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. 2021 Apr 22;2(3):231-238.
doi: 10.1016/j.hroo.2021.04.002. eCollection 2021 Jun.

Excessive supraventricular ectopic activity and risk of incident atrial fibrillation in a consecutive population referred to ambulatory cardiac monitoring

Bjørn Strøier Larsen  1 , Mark Aplin  1 , Olav Wendelboe Nielsen  1 , Maria Helena Dominguez Vall-Lamora  1 , Nis Baun Høst  1 , Ole Peter Kristiansen  1 , Hanne Kruuse Rasmusen  1 , Ulla Davidsen  1 , Finn Michael Karlsen  1 , Søren Højberg  1 , Ahmad Sajadieh  1
Affiliations

Excessive supraventricular ectopic activity and risk of incident atrial fibrillation in a consecutive population referred to ambulatory cardiac monitoring

Bjørn Strøier Larsen et al. Heart Rhythm O2. .

Abstract

Background: Excessive supraventricular ectopic activity (ESVEA), defined as ≥720 premature atrial contractions (PAC) per day or any runs of ≥20 PACs, has been proposed as a surrogate marker for paroxysmal atrial fibrillation (PAF).

Objective: We aimed to estimate the prognostic impact of ESVEA on the future development of PAF in consecutive patients referred to ambulatory cardiac monitoring.

Methods: The cohort consists of a population with comorbidities referred to 48-hour ambulatory electrocardiogram aged 30-98 (n = 1316) between 2009 and 2011. After exclusion of known or current atrial fibrillation (AF) (n = 527) and patients with pacemakers (n = 7), 782 patients were included, with a median follow-up of 8.1 years. Events of incident AF and death were retrieved from patient records.

Results: Mean age was 58.6 ± 15.5 years and 56.5% were women. A total of 101 patients had ESVEA at baseline (12.9%). During follow-up, 69 (8.9%) developed incidental AF. Twenty-three patients with ESVEA developed AF (23%). Incidence rate of AF in patients with and without ESVEA was 37.1/1000 person-years and 9.1 per 1000 person-years, respectively (P < .001). ESVEA was associated with incident AF after adjustment for potential confounders in Cox regression analysis (hazard ratio [HR]: 2.39; 95% confidence interval [CI]: 1.40-4.09) and in competing risk analysis with death as competing risk (subdistribution HR: 2.35; 95% CI: 1.30-4.17).

Conclusion: ESVEA increases the risk of incident AF substantially in a population referred to ambulatory cardiac monitoring.

Keywords: Atrial fibrillation; Epidemiology; Premature atrial contractions; Risk stratification; Survival analysis.

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Figures

Figure 1
Figure 1
Flow diagram of inclusion. AF = atrial fibrillation; ECG = electrocardiogram.
Figure 2
Figure 2
Cumulative incidence of atrial fibrillation (AF) according to excessive supraventricular ectopic activity (ESVEA). The risk of AF was greater in patients with ESVEA (P < .001).
Figure 3
Figure 3
Cumulative incidence of atrial fibrillation (AF) according to premature atrial contractions (PACs) per day and length of run of PACs. The risk of AF increased with increasing number of PACs per day (P < .001) and length of run of PACs (P < .001).
Figure 4
Figure 4
Cumulative incidence of atrial fibrillation (AF) according to excessive supraventricular ectopic activity (ESVEA) and age. The risk of AF associated with ESVEA seemed to have an earlier onset in patients aged ≥65 years (P < .001 and P = .0164, respectively).
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