Association between Left Atrial Enlargement on Echocardiography and In-hospital Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke

ABSTRACT

OBJECTIVE: Longstanding hypertension lead to left ventricular diastolic dysfunction with a development of a left atrial enlargement (LAE) which may result in vulnerability to atrial fibrillation (AF). Paroxysmal AF is usually unrevealed in the acute period of ischemic stroke, but is crucial for anticoagulation to prevent recurrent stroke. This study was aimed to investigate the frequency of LAE and the predictors of paroxysmal AF during the hospitalization of acute ischemic stroke. METHODS: A total 1,643 consecutive patients with acute ischemic stroke were registered in between January 2005 and December 2014. The subjects who had AF before index stroke or at admission were excluded. The clinical and echocardiographic findings of all patients were reviewed. Paroxysmal AF were detected on electrocardiography of Holter monitoring during hospitalization. LAE were defined as LA diameter larger than 44 mm in echocardiography. We compared the frequency of LAE between the patients with or without AF. Logistic regression analysis were performed to determine the echocardiographic parameters for prediction of paroxysmal AF. RESULTS: The mean age was 67.3 and the male was 55.6%. AF were detected in 123 (11.4%) of LAE(-) group but were detected in 102 (49.0%) in LAE(+) group. In logistic regression analysis, LAE significantly predicted for newly detected AF during hospitalization after adjusting covariates (odds ratio, 5.698; 95% confidence interval, 3.799-8.546; P<0.001). CONCLUSION: LAE was an independent predictor for AF during hospitalization in patients with acute ischemic stroke. Prolonged electrocardiography monitoring should be meticulously indicated for acute ischemic stroke with LAE to detect paroxysmal AF.