Prognostic significance of premature atrial complexes burden in prediction of long-term outcome

Chin Yu Lin, Yenn Jiang Lin, Yun Yu Chen, Shih Lin Chang*, Li Wei Lo, Tze Fan Chao, Fa Po Chung, Yu Feng Hu, Eric Chong, Hao Min Cheng, Ta Chuan Tuan, Jo Nan Liao, Chuen Wang Chiou, Jin Long Huang, Shih Ann Chen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

Background-The 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 Results-We 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. Conclusions-The burden of PACs is independently associated with mortality, cardiovascular hospitalization, new-onset AF, and PPM implantation in the long term.

Original languageEnglish
Article numbere002192
JournalJournal of the American Heart Association
Volume4
Issue number9
DOIs
StatePublished - 1 Sep 2015

Keywords

  • Atrial fibrillation
  • Permanent pacemaker
  • Premature atrial complex
  • Sick sinus syndrome

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