Evaluation of arrhythmia frequency by holter electrocardiography in patients with acute ischemic cerebrovascular events
Abstract
Aim: After acute ischemic cerebrovascular accident (CVA), identification of high-risk patients, appropriate cardiac follow-up and detection of arrhythmias are important to prevent cardiac morbidity and mortality. The aim of our study is to determine the underlying etiology and the frequency of arrhythmia by holter electrocardiography (ECG) in patients referred to the cardiology clinic due to acute ischemic CVA.
Materials and Methods: A total of 135 consecutive patients who had acute ischemic CVA between January 2019 and June 2021 and whose basal ECG was sinus rhythm were included in the study. This study was a retrospective cross-sectional study.
Results: The mean age of the patients was 72.02±11.02 years, the mean systolic arterial blood pressure was 138.84±20.45 mmHg, and the mean heart rate was 81.63±16.18 beats/min. The most common comorbid diseases were HT (n=67, %49.6) and CAD (n=55, %40.7). 5.9% of patients had prosthetic heart valve and 5.2% had permanent pacemaker. Intracardiac thrombus was detected in 5 (3.7%) patients. The mean left ventricular ejection fraction was 54.4±9.1%. In carotid doppler ultrasonography (USG), 27 (20%) patients had unilateral and 17 (12.6%) bilateral severe carotid arterial stenosis. The most common arrhythmias detected on holter ECG were ventricular extrasystole (n=34, 25.2%) and paroxysmal atrial fibrillation (n=31, 23%). In addition, non-sustained ventricular tachycardia was detected in 6 (4.4%) patients.
Conclusion: Determining the underlying etiology in patients with acute ischemic CVA is important for the treatment of the disease. The incidence of arrhythmia that should be treated in this patient group is too high to be ignored.
References
- Fernández-Menéndez S, García-Santiago R, Vega-Primo A, et al. Cardiac arrhythmias in stroke unit patients. Evaluation of the cardiac monitoring data. Neurología. 2016; 31: 289-95.
- Ruthirago D, Julayanont P, Tantrachoti P, Kim J, Nugent K. Cardiac Arrhythmias and Abnormal Electrocardiograms After Acute Stroke. Am J Med Sci. 2016; 351: 112-8.
- Ertas F. Epidemiological approach to the atrial fibrillation patients. Dicle med j. 2013; 40: 332-9.
- Britton M, de Faire U, Helmers C, et al. Arrhythmias in patients with acute cerebrovascular disease. Acta Med Scand. 1979; 205: 425-8.
- Arslan Y, Selbest Demirtaş B, Ekmekci C, Şener U. Investigation of risk factors in cryptogenic ischemic stroke. Turkish Journal of Cerebrovascular Diseases. 2019; 25: 26-30.
- Dogdus M, Burhan S, Bozgun Z, et al. Cardiac autonomic dysfunctions are recovered with vitamin D replacement in apparently healthy individuals with vitamin D deficiency. Ann Noninvasive Electrocardiol. 2019 Nov; 24 (6): e12677. doi: 10.1111/anec.12677.
- Brown RD, Whisnant JP, Sicks JD, et al. Stroke incidence,prevalence, and survival: secular trends in Rochester,Minnesota, through 1989. Stroke. 1996; 27: 373-80.
- Di Carlo A, Lamassa M, Baldereschi M, et al. Sexdifferences in the clinical presentation, resource use, and3-month outcome of acute stroke in Europe: data froma multicenter multinational hospital-based registry. Stroke. 2003; 34: 1114-9.
- Kapral MK, Fang J, Hill MD, et al. Sex differences instroke care and outcomes: results from the Registry ofthe Canadian Stroke Network. Stroke. 2005; 36: 809-14.
- Gibson CL. Cerebral ischemic stroke: is gender important?J Cereb Blood Flow Metab. 2013; 33: 1355-61.
- Sacco RL, Benjamin EJ, Broderick JP, et al. American Heart Association Prevention Conference. IV. Prevention and rehabilitation of stroke Risk factors. Stroke. 1997; 28: 1507-17.
- Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary WorkingGroup; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, andMetabolism Council; and the Quality of Care andOutcomes Research Interdisciplinary Working Group: theAmerican Academy of Neurology affirms the value ofthis guideline. Stroke. 2006; 37: 1583-633.
- Orlandi G, Fanucchi S, Strata G, et al. Transient autonomic nervous system dysfunction during hyperacute stroke. Acta Neurol Scand. 2000; 102: 317-21.
- Prosser J, Mac Gregor L, Lees KR, et al. Predictors of early cardiac morbidity and mortality after ischemic stroke. Stroke. 2007; 38: 2295-302.
- Pasquini M, Laurent C, Kroumova M. Insular infarcts and electrocardiographic changes at admission: results of the prognostic of insular cerebral infarcts study (PRINCESS). J Neurol. 2006; 253: 618-24.
- Christensen H, Fogh Christensen A, Boysen G. Abnormalities on ECG and telemetry predict stroke outcome at 3 months. J Neurol Sci. 2005; 234: 99-103.
- Silver FL, Norris JW, Lewis AJ, Hachinski VC. Early mortality following stroke: a prospective review. Stroke. 1984;15: 492–6.
- Adams RJ, Chimowitz MI, Alpert JS, et al. Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/Am Stroke Association. Stroke. 2003; 34: 2310 –22.
- Cheung RTF, Hachinski VC. The insula and cerebrogenic sudden death. Arch Neurol. 2000; 57: 1685–8.
- Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation. 1996; 93: 1043–106.
- American Virani SS, Alonso A, Aparicio HJ, et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021; 143: e254-e743.
- Font MÀ, Krupinski J, Arboix A. Antithrombotic medication for cardioembolic stroke prevention. Stroke Res Treat. 2011; 2011: 1-23. doi: 10.4061/2011/607852
- Uzunkopru C, Tiryaki EN, Tiryaki M. The Relationship Between Transthoracic Echocardiography Findings, Localization of Stroke, and Risk Factors in Patients With Ischemic Stroke. Dicle Med J. 2021; 48: 220-7
- Abreu TT, Mateus S, Correia J. Therapy Implications of Transthoracic Echocardiography in Acute Ischemic Stroke Patients. Stroke. 2005; 36: 1565-6.
- Di Pasquale G, Andreoli A, Grazi P, Dominici P, Pinelli G. Cardioembolic stroke from atrial septal aneurysm. Stroke. 1988; 19: 640-3.
- Dusleag J, Klein W, Eber B, et al. Frequency of magnetic resonance signal abnormalities of the brain in patients aged less than 50 years with idiopathic dilated cardiomyopathy. Am J Cardiol. 1992; 69: 1446-50.
- Gonzalez-Torrecilla E, Garcia-Fernandez MA, Perez-David E, et al. Predictors of left atrial spontaneous echo contrast and thrombi in patients with mitral stenosis and atrial fibrillation. Am J Cardiol. 2000; 86: 529-34.
- Cokar O, Ozturk O, Aydemir T, et al. Transoesophageal echocardiographic findings in patients with ischemic lacunar and nonlacunar stroke. J Clin Neurosci. 2008; 15: 246-52.
- Kasner SE, Lynn MJ, Jackson BP, Pullicino PM, Chimowitz MI. Warfarin Versus Aspirin for Symptomatic Intracranial Disease (WASID) Trial Investigators. Echocardiography in Patients With Symptomatic Intracranial Stenosis. J Stroke Cerebrovasc Dis. 2007; 16: 216-9
Akut iskemik serebrovasküler olay geçiren hastalarda aritmi sıklığının holter elektrokardiyografi ile değerlendirilmesi
Abstract
Amaç: Akut iskemik serebrovasküler olaydan (SVO) sonra yüksek riskli hastaların belirlenmesi, uygun kardiyak izlem ve aritmilerin saptanması, kardiyak morbidite ve mortalitenin önlenmesi açısından önemlidir. Çalışmamızın amacı, akut iskemik SVO nedeniyle kardiyoloji kliniğine yönlendirilen hastalarda, altta yatan etiyolojinin belirlenmesi ve 24 saatlik holter elektrokardiyografi (EKG) ile aritmi sıklığının saptanmasıdır.
