Background. Atrial fibrillation (AF) is a significant stroke risk factor. Further research is needed to clarify whether higher atrial fibrillation burden (AFB) link to the elevated risk of ischemic embolism, and how AF burden could combine with CHA₂DS₂-VASc score to improve the anticoagulation strategy. We aim to evaluate if the AF burden characterized using 24-hours Holter ECG monitoring is associated with the risk of ischemic stroke. Methods. This cohort study enrolled 210 Holter ECG monitoring detected atrial fibrillation patients. The burden of atrial fibrillation was defined as the percentage of time in atrial fibrillation during the monitoring period, and the AF burden and CHA₂DS₂-VASc score were compared between patients with and without thromboembolic outcomes. Multivariate regressions were conducted to estimate the predictors of thromboembolic outcomes. Results. Eighteen thromboembolic events occurred within a median follow-up of 11.39 months. Patients with ischemic stroke had higher CHA₂DS₂-VASc scores but not higher AF burden. After adjusting for age, hypertension, diabetes, anticoagulation, antithrombotic therapy, AF burden, and AF with higher CHA₂DS₂-VASc score was associated with increased risk for ischemic stroke (hazard ratio (HR), 15.17). CHA₂DS₂-VASc score > 4.5 was a predictor of significantly higher risk of future stroke (AUC 0.92). Conclusions. In Holter ECG monitoring detected AF, AF burden does not significantly impact the subsequent risk of stroke; whereas, CHA₂DS₂-VASc scoring is still a robust predictor of stroke risk. This may illustrate that once AF is detected from Holter ECG monitoring, underlying risk factors appear to be more predictive of subsequent stroke risk than atrial fibrillation burden.

中文翻译：

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动态心电图如何预测心房颤动患者的中风？

背景。心房颤动 (AF) 是一个重要的卒中危险因素。需要进一步研究来阐明较高的心房颤动负荷 (AFB) 是否与缺血性栓塞风险升高有关，以及 AF 负荷如何与 CHA ₂ DS ₂ -VASc 评分相结合以改善抗凝策略。我们旨在评估使用 24 小时动态心电图监测表征的 AF 负担是否与缺血性卒中风险相关。方法。该队列研究招募了 210 名动态心电图监测检测到的心房颤动患者。房颤负担定义为监测期间房颤发生时间的百分比，以及房颤负担和 CHA ₂ DS ₂-VASc 评分在有和没有血栓栓塞结局的患者之间进行比较。进行多变量回归以估计血栓栓塞结果的预测因素。结果。在中位随访 11.39 个月内发生了 18 次血栓栓塞事件。缺血性卒中患者的 CHA ₂ DS ₂ -VASc 评分较高，但 AF 负担不高。在调整了年龄、高血压、糖尿病、抗凝、抗血栓治疗、AF 负担和具有较高 CHA ₂ DS ₂ -VASc 评分的 AF 与缺血性卒中风险增加相关（风险比 (HR)，15.17）。CHA ₂ DS ₂-VASc 评分 > 4.5 是未来卒中风险显着升高的预测因子（AUC 0.92）。结论。在动态心电图监测中检测到 AF，AF 负担不会显着影响随后的卒中风险；而 CHA ₂ DS ₂ -VASc 评分仍然是卒中风险的可靠预测指标。这可能说明，一旦从动态心电图监测中检测到 AF，潜在风险因素似乎比心房颤动负担更能预测随后的卒中风险。