Excessive Supraventricular Ectopic Activity in Patients With Acute Ischemic Stroke Is Associated With Atrial Fibrillation Detection Within 24 Months After Stroke: A Predefined Analysis of the MonDAFIS Study
Background Excessive supraventricular ectopic activity (ESVEA) is regarded as a risk marker for later atrial fibrillation (AF) detection. Methods and Results The investigator‐initiated, prospective, open, multicenter MonDAFIS (Impact of Standardized Monitoring for Detection of Atrial Fibrillation in...
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2025-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| author | Karl Georg Haeusler Serdar Tütüncü Cornelia Fiessler Muhammad Jawad‐Ul‐Qamar Claudia Kunze Johannes Schurig Joanna Dietzel Michael Krämer Gabor C. Petzold Georg Royl Torsten Helberg Götz Thomalla Darius G. Nabavi Joachim Röther Ulrich Laufs Roland Veltkamp Peter U. Heuschmann Paulus Kirchhof Manuel C. Olma Matthias Endres |
| author_facet | Karl Georg Haeusler Serdar Tütüncü Cornelia Fiessler Muhammad Jawad‐Ul‐Qamar Claudia Kunze Johannes Schurig Joanna Dietzel Michael Krämer Gabor C. Petzold Georg Royl Torsten Helberg Götz Thomalla Darius G. Nabavi Joachim Röther Ulrich Laufs Roland Veltkamp Peter U. Heuschmann Paulus Kirchhof Manuel C. Olma Matthias Endres |
| author_sort | Karl Georg Haeusler |
| collection | DOAJ |
| description | Background Excessive supraventricular ectopic activity (ESVEA) is regarded as a risk marker for later atrial fibrillation (AF) detection. Methods and Results The investigator‐initiated, prospective, open, multicenter MonDAFIS (Impact of Standardized Monitoring for Detection of Atrial Fibrillation in Ischemic Stroke) study randomized 3465 patients with acute ischemic stroke without known AF 1:1 to usual diagnostic procedures for AF detection or additive Holter monitoring in hospital for up to 7 days, analyzed in a core laboratory. Secondary study objectives include the comparison of recurrent stroke, myocardial infarction, major bleeding, and all‐cause death within 24 months in patients with ESVEA (defined as ectopic supraventricular beats ≥480/day or atrial runs of 10–29 seconds or both) versus patients with newly diagnosed AF versus patients without ESVEA or AF (non‐ESVEA/AF), randomized to the intervention group. Overall, 1435 (84.8%) of 1714 patients randomized to the intervention group had analyzable study ECG monitoring of at least 48 hours' duration within the first 72 hours of monitoring. ESVEA was detected in 363 (25.3%) patients, while AF was first detected in 48 (3.3%) patients. Within 24 months, AF was newly detected in 67 (18.5%) patients with ESVEA versus 60 (5.9%) patients without ESVEA/AF‐ (P<0.001). The composite outcome at 24 months was not different between patients with ESVEA and patients without ESVEA/AF (15.2% versus 12.6%; P=0.242). All‐cause death was numerically higher in patients with ESVEA (6.6% versus 3.2%), but failed statistical significance (P=0.433) in multivariate analysis (including age, heart failure, stroke severity, and creatinine at baseline). Conclusions ESVEA in the acute phase of ischemic stroke or transient ischemic attack is associated with AF detection during follow‐up and therefore may be used to select patients for prolonged ECG monitoring. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02204267. |
| format | Article |
| id | doaj-art-c4a6e1ff755349c08fa57adf3557da7a |
| institution | OA Journals |
| issn | 2047-9980 |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-c4a6e1ff755349c08fa57adf3557da7a2025-08-20T02:34:40ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-01-0114210.1161/JAHA.123.034512Excessive Supraventricular Ectopic Activity in Patients With Acute Ischemic Stroke Is Associated With Atrial Fibrillation Detection Within 24 Months After Stroke: A Predefined Analysis of the MonDAFIS StudyKarl Georg Haeusler0Serdar Tütüncü1Cornelia Fiessler2Muhammad Jawad‐Ul‐Qamar3Claudia Kunze4Johannes Schurig5Joanna Dietzel6Michael Krämer7Gabor C. Petzold8Georg Royl9Torsten Helberg10Götz Thomalla11Darius G. Nabavi12Joachim Röther13Ulrich Laufs14Roland Veltkamp15Peter U. Heuschmann16Paulus Kirchhof17Manuel C. Olma18Matthias Endres19Department of Neurology University of Ulm Ulm GermanyCenter for Stroke Research Berlin Charité—Universitätsmedizin Berlin Berlin GermanyInstitute for Clinical Epidemiology and Biometry, University of Würzburg Würzburg GermanyDepartment of Cardiology Hull University Teaching Hospitals, NHS trust Hull United KingdomCenter for Stroke Research Berlin Charité—Universitätsmedizin Berlin Berlin GermanyDepartment of Radiology and Neuroradiology Städtisches Klinikum Dresden Friedrichstadt Dresden GermanyInstitute of Social Medicine, Epidemiology and Health Economics, Charité Berlin GermanyCenter for Stroke Research Berlin Charité—Universitätsmedizin Berlin Berlin GermanyDepartment of Vascular Neurology University of Bonn GermanyDepartment of Neurology and Neurovascular Center University Hospital Schleswig Holstein Luebeck GermanyDepartment of Neurology MediClin Hospital