Welcome to the ESOC 2021 Virtual Conference Calendar
The Conference will officially run on Central European Summer Time (GMT/UTC+2). To convert the conference time to your local time - Click Here
The viewing of sessions cannot be accessed from this conference calendar.
All sessions are accessible via the Main Lobby on the Virtual Platform.
ESOC TV 
On Demand Session (watch anytime) 
Pre-recorded Session with Live Q&A
Session with Voting 
Live Session
Introduction by the Convenors
PREDICTORS OF ATRIAL FIBRILLATION IN PATIENTS WITH LARGE AND SMALL VESSEL ISCHEMIC STROKE: INSIGHTS FROM THE STROKE AF STUDY
Abstract
Group Name
The STROKE AF Investigators
Background And Aims
The STROKE AF trial found that approximately 1 in 8 patients with recent ischemic strokes attributed to large or small vessel disease had atrial fibrillation (AF) detected by an insertable cardiac monitor (ICM) at 12 months. We investigated demographic, electrocardiographic, and echocardiographic predictors of AF in this population.
Methods
Patients randomized to the ICM arm of the STROKE AF study were included. The device automatically detects AF episodes ≥2 minutes and episodes were adjudicated by an expert committee. Cox regression multivariable modelling included all parameters identified in the univariate analysis having p-values <0.1. AF detection rates were calculated using Kaplan-Meier survival estimates.
Results
Among 240 ICM patients (66.6±9.3 years, 60.0% male) who were included and followed for 11.0±3.0 months, 27 developed AF. Univariate predictors of AF detection included age, CHA2DS2VASc score, chronic obstructive pulmonary disease, congestive heart failure (CHF), left atrial (LA) diameter and volume, QRS duration, and renal dysfunction. Upon multivariable modeling (n=110), only CHF (HR 5.69 [1.45-22.31], p=0.013) and LA volume (HR 1.45 per 10mL [1.12-1.88], p=0.005) remained significant predictors of AF. At 12 months, patients with CHF or LA volume enlargement (40 of 142 patients) had an AF detection rate of 36.4% vs 5.3% for patients with neither attribute (p<0.001).
Conclusions
Among patients with ischemic strokes ascribed to large or small vessel disease, CHF and LA volume were associated with a significantly increased risk of AF. These patients may benefit most from the use of ICMs as part of a secondary stroke prevention strategy.
Trial Registration Number
ClinicalTrials.gov Identifier: NCT02700945
PATHOLOGICAL ECG FINDINGS IN HOSPITALIZED PATIENTS WITH STROKE OR TIA – A SUB-ANALYSIS OF THE MONDAFIS STUDY
Abstract
Background And Aims
Patients with acute ischemic stroke often have cardiac co-morbidities and are susceptible to stroke-induced cardiac damage. However, data on the prevalence of ECG abnormalities during extended monitoring in hospitalized patients with acute stroke are scarce.
Methods
The MonDAFIS study was an investigator-initiated, open-label, randomized, multicenter study (Haeusler et al; Lancet Neurol., in press). Overall, 3,470 patients with ischemic stroke or TIA without known atrial fibrillation (AF) were randomized 1:1 to Holter-ECG recording for up to 7days in hospital or to standard diagnostic care and were followed for 24months. Here, we report on pre-defined “relevant ECG findings” in the intervention group.
Results
Relevant findings were identified in 326(19.3%)/1,693 patients (median age 73 years, 38.3% female sex, median NIHSS score on admission 3(IQR 1-5) points) during median ECG recording of 143.2hours (IQR 93.5–168.0). Of the 326 patients with relevant ECG findings, 90(27.6%) had more than one relevant finding (Table), 19(5.8%) received a pacemaker and 43(13.2%) were anticoagulated at hospital discharge.
| Pathological ECG findings | Definition | Detection rate of relevant findings in 1,693 patients according to duration of Holter-ECG monitoring | ||
| ≤24hours | ≤72hours | ≤7days | ||
| Atrial fibrillation | ≥30sec | 37(2.2%) | 58(3.4%) | 76(4.5%) |
| Supraventricular tachycardia | >180bpm, <30sec | 27(1.6%) | 47(2.8%) | 61(3.6%) |
| Non-sustained ventricular tachycardia | 4-30beats, >100bpm | 17(1.0%) | 38(2.2%) | 50(3.0%) |
| Ventricular run | 4-30beats, ≤100bpm | 63(3.7%) | 130(7.7%) | 165(9.7%) |
| Pauses (intermediate) | >2sec, <5sec | 20(1.2%) | 32(1.9%) | 49(2.9%) |
| Pauses | ≥5sec | 5(0.3%) | 8(0.5%) | 9(0.5%) |
| AV-block 2nd | type I and II | 6(0.4%) | 13(0.8%) | 16(0.9%) |
Conclusions
Relevant ECG abnormalities are frequently found after ischemic stroke/TIA. A correlation with clinical endpoints will be presented at the ESO Conference 2021.
