The presence of ectopic atrial rhythm predicts adverse cardiovascular outcomes in a large hospital-based population

Sung Hao Huang, Yu Feng Hu*, Pei Fen Chen, Yenn Jiang Lin, Shih Lin Chang, Li Wei Lo, Fa Po Chung, Ta Chuan Tuan, Tze Fan Chao, Jo Nan Liao, Ting Yung Chang, Chin Yu Lin, Chih Min Liu, Ting Chun Huang, Jennifer Jeanne B. Vicera, Po Tseng Lee, Isaiah Carlos Lugtu, Ankit Jain, I. Chien Wu, Shih Ann Chen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Whether ectopic atrial rhythm (EAR) is a high-risk cardiovascular phenotype (eg, the manifestation of a diseased sinoatrial node) or just a benign accelerated ectopic pacemaker remains unclear. Objective: We aimed to analyze the cardiovascular outcomes and underlying mechanisms in patients with EAR. Methods: From a 12-lead electrocardiogram hospital-based electrocardiogram database, a total of 2896 adults with EAR were propensity score matched at 1:5 with 14,480 patients with sinus rhythm (SR). Patients were retrospectively followed up for cardiovascular mortality (the primary outcome) and permanent pacemaker implantation (the secondary outcome). Heart rate variability was analyzed to compare autonomic function between patients with EAR and those with SR. Results: The prevalence of EAR was 1.13%, which increased with age. Compared with the matched patients, those with EAR had a higher risk of cardiovascular mortality (adjusted hazard ratio 1.93; 95% confidence interval 1.52–2.44; P < .0001) and permanent pacemaker implantation (adjusted hazard ratio 5.94; 95% confidence interval 3.89–9.09; P < .0001) according to the Cox proportional hazards regression model. The risk of cardiovascular mortality was similar across the subgroups on the basis of age, sex, hypertension, type 2 diabetes mellitus, congestive heart failure, myocardial infarction, stroke, and chronic kidney diseases. In patients with EAR, the low frequency/high frequency and standard deviation of the mean normal-to-normal intervals/root mean square of successive RR interval differences ratios for heart rate variability were both lower than those in patients with SR. This implied autonomic imbalance in patients with EAR. Conclusion: Patients with EAR have a higher risk of cardiovascular mortality and permanent pacemaker implantation, which was associated with autonomic imbalance.

Original languageEnglish
Pages (from-to)967-974
Number of pages8
JournalHeart Rhythm
Issue number6
StatePublished - Jun 2020


  • Autonomic imbalance
  • Cardiovascular mortality
  • Ectopic atrial rhythm
  • Heart rate variability
  • Pacemaker


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