Abstract 3398: Excessive Supraventricular Ectopic Activity On 24h-Holter Predicts Paroxysmal Atrial Fibrillation In Patients With Cerebral Ischemia Presenting In Sinus Rhythm

Background Detection of paroxysmal atrial fibrillation (PAF) in patients with cerebral ischemia is challenging. Echocardiography (LAVI/á, an index of left atrial remodeling) can select a subgroup of patients for extended ECG-monitoring. Excessive supraventricular ectopic activity (ESVEA), measured as atrial premature beats (APB) and longest supraventricular run on 24h-Holter-ECG (SV-run 24h ) may further improve prediction of PAF. Methods Retrospective analysis from a prospective monocentric observational trial (Find-AF) in patients >18y with cerebral ischemia (ISRCTN 46104198). PAF was diagnosed by 7d-Holter monitoring. Transthoracic echocardiography parameters were prospectively assessed. ESVEA was quantified in one 24h interval, which had to be free from PAF. For the present analysis, 44 patients with atrial fibrillation at baseline and 20 patients with limited evaluability for ESVEA (9 with pacemaker rhythms, 4 with low-quality recordings and 7 with PAF who had no 24h interval free from PAF) were excluded. Results PAF was detected in 21 out of 215 patients (9.8%) of the analysis population. PAF was more prevalent in those with ESVEA above the median: 17.3 vs. 2.7% for APB > vs. 24h > vs. 24h 10 [7; 18] vs. 0 [0; 8] beats (both p24h ) (p=0.022) were independently predictive for the presence of PAF. 0% of patients with normal LAVI/á and APB 4/h, and 27.1% of those with both abnormal LAVI/á and APB >4/h had PAF (p Conclusions In patients with cerebral ischemia, ESVEA discriminates PAF from Non-PAF beyond clinical factors and LAVI/á. PAF is ruled out in patients with normal LAVI/á and APB 4/h.