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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 
 BMC NEUROLOGY, Vol.16 : 113, 2016 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Atrial Fibrillation/diagnosis ; Bradycardia/diagnosis* ; Brain Ischemia/diagnosis ; Case-Control Studies ; Colitis, Ischemic/diagnosis ; Electrocardiography/methods ; Extremities/blood supply ; Female ; Follow-Up Studies ; Humans ; Infarction/diagnosis ; Ischemia/diagnosis ; Kidney/blood supply ; Male ; Middle Aged ; Pulmonary Embolism/diagnosis ; Retrospective Studies ; Risk Factors ; Stroke/diagnosis* ; Thromboembolism/diagnosis
Junctional bradycardia ; Stroke ; Thromboembolic events
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.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Gwang Sil(김광실)
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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