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Irregularity and lack of p waves in short tachycardia episodes predict atrial fibrillation and ischemic stroke

Published:February 12, 2018DOI:https://doi.org/10.1016/j.hrthm.2018.02.011

      Background

      Atrial fibrillation (AF) is defined as an irregular supraventricular tachycardia (SVT) without p waves, with duration >30 seconds. Whether AF characteristics during short SVT episodes predict AF and stroke is not known.

      Objective

      The purpose of this study was to determine whether irregularity and lack of p waves, alone or in combination, during short SVT episodes increase the risk of incident AF and ischemic stroke.

      Methods

      The population-based Malmö Diet and Cancer study includes 24-hour ECG screening of 377 AF-free individuals (mean age 64.5 years; 43% men) who were prospectively followed for >13 years. There were 65 AF events and 25 ischemic stroke events during follow-up. Subjects with an SVT episode ≥5 beats were identified, and the longest SVT episode was assessed for irregularity and lack of p waves. The association between SVT classification and AF and stroke was assessed using multivariable adjusted Cox regression.

      Results

      The incidence of AF increased with increasing abnormality of the SVTs. The risk-factor adjusted hazard ratio for AF was 4.95 (95% confidence interval 2.06–11.9; P <.0001) for those with short irregular SVTs (<70 beats) without p waves. The incidence of ischemic stroke was highest in the group with regular SVT episodes without p waves (hazard ratio 14.2; 95% confidence interval 3.76–57.6; P <.0001, adjusted for age and sex).

      Conclusion

      Characteristics of short SVT episodes detected at 24-hour ECG screening are associated with incident AF and ischemic stroke. Short irregular SVTs without p waves likely represent early stages of AF or atrial myopathy. Twenty-four–hour ECG could identify subjects suitable for primary prevention efforts.

      Keywords

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      Linked Article

      • Is a little atrial fibrillation still too much?
        Heart RhythmVol. 15Issue 6
        • Preview
          Atrial fibrillation (AF) is most often viewed as a dichotomous variable, one that is either entirely present or absent. Guidelines support this perspective by recommending anticoagulation based on underlying stroke risk without regard to AF “type,” duration, or burden.1 The use of cardiac monitoring, however, has allowed us to quantify AF and associate outcomes with various arrhythmia characteristics.2,3 These types of studies have raised legitimate doubts as to whether the 30-second threshold used to define AF is associated with meaningful consequences and have created equipoise for subclinical AF episodes lasting minutes to hours.
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