Long-Term Mortality Risk in Individuals With Atrial or Ventricular Premature Complexes (Results from the Third National Health and Nutrition Examination Survey)

Abstract

Premature ectopic beats are frequently detected on routine 12-lead screening-electrocardiogram (ECG). However, their prognostic importance in individuals without known cardiovascular disease (CVD) is not well established. We evaluated prognostic value of atrial premature complexes (APC’s) and ventricular premature complexes (VPC’s) detected by a single 12-lead-ECG. A prospective cohort of 7504 participants selected from nationally-representative, community-dwelling individuals living in United States, enrolled in the Third Health and Nutrition Examination Survey (NHANES-III) from 1988 – 94 with follow up through December 2006 without known CVD. The main outcomes were all – cause mortality, CVD related mortality and IHD related mortality. Out of 7504 participants (mean age 60 ± 14 years, 47% women, 49% whites), 89 (1.2%) had APC’s and 110 (1.5%) had VPC’s on 12 – lead ECG. During a follow up of up to 18 years, 2386 deaths occurred, of which 963 were due to CVD and 511 were due to IHD. In a multivariable adjusted for demographics, clinical variables and ECG measures, APC’s were significantly associated with all-cause mortality [HR, 1.41 (95% CI, 1.08–1.80)], CVD death [HR, 1.78 (95% CI, 1.26–2.44)] and IHD death [HR, 2.40 (95% CI, 1.59–3.47)]. For VPCs, however, there were no significant associations with all – cause mortality [HR, 1.05 (95% CI, 0.80–1.36)], CVD death [HR, 0.96 (95% CI, 0.62–1.43)] and IHD death [HR, 0.89 (95% CI, 0.47–1.52)]. In conclusion, APC’s, but not VPC’s, on routine screening ECG are predictive of adverse events in community-dwelling individuals without known CVD.

Relation of premature atrial complexes with stroke and death: Systematic review and meta‐analysis

“…The database search identified 325 potentially eligible studies. After screening titles/abstracts and retrieving full‐text articles, a total of 11 studies including 129 514 participants fulfilled the inclusion criteria, 2 of which were from the same study: Atherosclerosis Risk in Communities (ARIC; see Supporting Information, Figure 1, in the online version of this article) …”

Decreased prevalence of cardiac arrhythmias during and after vigorous and prolonged exercise in healthy male marathon runners

“…Atrial premature complexes might be a sign of a subclinical CVD or an early marker of structural and electrical remodeling in response to training. 27,28 Two studies found an increased risk of SCD, 28,29 , whereas Cheriyath et al 30 found no increased risk of SCD. There are only sparse data dealing with APCs during exercise.…”

A 54-year-old woman with premature ventricular complexes and a rapidly changing ECG

“…Lin et al 5 reviewed 24 h Holter tracings of 3351 individuals with apparently normal heart and concluded that multiform PVCs were associated with a significant higher HR for mortality, hospitalisation, transient ischaemic attacks and new-onset heart failure and new-onset atrial fibrillation in the following 10 years. On the contrary, study by Qureshi et al 6 in an 18-year follow-up of 7504 patients with arrhythmias from standard 12-lead ECGs showed increased mortality and morbidity with premature atrial complexes and not PVCs. One meta-analysis study suggested that the poor prognosis of PVCs maybe confounded by occult structural heart diseases in those so-called ‘normal’ patients which are not divulged by advanced cardiac tests 7.…”