Runs of premature atrial complexes predict increased mortality in patients with ischemic stroke and sinus rhythm

Purpose: Atrial fibrillation (AF) is strongly related to ischemic stroke (IS), and it has been suggested that runs of premature atrial complexes (PACs) might be a precursor of paroxysmal AF. The aim of this study was to evaluate the prognostic significance of runs of PACs on 48 hours continuous in-hospital cardiac telemetry (CICT) in patients with IS and sinus rhythm (SR). Methods: Between August 2008 and April 2011, 976 patients were admitted with stroke. Patients diagnosed with IS were enrolled in this study, and those without known AF underwent 48 hours CICT. We registered new onset AF lasting > 30 seconds, and runs of PACs defined as minimum 3 consecutive PACs. Patients were followed until November 2012, the end-point being all-cause mortality, which was obtained from the National Central Person Register. Potential confounders used in a Cox regression model were age, gender, previous stroke, hypertension, previous myocardial infarction, diabetes mellitus and intermittent claudication. Results: Overall, 870 (89%) patients had IS. Seventy-two patients did not undergo CICT, and were thus excluded. Of the remaining 798 patients, 575 (72%) had SR, of which 160 (28%) were identified with runs of PACs. During a median follow-up of 28 months, 257 (32%) patients died. Thirty five per cent of patients with runs of PACs, and 21% of patients with SR without runs of PACs, died. After adjustment for potential confounders, mortality was significantly higher in patients with runs of PACs (HR: 1.6; 95% CI: 1.1-2.3; P=0.023) compared to patients with SR without runs of PACs. Figure 1. Kaplan-Meier survival by heart rhythm Figure 1. Kaplan-Meier survival by heart rhythm Conclusions: In patients with IS and SR, mortality was significantly higher in those who had runs of PACs. It is unknown whether patients with runs of PACs will benefit from long-term oral anticoagulation.