Abstract 14422: Frequent Premature Atrial Complexes and their Association With Risk of Atrial Fibrillation
Introduction: Atrial fibrillation (AF) is the most common arrhythmia in the elderly. Identification of precursors and early prediction could prevent onset and reduce associated morbidity and mortality. Although recent studies have suggested frequent premature atrial complexes (PACs) as a risk factor for AF, more work is needed to establish this relationship.
Hypothesis: We assessed the hypothesis that frequent PACs are associated with increased risk of AF.
Methods: We analyzed Holter recordings obtained between 2000 and 2010 of 1357 veterans free of AF at baseline. Electronic medical records and EKGs were reviewed to ascertain baseline characteristics as well as development of AF during median follow up period of 7.5 yrs. Holter groups with frequent (>100/day) and infrequent (<100/day) PACs were compared for development of AF. Logistic regression and Kaplan-Meier analyses were performed.
Results: Mean age was 64 yrs with 93% men. Mean BMI, A1c, LDL, left atrial size and average HR were 31.24 kg/m2, 6.42%, 107.92 mg/dL, 42.56 mm and 73 bpm, respectively. AF was noted in 21.8% of those with frequent PACs compared to 5.6% of those with infrequent PACs (OR 4.68, 95% CI 3.27-6.71, P<0.0001). Additionally, atrial couplets (>50/day), frequent runs of ≥3 PACs (>20 runs/day) as well as longer runs (>10 beats/run) were significantly associated with AF (OR 4.22, 4.28 and 2.46 respectively, all P<0.0001). After adjusting for demographics, medication use, co-morbidities, lab and echocardiographic findings, multivariate regression analyses confirmed frequent PACs to be independently associated with higher incidence of AF (OR 3.37, 95% CI 1.98-5.72, P<0.0001). We also found frequent PACs to be associated with higher all-cause mortality (OR 1.44, 95% CI 1.07-1.92, P=0.015).
Conclusions: In conclusion, frequent PACs (>100/day) are associated with higher risk of AF. Future randomized control studies are needed to evaluate the benefit of suppressing frequent PACs to prevent onset of AF.
- © 2013 by American Heart Association, Inc.