P-wave dispersion and left atrial indices as predictors of paroxysmal atrial fibrillation in patients with non hemorrhagic cerebrovascular strokes and transient ischemic attacks

Background: One-third of stroke and Transient Ischemic Attack (TIA) are cryptogenic requiring additional investigation and intervention. Occult Paroxysmal Atrial Fibrillation (PAF) has been suggested as a possible cause for these cryptogenic strokes. Objective: The aim of our study is to evaluate the role of simple ECG & bedside echocardiographic parameters for prediction of PAF in patients presenting with stroke or TIAs. Patients & methods: The study included 60 patients with non hemorrhagic stroke. During 1 week of continuous ICU monitoring, 30% of patients had PAF (group 1), the remaining 42 patients did not develop PAF (group 2). All patients were subjected to detailed history taking, thorough clinical examination including NIHSS, serial ECGs for calculation of maximum and minimum P wave duration (P-max, and P-min) & P wave dispersion (P-dis), and transthoracic echocardiography for calculation of left atrial volume (LAV), and left atrial volume index (LAVI). Results: It was found that Pmax & Pdis were significantly higher in group 1 in comparison to group 2 (147.7 +/- 9.6 mm vs 114.3 +/- 9 mm, P: < 0.001) and (54.1 +/- 7.5 mm vs 30.2 +/- 7 mm, P: < 0.001), respectively. Also LAV & LAVI were significantly higher in group 1 compared to group 2 (57.1 +/- 10 mm vs 40.1 +/- 12 mm, P: < 0.001) & (28.9 +/- 3 mm(2)/m(2) vs 20.1 +/- 8 mm(2)/m(2), P: < 0.001), respectively. On multivariate logistic regression analysis Pmax, Pdis, and LAVI were the most significant independent predictors of PAF. Conclusion: PAF is a possible etiology of patients with ischemic cerebrovascular accidents patients even in those who had normal sinus rhythm on admission. P-max >= P125 mm, P-dis >= P 40 mm, and LAVI P 24 are highly significant predictors of PAF with PPV of 99%, 96% and 78%, respectively,sensitivity of 98%, 94% and 89%, respectively, specificity 96%, 93% and 75%, respectively and AUC of 0.99, 0.98 and 0.87, respectively. (C) 2013 Production and hosting by Elsevier B.V.