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Title: Association of Electrocardiographic P-Wave Markers and Atrial Fibrillation in Embolic Stroke of Undetermined Source
Authors: Li, Tony Y.W.
Yeo, Leonard Leong L. 
Ho, Jamie Sin Ying
Leow, Aloysius S.
Chan, Mark Y. 
Dalakoti, Mayank
Chan, Bernard P.L.
Teoh, Hock Luen
Seow, Swee-Chong 
Kojodjojo, Pipin 
Sharma, Vijay K. 
Tan, Benjamin Y.-Q.
Sia, Ching-Hui 
Keywords: Atrial fibrillation
Ischaemic stroke
Cerebrovascular disease/stroke
Issue Date: 11-Dec-2020
Publisher: S. Karger AG
Citation: Li, Tony Y.W., Yeo, Leonard Leong L., Ho, Jamie Sin Ying, Leow, Aloysius S., Chan, Mark Y., Dalakoti, Mayank, Chan, Bernard P.L., Teoh, Hock Luen, Seow, Swee-Chong, Kojodjojo, Pipin, Sharma, Vijay K., Tan, Benjamin Y.-Q., Sia, Ching-Hui (2020-12-11). Association of Electrocardiographic P-Wave Markers and Atrial Fibrillation in Embolic Stroke of Undetermined Source. Cerebrovascular Diseases 50 (1) : 46–53. ScholarBank@NUS Repository.
Rights: Attribution-NonCommercial 4.0 International
Abstract: Background: Several P-wave indices are thought to represent underlying atrial remodeling and have been associated with ischaemic stroke even in the absence of atrial fibrillation (AF). However, the utility of these P-wave indices in predicting outcomes in patients with embolic stroke of undetermined source (ESUS) has not been studied. The aim of this study is to examine these different P-wave indices towards predicting new-onset AF and stroke recurrence in a cohort of patients with ESUS, thereby demonstrating the value of these electrocardiographic markers for stroke risk stratification. Methods: Between October 2014 and October 2017, consecutive patients diagnosed with ESUS were followed for new-onset AF and ischaemic stroke recurrence. The various P-wave indices, namely, the P-terminal force in the precordial lead V1 (PTFV1), P-wave duration, P-wave dispersion, interatrial blocks, and P-wave axis, were assessed on the initial electrocardiogram on presentation and studied for their relation to eventual AF detection and recurrent stroke. Results: 181 ischaemic stroke patients with ESUS were recruited and followed up for a median duration of 2.1 years. An abnormal PTFV1 was associated with occult AF detection but not with recurrent ischaemic strokes. No significant association was observed between the other P-wave indices with either occult AF or stroke recurrence. Conclusion: PTFV1 is associated with AF detection but not recurrent strokes in ESUS patients and can be a useful electrocardiographic marker for further risk stratification in ESUS patients.
Source Title: Cerebrovascular Diseases
ISSN: 10159770
DOI: 10.1159/000512179
Rights: Attribution-NonCommercial 4.0 International
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