Trial Registration Number
NCT02204267
ACUTE ISCHEMIC STROKE DESPITE ANTICOAGULANT THERAPY IN PATIENTS WITH ATRIAL FIBRILLATION – COMPETING CAUSES, QUALITY OF ANTICOAGULATION ON HOSPITAL ADMISSION AND SECONDARY PREVENTION STRATEGIES
Abstract
Background And Aims
Knowledge about assumed causes and subsequent treatment in patients with atrial fibrillation (AF) and ischemic stroke despite anticoagulant therapy is limited.
Methods
Retrospective analysis of patients with known AF and acute ischemic stroke despite therapy with vitamin-K-antagonists(VKA) or direct oral anticoagulants(DOAC). We determined probable stroke cause(s) as either (a)competing etiology other than AF (e.g. large artery atherosclerosis), (b)medication error (subtherapeutic DOAC-level or off-label DOAC-dosing/INR<2.0 or reported non-adherence) or (c)cardoembolic stroke despite anticoagulation (absence of medication error and competing etiology) and subsequent prevention therapies. The composite of recurrent ischemic stroke, intracranial hemorrhage, or all-cause death was assessed at 3 months.
Results
We analyzed 2,949 patients from 11 centers (age 81years, IQR[76-86], 48%Female, NIHSS 6,IQR[2-14], 57% DOAC, 913 with DOAC-levels, median CHA2DS2-VASc score 4,IQR[4,6]). Of those, 24% had competing etiology (DOAC vs VKA: 28% vs 20%, aOR1.3, 95%CI 0.96-1.7), 32% medication error (23% vs 43%, aOR0.5,95%CI 0.4–0.6) and 44% cardoembolic stroke despite anticoagulation(49% vs 37%, aOR1.6,95%CI 1.2-2.1). After index stroke, anticoagulant drug was changed in 45.8% of patients(1317/2877), antiplatelets were added in 7.1% (203/2873), 3.4% (94/2776) received carotid revascularization therapies and 1%(17/1764) underwent left atrial appendage occlusion. Eight centers collected 3-month outcome data (2,084 patients). In those, stroke recurred in 4.6% (84/1844; completeness 88.5%). The composite outcome occurred in 27% (516/1908, completeness 91.6%), and no specific prevention strategy reduced its odds.
Conclusions
Stroke despite anticoagulation comprises heterogeneous causes with 1/3 of strokes potentially preventable and 1/4 attributable to competing etiologies. Recurrence rate is high and the optimal secondary prevention strategy needs to be determined.
Trial Registration Number
Not applicable
STANDALONE TOTALLY THORACOSCOPIC LEFT APPENDAGE EXCLUSION FOR STROKE PREVENTION AND CONTRAINDICATION TO ANTICOAGULATION AND ANTIPLATELET THERAPY: A REFERRAL CENTRE EXPERIENCE
Abstract
Background And Aims
The most appropriate treatment for stroke prevention in stand-alone atrial fibrillation patients with a high CHA2DS2VASC and HAS BLED score contraindicated for oral anticoagulation still needs to be defined. Percutaneous left atrial appendage (LAA) closure devices because of their endocardial positioning need a period of antiplatelet therapy( APT). This study aimed to evaluate safety and efficacy of epicardial left atrial appendage clipping in patients contraindicated for (N)OAC and APT therapy.
Methods
80 patients with non valvular AF and contraindication to oral anticoagulation (47 cerebral hemorrhages,20 GI bleeding, 5 non cerebral/GI bleeding requiring multiple transfusions, 8 anatomy unsuitable for percutaneous closure, 75%male, patients age ranged 53-87years,mean CHAD-VASC 6.4,mean HASBLED range 4.7, underwent standalone totally thoracoscopic appendage exclusion. All patients were not on anticoagulation nor antiplatelet therapy from the time of surgery to latest follow up. Follow up (range 12-48 months) included outpatient visit and CT scan at 3-6-12 month. Perioperative mortality, early and late morbidity and freedom from neurological events were analyzed by chart evaluation and full outpatient neurological examination.
Results
Mean duration of surgery was 41.4 minutes. There were no deaths nor procedure related morbidities. At CT scan 100% of patients had complete exclusion of the left appendage. Freedom from neurological events in all patients was documented in absence of anticoagulation or antiplatelet regime from the time of surgery to the latest follow up visit.
Conclusions
Standalone thoracoscopic epicardial LAA clipping is safe and potentially effective for stroke prevention in patients contraindicated for anticoagulant or antiplatelet therapy.
Trial Registration Number
not applicable
THE ROLE OF ELECTROCARDIOGRAPHIC MARKERS FOR PREDICTION OF ATRIAL FIBRILLATION IN PATIENTS WITH ACUTE ISCHEMIC STROKE: DATA FROM THE BIOSIGNAL COHORT STUDY
Abstract
Background And Aims
We assessed pre-selected ECG parameters after acute ischemic stroke (AIS) and their value for predicting newly diagnosed atrial fibrillation (NDAF) after admission and up to 365 days after the index AIS.
