Excessive Supraventricular Ectopic Activity after Stroke or TIA may Predict Atrial Fibrillation, reveals study

The MonDAFIS study assessed the value of standardized monitoring, including prolonged Holter ECG, in the diagnosis of AF in patients with acute ischemic stroke or TIA without prior AF. The secondary outcomes evaluated included recurrent stroke, myocardial infarction, major bleeding, and all-cause death at 24 months. The MonDAFIS trial was a multicenter, investigator-initiated, prospective, open-label study. A total of 3,465 patients with acute ischemic stroke or TIA without known AF were randomized 1:1 into two groups:

• Usual diagnostic procedures for AF detection.

• Additive Holter monitoring for up to 7 days, analyzed in a core laboratory.

 Among the 1,714 patients in the intervention group, 1,435 (84.8%) completed analyzable ECG monitoring of at least 48 hours within the first 72 hours. ESVEA was defined as ≥480 ectopic supraventricular beats per day, atrial runs lasting 10-29 seconds, or both. Patients were categorized into three groups:

• ESVEA-positive.

• Newly diagnosed AF.

• Neither ESVEA nor AF (non-ESVEA/AF).

Results

• Detection of ESVEA and AF:

• ESVEA was identified in 363 patients (25.3%).

• AF newly diagnosed at 48 patients (3.3%) at initial monitoring.

Follow-Up AF Detection:

• ESVEA was associated with newly diagnosed AF at 24 months in 67 patients (18.5%).

• In comparison, newly diagnosed AF was found in only 60 patients (5.9%) without ESVEA or AF (p<0.001).

Composite End Points:

• The composite end point at 24 months: recurrent stroke, myocardial infarction, major bleeding, or all-cause death was not different between the group ESVEA (15.2%) and the non-ESVEA/AF group (12.6%, p=0.242).

Mortality Trends:

• The death rate from any cause was more in the ESVEA group (6.6%) as compared to the non-ESVEA/AF group at 3.2%, and this was statistically insignificant (p=0.433).

Involvement of the supraventricular ectopic activity in an excessive amount in the acute phase of ischemic stroke or TIA was strongly associated with future detection of AF. This underlines its utility as a predictive marker, enabling targeted monitoring and improving long-term outcomes for high-risk patients.

Reference:

Haeusler KG, Tütüncü S, Fiessler C, Jawad-Ul-Qamar M, Kunze C, Schurig J, Dietzel J, Krämer M, Petzold GC, Royl G, Helberg T, Thomalla G, Nabavi DG, Röther J, Laufs U, Veltkamp R, Heuschmann PU, Kirchhof P, Olma MC, Endres M. Excessive Supraventricular Ectopic Activity in Patients With Acute Ischemic Stroke Is Associated With Atrial Fibrillation Detection Within 24 Months After Stroke: A Predefined Analysis of the MonDAFIS Study. J Am Heart Assoc. 2025 Jan 10:e034512. doi: 10.1161/JAHA.123.034512. Epub ahead of print. PMID: 39791425.