinika LF UP a FN Olomouc), J. Zapletalová, K. Langová (Ústav lékařské biofyziky, biometrie a statistiky, LF UP v Olomouci), R. Herzig (Neurologická klinika LF UK a FN Hradec Králové), D. Školoudík (Ústav ošetřovatelství, Fakulta zdravotních věd, UP v Olomouci).

Overview

Background and aim:
The cause of ischemic stroke (IS) in young patients remains often cryptogenic. In elderly population, undetected heart arrhythmias with a risk of embolization are considered the cause of cryptogenic IS (CIS). The aim of this prospective study was to assess the presence of heart arrhythmias in young CIS patients using a long-term ECG-Holter monitoring and implantable subcutaneous heart monitor.

Patients and methods:
Study set consisted of acute IS patients < 50 years enrolled in the HISTORY (Heart and Ischemic STrOke Relationship studY) study. CIS was defined according to the TOAST criteria. In all patients, brain ischemia was confirmed on CT/MRI. Admission ECG, serum levels of cardio-markers, markers of thrombophilia including genetic screening, neurosonology, transoesophageal echocardiography, 24-hour and 3-week ECG-Holter monitoring were performed in all patients. In selected patients with negative 3-week Holter, subcutaneous heart monitor was implanted.

Results:
Out of 838 patients enrolled in the HISTORY study, 123 patients were < 50 years and 102 (83%) of them were identified as cryptogenic (56 males, mean age 39 ± 8.5 years). Cardiac arrhythmia was detected in 12 (12%) patients (nine males, mean age 43 ± 4.2 years). In nine (75%) patients, atrial fibrillation was presented. In three patients, the arrhythmia was detected during 24-h ECG-Holter and during 3-week monitoring in the remaining nine patients. The subcutaneous monitor was implanted in 12 patients, but no arrhythmia was detected during study period (median 122 days). Conclusion: Heart arrhythmia was detected in 12% of young CIS patients. Prolongation of ECG-Holter monitoring increased the detection rate significantly. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT01541163.

Key words:
cryptogenic ischemic stroke – cardiac arrhythmias – atrial fibrillation – ECG-Holter monitoring

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


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Paediatric neurology Neurosurgery Neurology
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