Left Atrial Volume Index Predicts Recurrence of Stroke in Patients with Nonsustained Atrial Tachycardia

Background: Nonsustained atrial tachycardia (NSAT) is known to appear more frequently in patients with paroxysmal atrial fibrillation (AF). Enlarged left atrium (LA) is considered to be an independent risk factor for newly diagnosed AF. Methods: We investigated the risk factors for predicting the stroke recurrence in NSAT patients. In total, 252 patients (114 women, mean 70 +/- 11 years) with acute ischemic stroke and documented NSAT in 24-hour Holter monitoring were enrolled and followed. All patients underwent echo-Doppler evaluations. Results: During a mean follow-up period of 35 +/- 31 months, the stroke recurrence rate was 11.1% (28 of 252). The patients with recurrence (n = 28) had higher left atrium volume index (LAVI, P < .001) and higher E/e' (P = .028) compared with those without recurrence (n = 224). On the Kaplan-Meier survival analysis, stroke recurrence rate was significantly higher in patients with enlarged LA (LAVI >28 mm(3)/m(2); P < .001 by the log-rank test), and it remained significant in multivariate analysis (hazard ratio, 1.154; 95% confidence interval [CI], 1.099-1.212, P < .001). Conclusions: In patients with acute ischemic stroke and NSAT, enlarged LA predicts an increased risk of stroke recurrence. This study supports the necessity of prolonged rhythm monitoring in stroke patients with NSAT and enlarged LA to detect undiagnosed AF and consequently considering anticoagulation therapy.