ECG Abnormalities and Stroke Incidence
ECG Abnormalities and Stroke Incidence
Several ECG markers of atrial or AV nodal mechanical/substrate/electrical conduction abnormalities have been related to both incident AF and stroke. P terminal force (negative portion of P in V1) is associated with both AF and stroke. Among several ECG predictors of AF, it was the strongest predictor of stroke. P wave area was associated with both an increased risk of AF and stroke. P wave morphology, such as notching – a likely indicator of left atrial enlargement – was found to be associated with incident stroke. Among several predictors of AF, P wave duration was one of the strongest predictors of AF incidence. However, it was not independently associated with higher stroke risk when continuous P wave duration was regressed with log–linear risk of stroke. In another study, a prolonged P wave interval of >120 ms was associated with higher risk of stroke; atrial late potentials (using signal-averaged ECG) were the strongest predictor (hazard ratio: 11.15) of AF detected within a 1-year poststroke follow-up. Signal-averaged ECGs require specialized equipment, high fidelity and for the patient to lie completely still for 3–5 min.
The use of these ECG markers for risk stratification and trials with antiplatelets/anticoagulants to reduce stroke risk in high-risk groups needs strong consideration.
Other Atrial or AV Conduction ECG Parameters
Several ECG markers of atrial or AV nodal mechanical/substrate/electrical conduction abnormalities have been related to both incident AF and stroke. P terminal force (negative portion of P in V1) is associated with both AF and stroke. Among several ECG predictors of AF, it was the strongest predictor of stroke. P wave area was associated with both an increased risk of AF and stroke. P wave morphology, such as notching – a likely indicator of left atrial enlargement – was found to be associated with incident stroke. Among several predictors of AF, P wave duration was one of the strongest predictors of AF incidence. However, it was not independently associated with higher stroke risk when continuous P wave duration was regressed with log–linear risk of stroke. In another study, a prolonged P wave interval of >120 ms was associated with higher risk of stroke; atrial late potentials (using signal-averaged ECG) were the strongest predictor (hazard ratio: 11.15) of AF detected within a 1-year poststroke follow-up. Signal-averaged ECGs require specialized equipment, high fidelity and for the patient to lie completely still for 3–5 min.
The use of these ECG markers for risk stratification and trials with antiplatelets/anticoagulants to reduce stroke risk in high-risk groups needs strong consideration.
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