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AF and stroke or stroke and AF?
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Introdução: Existe alguma controvérsia relativamente à etiologia da fibrilhação auricular (FA) primeiramente detetada após um acidente vascular cerebral (AVC) isquémico. Existem duas hipóteses atualmente colocadas: FA pré-existente ser a causa do AVC (hipótese cardiogénica), ou FA ser consequência do AVC (hipótese neurogénica). Estas duas entidades podem diferir em inúmeros parâmetros, pelo que é importante distingui-las.
Objetivos: Avaliar se os doentes diagnosticados com FA após um AVC isquémico apresentavam alterações do ritmo cardíaco prévias ao AVC que poderiam estar associadas a um maior risco de desenvolver FA, o que suportaria a hipótese cardiogénica.
Metodologia: Realizámos um estudo caso-controlo que incluiu doentes admitidos na Unidade de AVC do Hospital de Santa Maria entre 2009 e 2019 com o diagnóstico de AVC isquémico. De forma a ser incluídos, os doentes tinham de apresentar um registo Holter ECG 24h realizado antes da ocorrência do AVC. Foram excluídos doentes com o diagnóstico de FA prévio ao AVC. Os casos corresponderam aos doentes que desenvolveram FA nos primeiros cinco dias após o AVC, enquanto os controlos consistiram nos doentes que se mantiveram em ritmo sinusal. Recolhemos dados relativos ao sexo, idade, medicação, antecedentes pessoais, território do AVC e tempo decorrido entre a realização do exame Holter e o AVC. Os dois grupos foram comparados com base nos domínios do tempo (HR, pNN50, RMSSD, VarIndex, SDANN) e frequência (total power, VLF, LF, HF, LF/HF) dos Holter ECG.
Resultados: Foram incluídos 9 casos e 11 controlos. Os casos apresentavam idade superior aos controlos. Não existiram outras diferenças estatisticamente significativas entre os dois grupos, nomeadamente nos domínios do tempo e frequência dos registos Holter ECG.
Conclusões: A ausência de alterações prévias nos registos Holter dos doentes que desenvolveram FA nos primeiros dias após o AVC apoia a hipótese neurogénica.
Introduction: There is some controversy regarding the etiology of atrial fibrillation (AF) first detected after ischemic stroke. Currently, there are two proposed hypotheses: AF as the cause of stroke and therefore pre-existing (cardiogenic) or AF as a stroke consequence (neurogenic). These two entities may differ in many parameters, thus it is important to distinguish them. Objectives: To assess if patients diagnosed with AF after an ischemic stroke had previous heart rhythm changes that could be associated with a higher risk of developing AF supporting the cardiogenic hypothesis. Methods: We performed a case-control study which included patients admitted to the stroke unit of Santa Maria’s Hospital from 2009 to 2019, with the diagnosis of ischemic stroke. In order to be included patients had to have a 24h ECG Holter monitoring performed before stroke occurrence. We excluded patients with a diagnosis of AF previous to the stroke. Our cases were patients that developed AF in the first five days after stroke. Controls were patients that maintained sinus rhythm. We collected data regarding sex, age, medication, personal history, stroke territory and time before stroke of Holter recording. We compared the two groups regarding time (HR, pNN50, RMSSD, VarIndex, SDANN) and frequency (total power, VLF, LF, HF, LF/HF) domains of the ECG Holters. Results: The study included 9 cases and 11 controls. Cases were older than controls. There were no other statistical differences between the two groups namely regarding time or frequency domains of the ECG Holters. Conclusions: The absence of previous changes in the ECG Holters of patients that developed AF in the first days after stroke supports the neurogenic hypothesis.
Introduction: There is some controversy regarding the etiology of atrial fibrillation (AF) first detected after ischemic stroke. Currently, there are two proposed hypotheses: AF as the cause of stroke and therefore pre-existing (cardiogenic) or AF as a stroke consequence (neurogenic). These two entities may differ in many parameters, thus it is important to distinguish them. Objectives: To assess if patients diagnosed with AF after an ischemic stroke had previous heart rhythm changes that could be associated with a higher risk of developing AF supporting the cardiogenic hypothesis. Methods: We performed a case-control study which included patients admitted to the stroke unit of Santa Maria’s Hospital from 2009 to 2019, with the diagnosis of ischemic stroke. In order to be included patients had to have a 24h ECG Holter monitoring performed before stroke occurrence. We excluded patients with a diagnosis of AF previous to the stroke. Our cases were patients that developed AF in the first five days after stroke. Controls were patients that maintained sinus rhythm. We collected data regarding sex, age, medication, personal history, stroke territory and time before stroke of Holter recording. We compared the two groups regarding time (HR, pNN50, RMSSD, VarIndex, SDANN) and frequency (total power, VLF, LF, HF, LF/HF) domains of the ECG Holters. Results: The study included 9 cases and 11 controls. Cases were older than controls. There were no other statistical differences between the two groups namely regarding time or frequency domains of the ECG Holters. Conclusions: The absence of previous changes in the ECG Holters of patients that developed AF in the first days after stroke supports the neurogenic hypothesis.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Acidente vascular cerebral Fibrilhação auricular Inflamação Holter ECG 24h Sistema nervoso autónomo Neurologia