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Premature atrial contractions are associated with atrial fibrillation, brain ischemia, and mortality: a systematic review and meta-analysis

Session Atrial fibrillation - Detection, treatment, outcomes

Speaker Jelle Caspar Lorenz Himmelreich

Event : ESC Congress 2018

  • Topic : arrhythmias and device therapy
  • Sub-topic : Arrhythmias, General – Epidemiology, Prognosis, Outcome
  • Session type : Rapid Fire Abstracts

Authors : J C L Himmelreich (Amsterdam,NL), WAM Lucassen (Amsterdam,NL), M Heugen (Amsterdam,NL), PMM Bossuyt (Amsterdam,NL), HL Tan (Amsterdam,NL), RE Harskamp (Amsterdam,NL), FS Van Etten-Jamaludin (Amsterdam,NL), HCPM Van Weert (Amsterdam,NL)

Authors:
J.C.L. Himmelreich1 , W.A.M. Lucassen1 , M. Heugen1 , P.M.M. Bossuyt2 , H.L. Tan3 , R.E. Harskamp1 , F.S. Van Etten-Jamaludin4 , H.C.P.M. Van Weert1 , 1Academic Medical Center of Amsterdam, Department of General Practice / Family Medicine - Amsterdam - Netherlands , 2Academic Medical Center of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics - Amsterdam - Netherlands , 3Academic Medical Center of Amsterdam, Department of Cardiology - Amsterdam - Netherlands , 4Academic Medical Center of Amsterdam, Medical Library - Amsterdam - Netherlands ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 262

Background: Premature atrial contractions (PACs) are a common cardiac phenomenon, traditionally considered to be of little clinical significance. Recent studies, however, suggest that PACs are associated with atrial fibrillation (AF), as well as ischemic stroke, transient ischemic attack (TIA), and mortality.

Purpose: To systematically review the association between PACs on standard ECG and PAC-count on Holter monitor and subsequent AF, ischemic stroke or TIA, and all-cause mortality in patients without a history of AF.

Methods: This systematic review and meta-analysis was in accordance with PRISMA guidelines and within the framework of the Cochrane Prognosis Methods Group exemplar protocol for systematic reviews on prognostic factors. We searched PubMed, Embase (OVID), and Cochrane Database of Systematic Reviews from inception through August 30th, 2017. Three investigators independently assessed risk of bias, extracted data, and synthesized the evidence using published criteria. The primary expression of associations in meta-analysis was the unadjusted hazard ratio (HR) between PACs, either on 12-lead ECG or on Holter, and the outcomes AF, ischemic stroke or TIA, and all-cause mortality, respectively.

Results: We included 31 cohort studies representing 30 databases for data extraction. Included studies represented Western and East Asian populations with a total of 198,330 participants. Number of participants per study (range 68–42,751), average age (range 52–76yrs), and follow-up (range 6mo-13yrs) varied considerably. The presence of ≥1 PAC on standard 12-lead ECG was associated with AF (HR: 3.24; 95% CI: 1.57–6.71) as well as all-cause mortality (HR: 2.72; 95% CI: 1.34–5.51). In meta-analysis of 24–48hr Holter studies, having frequent PACs was associated with AF (HR: 3.11; 95% CI: 2.41–4.03), first stroke (HR: 2.82; 95% CI: 1.57–5.05), and all-cause mortality (HR: 2.13; 95% CI: 1.85–2.45). In meta-analysis of log-transformed continuous PAC-count on 24–48h Holter a 10-fold increase in baseline PAC-count was associated both with AF (HR: 1.59; 95% CI: 1.39–1.83) and all-cause mortality (HR: 1.36; 95% CI: 1.26–1.47).

Conclusions: In a broad patient population without a history of AF the presence of PACs on 12-lead ECG as well as frequent PACs on 24–48h Holter are significantly associated with AF, stroke, and mortality.

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