Frequent premature atrial complexes predict new occurrence of atrial fibrillation and adverse cardiovascular events

Chong, Boon-Hor; Pong, Vincent; Lam, Kwok–Fai; Li, Shasha; Zuo, Ming J.; Lau, Yuk-Fai; Lau, Chu‐Pak; Tse, Hung‐Fat; Siu, Chung‐Wah

doi:10.1093/europace/eur389

Cited by 136 publications

(121 citation statements)

References 33 publications

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“…A hospital-based cohort study showed that patients with >100 APC/day had higher incident AF. 48 Findings of arrhythmia at a medical examination are thus extremely important for the prediction of AF.…”

Section: Resultsmentioning

confidence: 99%

Development of a Basic Risk Score for Incident Atrial Fibrillation in a Japanese General Population　― The Suita Study ―

Kokubo

Watanabe

Higashiyama

et al. 2017

Circ J

119

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Background: An atrial fibrillation (AF) risk score for a non-Western general population has not been established. Methods and Results:A total of 6,898 participants (30-79 years old) initially free of AF have been prospectively followed for incident AF since 1989. AF was diagnosed when AF or atrial flutter was present on ECG at a biannual health examination; was indicated as a current illness; or was in the medical records during follow-up. Cox proportional hazard ratios were analyzed after adjusting for cardiovascular risk factors at baseline. During the 95,180 person-years of follow-up, 311 incident AF events occurred. We developed a scoring system for each risk factor as follows: 0/−5, 3/0, 7/5, and 9/9 points for men/women in their 30 s-40 s, 50 s, 60 s, and 70 s, respectively; 2 points for systolic hypertension, overweight, excessive drinking, or coronary artery disease; 1 point for current smoking; −1 point for moderate non-high-density lipoprotein-cholesterol; 4 points for arrhythmia; and 8, 6, and 2 points for subjects with cardiac murmur in their 30 s-40 s, 50 s, and 60 s, respectively (C-statistic 0.749; 95% confidence interval, 0.724−0.774). Individuals with score ≤2, 10-11, or ≥16 points had, respectively, ≤1%, 9%, and 27% observed probability of developing AF in 10 years. Conclusions:We developed a 10-year risk score for incident AF using traditional risk factors that are easily obtained in routine outpatient clinics/health examinations without ECG.

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Section: Resultsmentioning

confidence: 99%

Development of a Basic Risk Score for Incident Atrial Fibrillation in a Japanese General Population　― The Suita Study ―

Kokubo

Watanabe

Higashiyama

et al. 2017

Circ J

119

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“…[9][10][11][12][13][14][15][16][17][18]20,22,23 Several recent studies indicate that Holterdetected frequent APBs, or APBs present on a routine 12-lead ECG, 19,20 are an independent risk factor for stroke or death; previous studies used different thresholds for defining frequent APBs during a 24-hour recording (>100, 16 >218, 14 >228 APBs, 18 or >720 APBs or episodes of atrial tachycardia >20 beats long 15 ). In our study, we found that nearly 50% patients with cryptogenic stroke had an APB frequency >720/24 h, which is potentially clinically important based on the above literature.…”

Section: Discussionmentioning

confidence: 99%

Atrial Premature Beats Predict Atrial Fibrillation in Cryptogenic Stroke

Gladstone

Dorian

Spring

et al. 2015

Stroke

170

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Background and Purpose— Many ischemic strokes or transient ischemic attacks are labeled cryptogenic but may have undetected atrial fibrillation (AF). We sought to identify those most likely to have subclinical AF. Methods— We prospectively studied patients with cryptogenic stroke or transient ischemic attack aged ≥55 years in sinus rhythm, without known AF, enrolled in the intervention arm of the 30 Day Event Monitoring Belt for Recording Atrial Fibrillation After a Cerebral Ischemic Event (EMBRACE) trial. Participants underwent baseline 24-hour Holter ECG poststroke; if AF was not detected, they were randomly assigned to 30-day ECG monitoring with an AF auto-detect external loop recorder. Multivariable logistic regression assessed the association between baseline variables (Holter-detected atrial premature beats [APBs], runs of atrial tachycardia, age, and left atrial enlargement) and subsequent AF detection. Results— Among 237 participants, the median baseline Holter APB count/24 h was 629 (interquartile range, 142–1973) among those who subsequently had AF detected versus 45 (interquartile range, 14–250) in those without AF ( P <0.001). APB count was the only significant predictor of AF detection by 30-day ECG ( P <0.0001), and at 90 days ( P =0.0017) and 2 years ( P =0.0027). Compared with the 16% overall 90-day AF detection rate, the probability of AF increased from <9% among patients with <100 APBs/24 h to 9% to 24% in those with 100 to 499 APBs/24 h, 25% to 37% with 500 to 999 APBs/24 h, 37% to 40% with 1000 to 1499 APBs/24 h, and 40% beyond 1500 APBs/24 h. Conclusions— Among older cryptogenic stroke or transient ischemic attack patients, the number of APBs on a routine 24-hour Holter ECG was a strong dose-dependent independent predictor of prevalent subclinical AF. Those with frequent APBs have a high probability of AF and represent ideal candidates for prolonged ECG monitoring for AF detection. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00846924.

