Increased periodic repolarization dynamics and supraventricular premature complexes frequency independently predicted atrial fibrillation detected after ischemic stroke and significantly improved risk prediction compared with the clinical CHASE-LESS score.
AFDAS occurred in 9.5% of acute ischemic stroke patients during a median follow-up of 17 months.
Patients who developed AFDAS had significantly higher PRD values than those who did not.
PRD independently predicted AFDAS in multivariable Cox regression analysis.
Supraventricular premature complexes frequency independently predicted AFDAS in multivariable Cox regression analysis.
A model combining PRD and supraventricular premature complexes per hour showed significantly better discrimination for AFDAS than the CHASE-LESS clinical score alone.
The study enrolled patients prospectively from the STROKE-CARD cohort between February 2021 and May 2023.
This research suggests that a novel heart rhythm measurement called Periodic Repolarization Dynamics (PRD) — which captures irregular fluctuations in the heart's electrical recovery phase linked to the nervous system — can help identify stroke patients who are likely to develop atrial fibrillation (an irregular heartbeat) after their stroke. The study followed 263 stroke patients for a median of about 17 months and found that roughly 1 in 10 developed this condition, known as atrial fibrillation detected after stroke (AFDAS). Patients who later developed AFDAS had nearly double the PRD values of those who did not, and PRD remained a significant predictor even after accounting for other risk factors. The researchers also found that the frequency of premature heartbeats originating in the upper chambers of the heart (supraventricular premature complexes) was another independent predictor of AFDAS. When PRD and premature heartbeat frequency were combined into a single prediction model, it outperformed a standard clinical risk score (the CHASE-LESS score) by a substantial margin — achieving an accuracy measure (AUC) of 0.82 compared to 0.67 for the clinical score alone. This research suggests that a simple, non-invasive 30-minute ECG recording performed within days of a stroke could meaningfully improve doctors' ability to identify which patients are most at risk of developing atrial fibrillation afterward. This matters because undetected atrial fibrillation after stroke is associated with a higher risk of recurrent stroke, and earlier detection could open the door to timely preventive treatments. Both PRD and premature heartbeat counts could potentially be added to existing clinical tools to improve patient monitoring and care decisions after stroke.
Schreinlechner M, Pavluk D, Mayer-Suess L, Hofer F, Theurl F, Maßmann C, et al.. (2026). Periodic Repolarization Dynamics Predicts Newly Detected Atrial Fibrillation After Stroke.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.049771