Periodic repolarization dynamics predicts newly detected atrial fibrillation after stroke
D Pavluk, M Schreinlechner, L Mayer-Suess, F Hofer, F Theurl, C Massmann, M Moessler, S Proell, C Boehme, M Knoflach, S Kiechl, A BauerAbstract
Background
Periodic repolarization dynamics (PRD) is a novel ECG-derived biomarker reflecting sympathetic activity–associated oscillations in cardiac repolarization (1). We hypothesized that elevated PRD identifies patients after acute ischemic stroke (AIS) who are at increased risk of developing atrial fibrillation detected after stroke (AFDAS) (2).
Methods
Between February 22, 2021, and May 5, 2023, 263 patients with AIS from the STROKE-CARD II cohort were prospectively enrolled. All were in sinus rhythm at baseline without prior or current atrial fibrillation (AF). Within 5 days after AIS, patients underwent a standardized 30-minute high-resolution ECG to assess PRD, heart rate variability, and supraventricular premature complexes (SPCs/hour). AFDAS was identified through continuous in-hospital monitoring, 6-month follow-ups, and electronic health record review. The CHASE-LESS score served as the clinical risk model for AFDAS.
Results
During a median follow-up of 17 (IQR 14) months, AFDAS occurred in 25 of 263 patients (9.5%). Patients with AFDAS exhibited higher PRD values than those without (5.80 vs. 2.93 deg², p = 0.005; Picture 1). In multivariable Cox regression, PRD independently predicted AFDAS (HR 1.27, 95% CI 1.03–1.44, p = 0.037), alongside SPC frequency (HR 1.02, 95% CI 1.01–1.03, p < 0.001). A model comprising PRD and SPC per hour showed better discrimination than the CHASE LESS score alone, with an AUC of 0.82 versus 0.67 respectively, p = 0.005 (Picture 2).
Conclusions
Increased PRD and SPC frequency independently predict AFDAS and significantly improved risk prediction compared to the clinical CHASE-LESS score.PRD in Patients with or without AFDASROC-Curves CHASE-LESS vs PRD + SPCs