P-wave dispersion and left atrial indices as predictors of paroxysmal atrial fibrillation in patients with non hemorrhagic cerebrovascular strokes and transient ischemic attacks

Abstract Background One-third of stroke and Transient Ischemic Attack (TIA) are cryptogenic requiring additional investigation and intervention. Occult Paroxysmal Atrial Fibrillation (PAF) has been suggested as a possible cause for these cryptogenic strokes. Objective The aim of our study is to evaluate the role of simple ECG & bedside echocardiographic parameters for prediction of PAF in patients presenting with stroke or TIAs. Patients & methods The study included 60 patients with non hemorrhagic stroke. During 1 week of continuous ICU monitoring, 30% of patients had PAF (group 1), the remaining 42 patients did not develop PAF (group 2). All patients were subjected to detailed history taking, thorough clinical examination including NIHSS, serial ECGs for calculation of maximum and minimum P wave duration (P max , and P min ) & P wave dispersion (P dis ), and transthoracic echocardiography for calculation of left atrial volume (LAV), and left atrial volume index (LAVI). Results It was found that P max & P dis were significantly higher in group 1 in comparison to group 2 (147.7 ± 9.6 mm vs 114.3 ± 9 mm, P : P : P : 2 /m 2 vs 20.1 ± 8 mm 2 /m 2 , P : max , P dis , and LAVI were the most significant independent predictors of PAF. Conclusion PAF is a possible etiology of patients with ischemic cerebrovascular accidents patients even in those who had normal sinus rhythm on admission. P max  ⩾ 125 mm, P dis  ⩾ 40 mm, and LAVI ⩾ 24 are highly significant predictors of PAF with PPV of 99%, 96% and 78%, respectively, sensitivity of 98%, 94% and 89%, respectively, specificity 96%, 93% and 75%, respectively and AUC of 0.99, 0.98 and 0.87, respectively.