Signal averaged electrocardiogram can detect the arrhythmogenic potential of right insular stroke

초록

Purpose : The right insular cortical lesion is believed to have arrhythmogenic potential such as secondary atrial fibrillation(AF). The P wavetriggered signalaveraged electrocardiogram(SAECG) can detect the P wave dispersion which is related to the risk of AF. However, there has been no relevant study and we investigated the P wave dispersion after stroke involving right insular cortex. Methods : We recruited consecutive acute stroke patients who admitted from February 2012 to October 2013 and took routine workup with SAECG. Patients who had AF on admission were excluded. SAECG was followed up two years after stroke onset. Significant Pwave dispersion of ‘Pwave duration (PWD) >125msec’ was defined as predictor of future AF risk. We analyzed the difference of SAECG between the right insular cortex lesion and other stroke. Results : A total of 252 subjects were enrolled and 49 among them had right insular involvement. Follow up SAECG were available in 69 patients. In acute stroke period, the patients with right insular lesion had longer P wave duration than the other stroke patients (154.0+29.6 vs. 133.5+26.5 ms, p<0.001). In the patients with right insular lesion, prolonged P wave duration in acute period was shortened again in follow up SAECG after two years (n=17, 164.5+35.2 vs. 131.7+22.3 ms, p=0.003). However, other stroke patients did not show such interval change. Conclusions : Our result suggests that the right insular lesion is related to increased P wave dispersion transiently in acute stroke period and this might explain the development of secondary AF after right insular cortex stroke.