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“…[13][14][15][16]26,27 For example, PACs have previously been associated with an increased risk of incident AF in population based cohort studies. [13][14][15][16] Furthermore, Inoue et al found that ablation of PACs in addition to pulmonary vein isolation was associated with a high probability of recurrence-free survival among patients with persistent AF undergoing catheter ablation, suggesting that these electric triggers may play an important role in AF initiation. 27 In addition, subclinical atrial arrhythmias like PACs or pacemaker-detected atrial tachyarrhythmias have been related to an increased risk of stroke and death.…”

Section: Discussionmentioning

confidence: 99%

“…27 In addition, subclinical atrial arrhythmias like PACs or pacemaker-detected atrial tachyarrhythmias have been related to an increased risk of stroke and death. [13][14][15][16][17][18] Taken together, although our study may not have immediate clinical implications, more data are urgently needed to better understand the significance of our findings that PACs are present in the great majority of individuals aged Ն50 years.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to the effect of LA structural remodeling, an increased number of premature atrial contractions (PACs) and subclinical atrial tachyarrhythmias have been shown to be strong and independent predictors of incident AF and associated complications, [13][14][15][16][17][18] pointing to an important role of atrial electric activity in AF initiation and maintenance. 19 -21 However, and in contrast to the structural LA component, few if any population-based studies have assessed risk factors for an increased atrial electric activity in general and PAC frequency in particular.…”

Section: Clinical Perspective On P 2308mentioning

confidence: 99%

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Premature Atrial Contractions in the General Population

Conen

Adam

Roche³

et al. 2012

Circulation

145

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Background-Premature atrial contractions (PACs) are independent predictors of atrial fibrillation, stroke, and death.However, little is known about PAC frequency in the general population and its association with other cardiovascular risk factors. Methods and Results-We performed a cross-sectional analysis among participants of the population-based Swiss cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA). 24-hour Holter electrocardiograms to assess PAC prevalence and frequency were performed in a random sample of 1742 participants aged Ն50 years. The median (interquartile range) number of PACs per hour was 0.8 (0.4 -1.8), 1.1 (0.5-2.4), 1.4 (0.7-4.6), 2.3 (0.8 -6.9), and 2.6 (1.

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Frequent premature atrial complexes predict new occurrence of atrial fibrillation and adverse cardiovascular events

Abstract: Frequent PACs predict new AF and adverse cardiovascular events.

Cited by 136 publications

References 33 publications

Development of a Basic Risk Score for Incident Atrial Fibrillation in a Japanese General Population　― The Suita Study ―

Development of a Basic Risk Score for Incident Atrial Fibrillation in a Japanese General Population　― The Suita Study ―

Atrial Premature Beats Predict Atrial Fibrillation in Cryptogenic Stroke

Premature Atrial Contractions in the General Population

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Frequent premature atrial complexes predict new occurrence of atrial fibrillation and adverse cardiovascular events

Abstract: Frequent PACs predict new AF and adverse cardiovascular events.

Cited by 136 publications

References 33 publications

Development of a Basic Risk Score for Incident Atrial Fibrillation in a Japanese General Population ― The Suita Study ―

Development of a Basic Risk Score for Incident Atrial Fibrillation in a Japanese General Population ― The Suita Study ―

Atrial Premature Beats Predict Atrial Fibrillation in Cryptogenic Stroke

Premature Atrial Contractions in the General Population

Contact Info

Product

Resources

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Development of a Basic Risk Score for Incident Atrial Fibrillation in a Japanese General Population　― The Suita Study ―

Development of a Basic Risk Score for Incident Atrial Fibrillation in a Japanese General Population　― The Suita Study ―