Methods
We measured P-wave alterations on 12-lead ECG on admission in all patients without known AF consecutively enrolled in the University Hospital Zurich from October 2014 – 2017 as part of the prospective BIOSIGNAL cohort study (Biomarker signature of stroke etiology, NCT02274727). The outcome of interest was NDAF, identified by prolonged electrocardiographic monitoring within 1 year after the AIS. To address potential bias by missing values, models with and without multiple imputation were analyzed. 10-fold cross-validation was performed to better estimate the accuracy of the best predictive model.
Results
NDAF was detected in 63 (7.6%) of 830 eligible patients during a follow-up of 365 days. Out of the pre-selected ECG parameters only advanced interatrial block (aIAB) (OR 5.90, 95% CI 3.35 – 10.38; p<0.001) was independently associated with NDAF in univariable analysis and multivariable analysis with and without multiple imputation. Adding aIAB to the best multivariable regression model improved the discriminatory accuracy from an AUC of 0.73 (95%-CI 0.71 – 0.75) to 0.80 (95%-CI 0.78 – 0.82, p<0.001). The inter-rater reliability for aIAB was excellent with an α of 0.84 (95%-CI 0.69 – 1.00).
Conclusions
AiAB in 12-lead surface ECG during sinus rhythm is independently associated with NDAF in patients with AIS and can be used as a screening tool to improve diagnostic stroke work-up to search for AF.
Trial Registration Number
NCT02274727
PREDICTING NEW BRAIN INFARCTS OR CLINICAL STROKES IN PATIENTS WITH ATRIAL FIBRILLATION
Abstract
Group Name
on behalf of the Swiss-AF Investigators
Background And Aims
Brain infarcts are very common in patients with atrial fibrillation (AF) on systematic magnetic resonance imaging (MRI). We aimed to create a multimodal model to predict new brain infarcts or stroke during two years of follow-up.
Methods
Swiss-AF is a prospective, multicentre cohort study of patients with known AF. We included patients with available brain MRI at enrolment and after 2-years of follow-up. The primary outcome was a composite of any new brain infarct (small non-cortical infarcts and large non-cortical or cortical infarcts) on the follow-up MRI and/or a clinically identified stroke. To predict the primary outcome, we built a multivariable logistic regression model including prespecified clinical, biomarker and baseline MRI variables.
Results
We included 1,232 patients, 89.8% of them taking oral anticoagulants (OAC). The primary outcome occurred in 78 patients (6.3%). The following baseline variables were significantly associated with the primary outcome in the multivariable model: white matter lesion volume (aOR 1.89, 95%CI 1.43-2.55), N-terminal-pro hormone B-type natriuretic peptide (aOR 2.01, 95%CI 1.21-3.44), and heart-type fatty acid binding protein (aOR 0.49, 95%CI 0.31-0.77). Brain infarcts on baseline MRI tended to be associated with the primary endpoint (aOR 1.85, 95%CI 0.97-3.60). The area-under-the-curve (AUC) of the model was 0.82 (95%CI 0.77-0.87), the AUC of the CHA2DS2-VASc score was 0.64 (95%-CI 0.58-0.70) (figure).
Conclusions
A combined clinical-biomarker-MRI model is superior to the CHA2DS2-VASc score in predicting new brain infarcts or stroke over a 2-year of follow-up.
Trial Registration Number
Not applicable
INCIDENCE AND CASE-FATALITY OF HEMORRHAGIC STROKE IN PATIENTS WITH ATRIAL FIBRILLATION: A NATIONWIDE REGISTRY-BASED COHORT STUDY
Abstract
Background And Aims
There are limited population-based data on the epidemiology of hemorrhagic stroke in patients with atrial fibrillation (AF). We aimed to describe hemorrhagic stroke incidence and case-fatality among patients with atrial fibrillation in Finland.
Methods
The Finnish AntiCoagulation in Atrial Fibrillation is a nationwide retrospective registry-linkage database of patients diagnosed with AF between 2004-2018 in Finland. To assess temporal trends, we compared two time periods, 2009-2013 and 2014-2018, with a minimum of 1-year follow-up. Patients with a prior diagnosis of any intracranial hemorrhage during a minimum look-back time of 5 years were excluded. Crude incidence rates and 30-day case-fatality were calculated for subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH).
Results
In years 2009-2013, 85,000 patients (49% female) contributed a total of 219,506 person-years. Crude incidence rate for SAH was 0.33 (95% confidence interval 0.26-4.18) and for ICH 2.28 (2.08-2.49) per 1,000 person-years, respectively. The 30-day case-fatality was 36% (26-48%) and 28% (25-33%), respectively. In years 2014-2018, 90,569 patients contributed altogether 238,631 person-years. Crude incidence rate for SAH was 0.38 (0.30-0.46) and for ICH 2.69 (2.48-2.90) per 1,000 person-years, respectively. The 30-day case-fatality was 23% (26-34%) for SAH and 23% (20-27%) for ICH.
Conclusions
In this population-based nationwide study, we observed an increasing incidence of both SAH and ICH in patients with AF during the last decade. However, 30-day mortality from hemorrhagic stroke decreased, particularly that of SAH.