Gereç ve Yöntem: Çalışmaya Ocak 2019-Haziran 2021 tarihleri arasında akut iskemik SVO geçiren ve bazal EKG’ si sinüs ritminde olan ardışık 135 hasta alındı. Çalışmamız, retrospektif kesitsel bir çalışmadır.
Bulgular: Hastaların ortalama yaşı 72.02±11.02 yıl, ortalama sistolik arteryal kan basıncı 138,84±20.45 mmHg ve ortalama kalp hızı 81.63±16.18 atım/dk idi. Hastalarda en sık görülen komorbid hastalıklar hipertansiyon (n=67, %49,6) ve koroner arter hastalığıydı (n=55, %40,7). Hastaların %5.9’unda protez kalp kapağı ve %5.2‘sinde kalıcı kalp pili vardı. 5 (%3,7) hastada intrakardiyak trombüs tespit edildi. Ortalama sol ventrikül ejeksiyon fraksiyonu %54,4±9,1 idi. Karotis dopler ultrasonografide (USG) hastaların 27 (%20)’ sinde tek taraflı ve 17’sinde (%12,6) iki taraflı ciddi karotis arter darlığı mevcuttu. Holter EKG’ de en sık tesbit edilen aritmiler ventriküler ekstrasistol (n=34, %25,2) ve paroksismal atrial fibrilasyondu (n=31, %23). Ayrıca 6 (%4,4) hastada non-sustained ventriküler taşikardi saptandı.
Sonuç: Akut iskemik SVO geçiren hastalarda alta yatan etiyolojiyi tesbit etmek hastalığın tedavisi açısından önem arz etmektedir. Bu hasta grubunda tedavi edilmesi gereken aritmi sıklığı göz ardı edilmeyecek kadar yüksektir.
Keywords
References
- Fernández-Menéndez S, García-Santiago R, Vega-Primo A, et al. Cardiac arrhythmias in stroke unit patients. Evaluation of the cardiac monitoring data. Neurología. 2016; 31: 289-95.
- Ruthirago D, Julayanont P, Tantrachoti P, Kim J, Nugent K. Cardiac Arrhythmias and Abnormal Electrocardiograms After Acute Stroke. Am J Med Sci. 2016; 351: 112-8.
- Ertas F. Epidemiological approach to the atrial fibrillation patients. Dicle med j. 2013; 40: 332-9.
- Britton M, de Faire U, Helmers C, et al. Arrhythmias in patients with acute cerebrovascular disease. Acta Med Scand. 1979; 205: 425-8.
- Arslan Y, Selbest Demirtaş B, Ekmekci C, Şener U. Investigation of risk factors in cryptogenic ischemic stroke. Turkish Journal of Cerebrovascular Diseases. 2019; 25: 26-30.
- Dogdus M, Burhan S, Bozgun Z, et al. Cardiac autonomic dysfunctions are recovered with vitamin D replacement in apparently healthy individuals with vitamin D deficiency. Ann Noninvasive Electrocardiol. 2019 Nov; 24 (6): e12677. doi: 10.1111/anec.12677.
- Brown RD, Whisnant JP, Sicks JD, et al. Stroke incidence,prevalence, and survival: secular trends in Rochester,Minnesota, through 1989. Stroke. 1996; 27: 373-80.
- Di Carlo A, Lamassa M, Baldereschi M, et al. Sexdifferences in the clinical presentation, resource use, and3-month outcome of acute stroke in Europe: data froma multicenter multinational hospital-based registry. Stroke. 2003; 34: 1114-9.
- Kapral MK, Fang J, Hill MD, et al. Sex differences instroke care and outcomes: results from the Registry ofthe Canadian Stroke Network. Stroke. 2005; 36: 809-14.
