Junctional bradycardia is a potential risk factor of stroke

Gwang Sil Kim, Jae Sun Uhm, Tae Hoon Kim, Hancheol Lee, Junbeom Park, Jin Kyu Park, Boyoung Joung, Hui Nam Pak, Moon Hyoung Lee

Research output: Contribution to journalArticle

Abstract

Background: This study aimed to determine the risk of thromboembolic events in patients with junctional bradycardia(JB). Methods: We retrospectively reviewed electrocardiograms(ECGs) for 380,682 patients. Those with JB on an ECG at least twice over a ≥3-month interval were included for analysis. We additionally included 138 CHADS2 score-matched patients(age, 68.4 ± 15.7 years; male, 52.2 %) in sinus rhythm as a control group. Between the JB patients(with or without retrograde P wave) and controls, we compared incidences of ischemic stroke and a composite of ischemic stroke, renal infarction, ischemic colitis, acute limb ischemia, and pulmonary embolism. Results: Among 380,682 patients (age, 47.6 ± 19.9 years; male, 49.3 %), 69 patients (age, 68.5 ± 16.5 years; male, 50.7 %) exhibited JB on an ECG at least twice over a ≥3-month interval; the overall prevalence of JB was 0.02 %. The mean follow-up period was 27.2 ± 26.2 months. Forty-five patients (65.2 %) in the JB group had no retrograde P wave. Ischemic stroke incidence was significantly higher in JB patients without a retrograde P wave than in controls (6/45 patients [13.3 %] and 3/138 patients [2.2 %], respectively; P = 0.007). The incidence of composite thromboembolic events was also significantly higher in JB patients without a retrograde P wave than in controls (8/45 patients [17.8 %] and 4/138 patients [2.9 %], respectively; P = 0.011). In a Cox proportional hazards model, JB patients without a P wave showed a greater incidence of stroke (hazard ratio, 8.89 [2.20-33.01], P = 0.007) than controls and JB patients with a P wave. Conclusions: Junctional bradycardia is potentially associated with ischemic stroke, particularly in the absence of an identifiable retrograde P wave.

Original languageEnglish
Article number113
JournalBMC neurology
Volume16
Issue number1
DOIs
Publication statusPublished - 2016 Jul 25

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Bradycardia
Stroke
Electrocardiography
Incidence
Ischemic Colitis
Pulmonary Embolism
Proportional Hazards Models
Infarction
Ischemia

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Kim, G. S., Uhm, J. S., Kim, T. H., Lee, H., Park, J., Park, J. K., ... Lee, M. H. (2016). Junctional bradycardia is a potential risk factor of stroke. BMC neurology, 16(1), [113]. https://doi.org/10.1186/s12883-016-0645-9
Kim, Gwang Sil ; Uhm, Jae Sun ; Kim, Tae Hoon ; Lee, Hancheol ; Park, Junbeom ; Park, Jin Kyu ; Joung, Boyoung ; Pak, Hui Nam ; Lee, Moon Hyoung. / Junctional bradycardia is a potential risk factor of stroke. In: BMC neurology. 2016 ; Vol. 16, No. 1.
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title = "Junctional bradycardia is a potential risk factor of stroke",
abstract = "Background: This study aimed to determine the risk of thromboembolic events in patients with junctional bradycardia(JB). Methods: We retrospectively reviewed electrocardiograms(ECGs) for 380,682 patients. Those with JB on an ECG at least twice over a ≥3-month interval were included for analysis. We additionally included 138 CHADS2 score-matched patients(age, 68.4 ± 15.7 years; male, 52.2 {\%}) in sinus rhythm as a control group. Between the JB patients(with or without retrograde P wave) and controls, we compared incidences of ischemic stroke and a composite of ischemic stroke, renal infarction, ischemic colitis, acute limb ischemia, and pulmonary embolism. Results: Among 380,682 patients (age, 47.6 ± 19.9 years; male, 49.3 {\%}), 69 patients (age, 68.5 ± 16.5 years; male, 50.7 {\%}) exhibited JB on an ECG at least twice over a ≥3-month interval; the overall prevalence of JB was 0.02 {\%}. The mean follow-up period was 27.2 ± 26.2 months. Forty-five patients (65.2 {\%}) in the JB group had no retrograde P wave. Ischemic stroke incidence was significantly higher in JB patients without a retrograde P wave than in controls (6/45 patients [13.3 {\%}] and 3/138 patients [2.2 {\%}], respectively; P = 0.007). The incidence of composite thromboembolic events was also significantly higher in JB patients without a retrograde P wave than in controls (8/45 patients [17.8 {\%}] and 4/138 patients [2.9 {\%}], respectively; P = 0.011). In a Cox proportional hazards model, JB patients without a P wave showed a greater incidence of stroke (hazard ratio, 8.89 [2.20-33.01], P = 0.007) than controls and JB patients with a P wave. Conclusions: Junctional bradycardia is potentially associated with ischemic stroke, particularly in the absence of an identifiable retrograde P wave.",
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Kim, GS, Uhm, JS, Kim, TH, Lee, H, Park, J, Park, JK, Joung, B, Pak, HN & Lee, MH 2016, 'Junctional bradycardia is a potential risk factor of stroke', BMC neurology, vol. 16, no. 1, 113. https://doi.org/10.1186/s12883-016-0645-9

Junctional bradycardia is a potential risk factor of stroke. / Kim, Gwang Sil; Uhm, Jae Sun; Kim, Tae Hoon; Lee, Hancheol; Park, Junbeom; Park, Jin Kyu; Joung, Boyoung; Pak, Hui Nam; Lee, Moon Hyoung.

