Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long‐Term Outcome

Abstract

BackgroundThe prognostic significance of premature atrial complex (PAC) burden is not fully elucidated. We aimed to investigate the relationship between the burden of PACs and long-term outcome.Methods and ResultsWe investigated the clinical characteristics of 5371 consecutive patients without atrial fibrillation (AF) or a permanent pacemaker (PPM) at baseline who underwent 24-hour electrocardiography monitoring between January 1, 2002, and December 31, 2004. Clinical event data were retrieved from the Bureau of National Health Insurance of Taiwan. During a mean follow-up duration of 10±1 years, there were 1209 deaths, 1166 cardiovascular-related hospitalizations, 3104 hospitalizations for any reason, 418 cases of new-onset AF, and 132 PPM implantations. The optimal cut-off of PAC burden for predicting mortality was 76 beats per day, with a sensitivity of 63.1% and a specificity of 63.5%. In multivariate analysis, a PAC burden >76 beats per day was an independent predictor of mortality (hazard ratio: 1.384, 95% CI: 1.230 to 1.558), cardiovascular hospitalization (hazard ratio: 1.284, 95% CI: 1.137 to 1.451), new-onset AF (hazard ratio: 1.757, 95% CI: 1.427 to 2.163), and PPM implantation (hazard ratio: 2.821, 95% CI: 1.898 to 4.192). Patients with frequent PAC had increased risk of mortality attributable to myocardial infarction, heart failure, and sudden cardiac death. Frequent PACs increased risk of PPM implantation owing to sick sinus syndrome, high-degree atrioventricular block, and/or AF.ConclusionsThe burden of PACs is independently associated with mortality, cardiovascular hospitalization, new-onset AF, and PPM implantation in the long term.

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) …”

“…Table and Table demonstrate the characteristics of the included studies. Three studies were conducted in Europe, 3 in the United States, and 4 in Asia . All but 2 of the studies were of a prospective design.…”

“…All of the studies enrolled middle‐aged and elderly participants. Population‐based subjects were included in 7 studies, whereas subjects referring to Holter monitoring for symptoms were enrolled in 3 studies . The percentage of male participants ranged from 32% to 100%.…”

“…Baseline frequent PACs prevalence varied from 0.8% to 38.6%. Eligible studies used different measurement methods to determine PACs: routine screening ECG was used in 3 studies, 15‐s ECG in 1 study, 2‐min ECG in 1 study, and Holter monitoring in 5 studies (4 studies monitored for 24 h and 1 for 48 h) . Any presence of PAC was defined as exposure in all studies using routine ECG, whereas the definition of frequent PACs in studies using Holter monitoring ranged from 76 beats of PACs recorded per day to >30% of the recording time per day.…”

Repeatability of ectopic beats from 48‐hr ambulatory electrocardiography: The Atherosclerosis Risk in Communities (ARIC) Study

“…Frequent PACs from aECG recording are linked to an increased risk of atrial fibrillation 1 and mortality. 2 Similarly, frequent PVCs are associated with AF, 3 heart failure, 4 stroke, 5 and mortality in population based studies. 3, 4, 6 In light of the prognostic significance of ectopic beats, there is a need to better understand the measurement variability of PACs and PVCs.…”