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Electrophysiological Ventricular Substrate of Stroke: a Prospective Cohort Study in the ARIC cohort.

Updated: Sep 3, 2021

Our manuscript is accepted for publication and published 9-3-21 in BMJ Open.

Our large prospective cohort study uncovered the electrophysiological ventricular substrate of stroke, reflecting the development of cardiac memory. In patients with ischemic stroke, cardiac memory was developed in response to PVCs. In patients with intracerebral hemorrhage, cardiac memory was developed in response to the transient tachycardia-dependent intermittent bundle branch block (TD-IBBB), suggesting an implication of amyloidosis. Our results suggest that the search for the sources of cardioembolic stroke should include an assessment of the PVC burden. Randomized clinical trials of the ablation of PVCs as a possible prevention strategy for a cardioembolic stroke of the uncertain source should be considered. The monitoring of cardiac memory on ECG may be useful to guide short-term dual antiplatelet therapy for prevention of ischemic stroke. TD-IBBB should be further studied as a marker of ICH risk, increasing clinical suspicion for cardiac amyloidosis.

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