- Gibson CL. Cerebral ischemic stroke: is gender important?J Cereb Blood Flow Metab. 2013; 33: 1355-61.
- Sacco RL, Benjamin EJ, Broderick JP, et al. American Heart Association Prevention Conference. IV. Prevention and rehabilitation of stroke Risk factors. Stroke. 1997; 28: 1507-17.
- Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary WorkingGroup; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, andMetabolism Council; and the Quality of Care andOutcomes Research Interdisciplinary Working Group: theAmerican Academy of Neurology affirms the value ofthis guideline. Stroke. 2006; 37: 1583-633.
- Orlandi G, Fanucchi S, Strata G, et al. Transient autonomic nervous system dysfunction during hyperacute stroke. Acta Neurol Scand. 2000; 102: 317-21.
- Prosser J, Mac Gregor L, Lees KR, et al. Predictors of early cardiac morbidity and mortality after ischemic stroke. Stroke. 2007; 38: 2295-302.
- Pasquini M, Laurent C, Kroumova M. Insular infarcts and electrocardiographic changes at admission: results of the prognostic of insular cerebral infarcts study (PRINCESS). J Neurol. 2006; 253: 618-24.
- Christensen H, Fogh Christensen A, Boysen G. Abnormalities on ECG and telemetry predict stroke outcome at 3 months. J Neurol Sci. 2005; 234: 99-103.
- Silver FL, Norris JW, Lewis AJ, Hachinski VC. Early mortality following stroke: a prospective review. Stroke. 1984;15: 492–6.
- Adams RJ, Chimowitz MI, Alpert JS, et al. Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/Am Stroke Association. Stroke. 2003; 34: 2310 –22.
- Cheung RTF, Hachinski VC. The insula and cerebrogenic sudden death. Arch Neurol. 2000; 57: 1685–8.
- Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation. 1996; 93: 1043–106.
- American Virani SS, Alonso A, Aparicio HJ, et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021; 143: e254-e743.
- Font MÀ, Krupinski J, Arboix A. Antithrombotic medication for cardioembolic stroke prevention. Stroke Res Treat. 2011; 2011: 1-23. doi: 10.4061/2011/607852
- Uzunkopru C, Tiryaki EN, Tiryaki M. The Relationship Between Transthoracic Echocardiography Findings, Localization of Stroke, and Risk Factors in Patients With Ischemic Stroke. Dicle Med J. 2021; 48: 220-7
- Abreu TT, Mateus S, Correia J. Therapy Implications of Transthoracic Echocardiography in Acute Ischemic Stroke Patients. Stroke. 2005; 36: 1565-6.
- Di Pasquale G, Andreoli A, Grazi P, Dominici P, Pinelli G. Cardioembolic stroke from atrial septal aneurysm. Stroke. 1988; 19: 640-3.
- Dusleag J, Klein W, Eber B, et al. Frequency of magnetic resonance signal abnormalities of the brain in patients aged less than 50 years with idiopathic dilated cardiomyopathy. Am J Cardiol. 1992; 69: 1446-50.
- Gonzalez-Torrecilla E, Garcia-Fernandez MA, Perez-David E, et al. Predictors of left atrial spontaneous echo contrast and thrombi in patients with mitral stenosis and atrial fibrillation. Am J Cardiol. 2000; 86: 529-34.
- Cokar O, Ozturk O, Aydemir T, et al. Transoesophageal echocardiographic findings in patients with ischemic lacunar and nonlacunar stroke. J Clin Neurosci. 2008; 15: 246-52.
- Kasner SE, Lynn MJ, Jackson BP, Pullicino PM, Chimowitz MI. Warfarin Versus Aspirin for Symptomatic Intracranial Disease (WASID) Trial Investigators. Echocardiography in Patients With Symptomatic Intracranial Stenosis. J Stroke Cerebrovasc Dis. 2007; 16: 216-9
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 13, 2022 |
| Submission Date | January 10, 2022 |
| Published in Issue | Year 2022Volume: 61 Issue: 2 |
