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

Abstract

AimsPremature atrial complexes (PACs) have been reported to increase the risk of adverse cardiovascular outcomes. Beta blockers at low dosages may help to reduce PAC symptoms, but it is unclear whether they can improve long-term outcomes.MethodsPatients enrolled from a Holter cohort in a medical referral center were stratified into high-burden (≥100 beats/24 h) and low-burden (<100 beats/24 h) sub-cohorts, and propensity score matching between treatment groups and non-treatment groups was conducted for each sub-cohort.ResultsIn the high-burden sub-cohort, after propensity score matching, the treatment group and non-treatment group respectively had 208 and 832 patients. The treatment group had significantly lower mortality rates than the non-treatment group [hazard ratio (HR) = 0.521, 95% confidence interval (CI) = 0.294–0.923, p = 0.025], but there was no difference in new stroke (HR = 0.830, 95% CI = 0.341–2.020, p = 0.681), and new atrial fibrillation (HR = 1.410, 95% CI = 0.867–2.292, p = 0.167) events. In the low-burden sub-cohort, after propensity score matching, there were 614 patients in the treatment group and 1,228 patients in the non-treatment group. Compared to the non-treatment group, up to 40% risk reduction in mortality was found in the treatment group (HR = 0.601, 95% CI = 0.396–0.913, p = 0.017), but no differences in new stroke (HR =0.969, 95% CI = 0.562–1.670, p = 0.910) or atrial fibrillation (HR = 1.074, 95% CI = 0.619–1.863, p = 0.800) were found.ConclusionsBeta blockers consistently decreased long-term mortality in high-burden and low-burden patients. Interestingly, this effect was not achieved through reduction of new-onset stroke or AF, and further research is warranted.

Migraine and heart: A reality check

“…Asymptomatic individuals with atrial premature contractions do not need any therapy, whereas symptomatic patients are counselled to avoid precipitants, such as alcohol and caffeine. Persistent symptoms are treated with beta blockers or catheter ablation 44 . For patients with premature ventricular contractions, risk factors and precipitants, such as alcohol, caffeine, uncontrolled hypertension, and thyroid abnormalities, are corrected.…”

Premature atrial contractions: A predictor of atrial fibrillation and a relevant marker of atrial cardiomyopathy

“…Standardized therapeutic management of nonsustained atrial arrhythmia is not currently consensual. Regarding a rhythm control strategy using beta-blockers, prospective interventional trials are lacking, and observational studies suggest a lack of benefit in terms of AF occurrence and ischemic stroke ( Huang et al, 2022 ). Invasive PAC ablation is an effective strategy regarding the PAC burden ( Wang et al, 2017 ), but its value in improving clinical prognosis has not been depicted.…”

How should we treat high-normal blood pressure and pre-atrial fibrillation?

“…The Japanese Circulation Society/The Japanese Heart Rhythm Society guidelines indicate the use of beta-blockers for symptomatic atrial premature contractions in Class IIa [11]. Multiple atrial premature contractions are associated not only with the development of AF but also with cardiovascular mortality [12], and beta-blockers for atrial premature contractions have been shown to be effective in reducing AF [13].…”