ABSTRACT NUMBER: ESOC2026A751 EXCESSIVE SUPRAVENTRICULAR ECTOPIC ACTIVITY AND NEW-ONSET ISCHEMIC STROKE: A RETROSPECTIVE COHORT STUDY

Abstract Background and aims Excessive supraventricular ectopic activity (ESVEA), a marker of paroxysmal atrial fibrillation (pAF) and atrial cardiomyopathy, may predict cryptogenic ischemic stroke earlier than pAF. This study aimed to explore the link between ESVEA and the risks of new-onset ischemic stroke and all-cause mortality in an Asian population and identify its predictive threshold. Methods This study collected data from 446 patients without a history of atrial fibrillation or stroke across three hospitals in China. Based on 24-hour ambulatory ECG monitoring, patients in the top 15% of the cohort were classified as the ESVEA group, while the rest were the non-ESVEA group. A Cox regression, with age modeled as a time-dependent covariate, was used to compare the incidence of new-onset ischemic stroke and all-cause mortality between the two groups during follow-up. Results The median follow-up duration was 13 months. After adjusting for confounding factors, ESVEA was significantly associated with new-onset ischemic stroke (HR: 2.798; 95% CI: 1.064–7.359; P = 0.037) and all-cause mortality (HR: 7.584; 95% CI: 1.302–44.163; P = 0.024). Subgroup analysis showed a consistent effect of ESVEA on new-onset ischemic stroke across different age groups. The rates of new-onset stroke in the non-ESVEA group (below the top 15th percentile but with supraventricular arrhythmia [ESVEA+/-] and non-supraventricular arrhythmia [ESVEA-]) and the ESVEA+ group were 0.70%, 5.90%, and 16.30%, respectively, showing a stepwise increase. Conclusions ESVEA in apparently healthy subjects is independently associated with the risks of new-onset ischemic stroke and all-cause mortality. Conflict of interest "Yujie Tang. nothing to disclose"."Yapeng Lin. nothing to disclose"."Guoliang Zhu. nothing to disclose"."Ruijuan Gang. nothing to disclose"."Qi Wang. nothing to disclose"."Rong Wang. nothing to disclose"."Yuetong Luo. nothing to disclose"."Jie Yang. nothing to disclose".