Can Atrial Arrhythmias Predict Strokes?

TOPLINE:

Atrial arrhythmias were found in 26% of patients with sickle cell disease (SCD), with a significant association with stroke history. Early detection and treatment of atrial arrhythmias may help prevent strokes in this population.

METHODOLOGY:

• A total of 130 adult patients with SCD were included in the DREPACOEUR prospective registry from November 2018 to November 2022.
• The patients underwent a comprehensive cardiac evaluation, including 24-hour electrocardiogram monitoring, echocardiography, and laboratory tests.
• The primary endpoint was the occurrence of atrial arrhythmias, defined by excessive supraventricular ectopic activity or any recent history of atrial fibrillation.
• Patients with a history of stroke or transient ischemic attack were also included in the PCDREP prospective registry for further assessment.
• Written informed consent was collected from all participating patients, and the study was approved by the ethics committee.

TAKEAWAY:

• Atrial arrhythmias were found in 26% of patients with SCD, with a significant association with stroke history (P = .001).
• Age and left atrial volume were independently associated with atrial arrhythmias, with optimal cutoffs of 47 years and 55 mL/m², respectively.
• Patients with atrial arrhythmias had higher diastolic blood pressure, worse kidney function, and higher NT pro-BNP levels than those without arrhythmias.
• Atrial arrhythmias were associated with an increased risk for stroke unrelated to cerebral vasculopathy or other defined causes (odds ratio [OR], 6.6; P = .009).

IN PRACTICE:

“Atrial arrhythmias were found in 26% of patients with sickle cell anemia, with a significant association with stroke history,” wrote the authors of the study. In a commentary published concurrently, Jonathan Uniat, MD, of Children’s Hospital Los Angeles, Los Angeles, wrote, “Early detection and treatment of atrial arrhythmias may help prevent strokes in this population.”

SOURCE:

The study was led by Thomas d’Humiéres, Henri Mondor Hospital in Créteil, France. It was published online on November 12 in Blood Advances.

LIMITATIONS:

This study was a pilot prospective study and was underpowered with atrial arrhythmias occurring in only 34 patients. The population was relatively old for sickle cell anemia (45 years), and the study was biased because patients were selected based on clinical criteria indicative of underlying cardiovascular abnormalities. The population was heterogeneous in terms of antiarrhythmic therapy, and overall, at an advanced stage of the disease with frequent organ complications.

DISCLOSURES:

The study was supported by grants from FHU-SENEC. Pablo Bartolucci received grants from Addmedica, Fabre Foundation, Novartis, and Bluebird in the past 36 months; received consulting fees from Addmedica, Novartis, Roche, GBT, Bluebird, Emmaus, Hemanext, and Agios; received honoraria for lectures from Novartis, Addmedica, and Jazz Pharmaceuticals; and reported being a member of the Novartis steering committee and cofounder of Innovhem. Additional disclosures are noted in the original article.