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Frequent atrial premature contractions as a surrogate marker for paroxysmal atrial fibrillation in patients with acute ischaemic stroke
  1. D Wallmann1,
  2. D Tüller1,
  3. N Kucher1,
  4. J Fuhrer1,
  5. M Arnold2,
  6. E Delacretaz1
  1. 1Swiss Cardiovascular Centre Bern, University Hospital, Bern, Switzerland
  2. 2Neurology, University Hospital, Bern
  1. Correspondence to:
    Professor Etienne Delacretaz, Swiss Cardiovascular Centre Bern, University Hospital, CH-3010 Bern, Switzerland;

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The association between atrial fibrillation (AF) and stroke is well documented.1 Oral anticoagulation may reduce the risk of stroke in relation to AF by about two thirds.1 Thus, patients with ischaemic stroke commonly undergo ambulatory ECG to detect asymptomatic paroxysmal AF. However, 24 hour ECG recordings have a low yield to detect AF in this population.2 Electrophysiological studies in patients with paroxysmal AF have identified frequent premature beats originating predominantly from the pulmonary veins as a main source of triggers that initiate AF.3,4 These frequent premature beats can be identified by 24 hour ECG recordings.5

The present study investigated whether the presence of frequent atrial premature contractions (APCs) in 24 hour ECG recordings is associated with a greater incidence of AF in patients with ischaemic stroke.


Consecutive patients who suffered an acute ischaemic stroke and without known AF were identified. Patients with persistent severe cognitive disturbances and severe aphasia, as well as those with a life expectancy shorter than six months, were excluded. Furthermore, documented AF in the initial 24 hour ECG was an exclusion criteria. The patients underwent an echocardiography and a 24 hour ECG recording within 2–6 days after admission. Nine patients were excluded after initial enrolment because of death (n = 6), retrospectively known …

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