Plau am See Plau am See GermanyDepartment of Neurology University Medical Center Hamburg‐Eppendorf Hamburg GermanyDepartment of Neurology Vivantes Klinikum Neukölln Berlin GermanyDepartment of Neurology Asklepios Klinik Altona Hamburg GermanyKlinik und Poliklinik für Kardiologie Universitätsklinikum Leipzig Leipzig GermanyDepartment of Neurology Alfried Krupp Krankenhaus Essen GermanyInstitute for Clinical Epidemiology and Biometry, University of Würzburg Würzburg GermanyCollege of Medical and Dental Sciences, Medical School Institute of Cardiovascular Sciences, University of Birmingham United KingdomCenter for Stroke Research Berlin Charité—Universitätsmedizin Berlin Berlin GermanyCenter for Stroke Research Berlin Charité—Universitätsmedizin Berlin Berlin GermanyBackground Excessive supraventricular ectopic activity (ESVEA) is regarded as a risk marker for later atrial fibrillation (AF) detection. Methods and Results The investigator‐initiated, prospective, open, multicenter MonDAFIS (Impact of Standardized Monitoring for Detection of Atrial Fibrillation in Ischemic Stroke) study randomized 3465 patients with acute ischemic stroke without known AF 1:1 to usual diagnostic procedures for AF detection or additive Holter monitoring in hospital for up to 7 days, analyzed in a core laboratory. Secondary study objectives include the comparison of recurrent stroke, myocardial infarction, major bleeding, and all‐cause death within 24 months in patients with ESVEA (defined as ectopic supraventricular beats ≥480/day or atrial runs of 10–29 seconds or both) versus patients with newly diagnosed AF versus patients without ESVEA or AF (non‐ESVEA/AF), randomized to the intervention group. Overall, 1435 (84.8%) of 1714 patients randomized to the intervention group had analyzable study ECG monitoring of at least 48 hours' duration within the first 72 hours of monitoring. ESVEA was detected in 363 (25.3%) patients, while AF was first detected in 48 (3.3%) patients. Within 24 months, AF was newly detected in 67 (18.5%) patients with ESVEA versus 60 (5.9%) patients without ESVEA/AF‐ (P<0.001). The composite outcome at 24 months was not different between patients with ESVEA and patients without ESVEA/AF (15.2% versus 12.6%; P=0.242). All‐cause death was numerically higher in patients with ESVEA (6.6% versus 3.2%), but failed statistical significance (P=0.433) in multivariate analysis (including age, heart failure, stroke severity, and creatinine at baseline). Conclusions ESVEA in the acute phase of ischemic stroke or transient ischemic attack is associated with AF detection during follow‐up and therefore may be used to select patients for prolonged ECG monitoring. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02204267.https://www.ahajournals.org/doi/10.1161/JAHA.123.034512atrial fibrillationatrial rundeathECGstrokesupraventricular ectopy |
| spellingShingle | Karl Georg Haeusler Serdar Tütüncü Cornelia Fiessler Muhammad Jawad‐Ul‐Qamar Claudia Kunze Johannes Schurig Joanna Dietzel Michael Krämer Gabor C. Petzold Georg Royl Torsten Helberg Götz Thomalla Darius G. Nabavi Joachim Röther Ulrich Laufs Roland Veltkamp Peter U. Heuschmann Paulus Kirchhof Manuel C. Olma Matthias Endres Excessive Supraventricular Ectopic Activity in Patients With Acute Ischemic Stroke Is Associated With Atrial Fibrillation Detection Within 24 Months After Stroke: A Predefined Analysis of the MonDAFIS Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation atrial run death ECG stroke supraventricular ectopy |
| title | Excessive Supraventricular Ectopic Activity in Patients With Acute Ischemic Stroke Is Associated With Atrial Fibrillation Detection Within 24 Months After Stroke: A Predefined Analysis of the MonDAFIS Study |
| title_full | Excessive Supraventricular Ectopic Activity in Patients With Acute Ischemic Stroke Is Associated With Atrial Fibrillation Detection Within 24 Months After Stroke: A Predefined Analysis of the MonDAFIS Study |
| title_fullStr | Excessive Supraventricular Ectopic Activity in Patients With Acute Ischemic Stroke Is Associated With Atrial Fibrillation Detection Within 24 Months After Stroke: A Predefined Analysis of the MonDAFIS Study |
| title_full_unstemmed | Excessive Supraventricular Ectopic Activity in Patients With Acute Ischemic Stroke Is Associated With Atrial Fibrillation Detection Within 24 Months After Stroke: A Predefined Analysis of the MonDAFIS Study |
| title_short | Excessive Supraventricular Ectopic Activity in Patients With Acute Ischemic Stroke Is Associated With Atrial Fibrillation Detection Within 24 Months After Stroke: A Predefined Analysis of the MonDAFIS Study |
| title_sort | excessive supraventricular ectopic activity in patients with acute ischemic stroke is associated with atrial fibrillation detection within 24 months after stroke a predefined analysis of the mondafis study |
| topic | atrial fibrillation atrial run death ECG stroke supraventricular ectopy |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.034512 |
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