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. 2023 Feb 3;4(2):112-118.
doi: 10.1093/ehjdh/ztad007. eCollection 2023 Mar.

Premature atrial and ventricular contractions detected on wearable-format electrocardiograms and prediction of cardiovascular events

Michele Orini  1   2   3 , Stefan van Duijvenboden  1   4   5 , William J Young  3   4 , Julia Ramírez  4   6 , Aled R Jones  3   4 , Andrew Tinker  4 , Patricia B Munroe  4 , Pier D Lambiase  1   3
Affiliations

Premature atrial and ventricular contractions detected on wearable-format electrocardiograms and prediction of cardiovascular events

Michele Orini et al. Eur Heart J Digit Health. .

Abstract

Aims: Wearable devices are transforming the electrocardiogram (ECG) into a ubiquitous medical test. This study assesses the association between premature ventricular and atrial contractions (PVCs and PACs) detected on wearable-format ECGs (15 s single lead) and cardiovascular outcomes in individuals without cardiovascular disease (CVD).

Methods and results: Premature atrial contractions and PVCs were identified in 15 s single-lead ECGs from N = 54 016 UK Biobank participants (median age, interquartile range, age 58, 50-63 years, 54% female). Cox regression models adjusted for traditional risk factors were used to determine associations with atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI), stroke, life-threatening ventricular arrhythmias (LTVAs), and mortality over a period of 11.5 (11.4-11.7) years. The strongest associations were found between PVCs (prevalence 2.2%) and HF (hazard ratio, HR, 95% confidence interval = 2.09, 1.58-2.78) and between PACs (prevalence 1.9%) and AF (HR = 2.52, 2.11-3.01), with shorter prematurity further increasing risk. Premature ventricular contractions and PACs were also associated with LTVA (P < 0.05). Associations with MI, stroke, and mortality were significant only in unadjusted models. In a separate UK Biobank sub-study sample [UKB-2, N = 29,324, age 64, 58-60 years, 54% female, follow-up 3.5 (2.6-4.8) years] used for independent validation, after adjusting for risk factors, PACs were associated with AF (HR = 1.80, 1.12-2.89) and PVCs with HF (HR = 2.32, 1.28-4.22).

Conclusion: In middle-aged individuals without CVD, premature contractions identified in 15 s single-lead ECGs are strongly associated with an increased risk of AF and HF. These data warrant further investigation to assess the role of wearable ECGs for early cardiovascular risk stratification.

Keywords: Arrhythmias; Atrial fibrillation; Heart failure; Premature contractions; Wearable ECG.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Flow diagram of the study. AF, atrial fibrillation; CVD, cardiovascular disease; HF, heart failure; LTVA, life-threatening ventricular arrhythmia; MI, myocardial infarction; PVCs and PACs, premature ventricular and atrial contractions. Electrocardiogram abnormality includes bundle branch block morphology, sinus node dysfunction, and atrial fibrillation.
Figure 2
Figure 2
Association of premature atrial contractions and premature ventricular contractions with outcomes in UK Biobank-1 (A) and UK Biobank-2 (B) cohorts. Models are adjusted for risk factors. Markers and bars represent hazard ratio and 95% confidence intervals. ACM, all-cause mortality; AF, atrial fibrillation; HF, heart failure; LTVAs, life-threatening ventricular arrhythmias; MI, myocardial Infarction. Transparent markers show non-significant associations (P > 0.05).
Figure 3
Figure 3
Risk of incident atrial fibrillation (vertical axes) as a function of premature atrial contraction prematurity (left) and premature atrial contraction number (right) in UK Biobank-1. Prematurity is measured as cycle length divided by the median RR interval (RRI) of the five previous beats. HR, hazard ratio; PAC, premature atrial contraction. *P < 0.05; **P < 0.005.
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