In: BMC neurology, Vol. 16, No. 1, 113, 25.07.2016.

Research output: Contribution to journalArticle

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T1 - Junctional bradycardia is a potential risk factor of stroke

AU - Kim, Gwang Sil

AU - Uhm, Jae Sun

AU - Kim, Tae Hoon

AU - Lee, Hancheol

AU - Park, Junbeom

AU - Park, Jin Kyu

AU - Joung, Boyoung

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

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N2 - Background: This study aimed to determine the risk of thromboembolic events in patients with junctional bradycardia(JB). Methods: We retrospectively reviewed electrocardiograms(ECGs) for 380,682 patients. Those with JB on an ECG at least twice over a ≥3-month interval were included for analysis. We additionally included 138 CHADS2 score-matched patients(age, 68.4 ± 15.7 years; male, 52.2 %) in sinus rhythm as a control group. Between the JB patients(with or without retrograde P wave) and controls, we compared incidences of ischemic stroke and a composite of ischemic stroke, renal infarction, ischemic colitis, acute limb ischemia, and pulmonary embolism. Results: Among 380,682 patients (age, 47.6 ± 19.9 years; male, 49.3 %), 69 patients (age, 68.5 ± 16.5 years; male, 50.7 %) exhibited JB on an ECG at least twice over a ≥3-month interval; the overall prevalence of JB was 0.02 %. The mean follow-up period was 27.2 ± 26.2 months. Forty-five patients (65.2 %) in the JB group had no retrograde P wave. Ischemic stroke incidence was significantly higher in JB patients without a retrograde P wave than in controls (6/45 patients [13.3 %] and 3/138 patients [2.2 %], respectively; P = 0.007). The incidence of composite thromboembolic events was also significantly higher in JB patients without a retrograde P wave than in controls (8/45 patients [17.8 %] and 4/138 patients [2.9 %], respectively; P = 0.011). In a Cox proportional hazards model, JB patients without a P wave showed a greater incidence of stroke (hazard ratio, 8.89 [2.20-33.01], P = 0.007) than controls and JB patients with a P wave. Conclusions: Junctional bradycardia is potentially associated with ischemic stroke, particularly in the absence of an identifiable retrograde P wave.

AB - Background: This study aimed to determine the risk of thromboembolic events in patients with junctional bradycardia(JB). Methods: We retrospectively reviewed electrocardiograms(ECGs) for 380,682 patients. Those with JB on an ECG at least twice over a ≥3-month interval were included for analysis. We additionally included 138 CHADS2 score-matched patients(age, 68.4 ± 15.7 years; male, 52.2 %) in sinus rhythm as a control group. Between the JB patients(with or without retrograde P wave) and controls, we compared incidences of ischemic stroke and a composite of ischemic stroke, renal infarction, ischemic colitis, acute limb ischemia, and pulmonary embolism. Results: Among 380,682 patients (age, 47.6 ± 19.9 years; male, 49.3 %), 69 patients (age, 68.5 ± 16.5 years; male, 50.7 %) exhibited JB on an ECG at least twice over a ≥3-month interval; the overall prevalence of JB was 0.02 %. The mean follow-up period was 27.2 ± 26.2 months. Forty-five patients (65.2 %) in the JB group had no retrograde P wave. Ischemic stroke incidence was significantly higher in JB patients without a retrograde P wave than in controls (6/45 patients [13.3 %] and 3/138 patients [2.2 %], respectively; P = 0.007). The incidence of composite thromboembolic events was also significantly higher in JB patients without a retrograde P wave than in controls (8/45 patients [17.8 %] and 4/138 patients [2.9 %], respectively; P = 0.011). In a Cox proportional hazards model, JB patients without a P wave showed a greater incidence of stroke (hazard ratio, 8.89 [2.20-33.01], P = 0.007) than controls and JB patients with a P wave. Conclusions: Junctional bradycardia is potentially associated with ischemic stroke, particularly in the absence of an identifiable retrograde P wave.

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Kim GS, Uhm JS, Kim TH, Lee H, Park J, Park JK et al. Junctional bradycardia is a potential risk factor of stroke. BMC neurology. 2016 Jul 25;16(1). 113. https://doi.org/10.1186/s12883-016-0645-9