Higher premature atrial complex burden from the Holter examination predicts poor cardiovascular outcome

Abstract

Premature atrial complexes (PACs) have been suggested to increase the risk of adverse events. The distribution of PAC burden and its dose–response effects on all-cause mortality and cardiovascular death had not been elucidated clearly. We analyzed 15,893 patients in a medical referral center from July 1st, 2011, to December 31st, 2018. Multivariate regression driven by ln PAC (beats per 24 h plus 1) or quartiles of PAC burden were examined. Older group had higher PAC burden than younger group (p for trend < 0.001), and both genders shared similar PACs distribution. In Cox model, ln PAC remained an independent risk factor for all-cause mortality (hazard ratio (HR) = 1.09 per ln PAC increase, 95% CI = 1.06‒1.12, p < 0.001). PACs were a significant risk factor in cause-specific model (HR = 1.13, 95% CI = 1.05‒1.22, p = 0.001) or sub-distribution model (HR = 1.12, 95% CI = 1.04‒1.21, p = 0.004). In ordinal PAC model, 4th quartile group had significantly higher risk of all-cause mortality than those in 1st quartile group (HR = 1.47, 95% CI = 1.13‒1.94, p = 0.005), but no difference in cardiovascular death were found in competing risk analysis. In subgroup analysis, the risk of high PAC burden was consistently higher than in low-burden group across pre-specified subgroups. In conclusion, PAC burden has a dose response effect on all-cause mortality and cardiovascular death.

The Burden of Ventricular Premature Complex Is Associated With Cardiovascular Mortality

“…This retrospective, observational study utilized the National Cheng Kung University Hospital-Electronic Medical Record (NCKUH-EMR) database and the NCKUH-Holter (NCKUH-Holter) database. The methodology for establishing these databases has been described and validated in our previous studies (15)(16)(17). The study population included all patients who underwent 24-h Holter ECG monitoring between July 1, 2011, and December 31, 2018, at the NCKUH.…”

The Beneficial Effects of Beta Blockers on the Long-Term Prognosis of Patients With Premature Atrial Complexes

“…We conducted a retrospective cohort study, using the Cardiovascular Disease Databank from National Cheng-Kung University Hospital (NCKU) to enroll consecutive patients who had undergone 24-h Holter monitoring. The Databank has previously been validated ( 2 ), and contains the complete anonymized inpatient and outpatient electronic medical records of the NCKU cardiovascular department, including patients who had undergone invasive or non-invasive cardiovascular studies. Longitudinal data regarding patient demographics, symptoms, laboratory data, medications, and imaging studies from January 1, 2009 to July 1, 2020 were collected.…”

“…Premature atrial complexes (PACs) are a common type of arrhythmic disturbance in the general population (1). PAC burden is known to be age-dependent, but is not associated with sex (2). Patients with PACs are at increased risk of stroke and mortality over the long term, either due to the burden of PAC itself, or to subsequent atrial fibrillation (AF) (3)(4)(5)(6).…”

“…Patients with PACs are at increased risk of stroke and mortality over the long term, either due to the burden of PAC itself, or to subsequent atrial fibrillation (AF) ( 3 – 6 ). We have previously revealed an association between higher PAC burden and higher risk of all-cause mortality and cardiovascular death ( 2 ), and PACs have been reported to be an important factor in the initiation and perpetuation of AF ( 7 ). The main focal mechanisms of PACs, including enhanced automaticity, early afterdepolarization, or delayed afterdepolarization, are highly related to adrenergic activation ( 7 ).…”

“…Patients with high PAC burden are commonly prescribed with beta blockers, especially for symptomatic sufferers, but the long-term effects of beta blockers on cardiovascular outcomes remain unclear as yet. Recently, we found that a threshold of ≥100 beats/24 h could serve as a cutoff for the prediction of adverse cardiovascular outcomes in patients with PACs ( 2 ). Therefore, in this study, we aimed to investigate the effects of beta blockers on the long-term prognosis of patients with a high (≥100 beats/24 h) or low (<100 beats/24 h) burden of PACs by using propensity score matched treatment and non-treatment groups.…”