Rita Marinheiro1, Leonor Parreira2, Pedro Amador3, Catarina Sá3, Tatiana Duarte3, Rui Caria3. 1. Centro Hospitalar de Setubal, Cardiology Department, Setubal, Portugal. Electronic address: ritamarinheiro@gmail.com. 2. Centro Hospitalar de Setubal, Cardiology Department, Setubal, Portugal. Electronic address: leonor.parreira@gmail.com. 3. Centro Hospitalar de Setubal, Cardiology Department, Setubal, Portugal.
Abstract
BACKGROUND: Excessive atrial ectopic activity (EAEA) has been related with an increased risk of atrial fibrillation (AF) and stroke but different cutoff values have been used. We aimed to determine the association between EAEA and stroke, AF and overall death. METHODS: Consecutive 24-hour Holter monitoring performed between 2005 and 2010 in a single center was evaluated. Patients with a previous diagnosis of stroke or AF were excluded. The number of premature atrial contractions (PACs) during 24h was analyzed in 2480 subjects and according to that 3 sub-groups were defined: >97PACs/h (above the top 5th percentile of the population) (EAEA+); intermediate value of PACs/h (below the top 5th percentile but above 30PACs/h) (EAEA+/-) and <30PACs/h (EAEA-). RESULTS: After adjusting for risk factors, laboratory findings and medication, EAEA+ was associated with ischemic stroke (hazard ratio [HR] 2.83; 95% confidence interval [CI], 1.65-4.84, p<0.001). Both EAEA+ and EAEA+/- were independently associated with AF (HR 2.05; 95% CI 1.31-3.23, p=0.010 for EAEA+ and HR 1.90; 95% CI 1.10-2.78, p=0.020 for EAEA+/-) and overall death (HR 2.17; 95% CI 1.48-3.28, p=0.031 for EAEA+; HR 2.01; 95% CI 1.06-2.52, p=0.029 for EAEA+/-). CONCLUSION: In this population, having >30PACs/h was independently associated with a higher risk of AF and overall death but only subjects with >97PACs/h had a higher risk of ischemic stroke. In the majority of subjects with stroke and EAEA+, AF has not been detected before stroke event.
BACKGROUND: Excessive atrial ectopic activity (EAEA) has been related with an increased risk of atrial fibrillation (AF) and stroke but different cutoff values have been used. We aimed to determine the association between EAEA and stroke, AF and overall death. METHODS: Consecutive 24-hour Holter monitoring performed between 2005 and 2010 in a single center was evaluated. Patients with a previous diagnosis of stroke or AF were excluded. The number of premature atrial contractions (PACs) during 24h was analyzed in 2480 subjects and according to that 3 sub-groups were defined: >97PACs/h (above the top 5th percentile of the population) (EAEA+); intermediate value of PACs/h (below the top 5th percentile but above 30PACs/h) (EAEA+/-) and <30PACs/h (EAEA-). RESULTS: After adjusting for risk factors, laboratory findings and medication, EAEA+ was associated with ischemic stroke (hazard ratio [HR] 2.83; 95% confidence interval [CI], 1.65-4.84, p<0.001). Both EAEA+ and EAEA+/- were independently associated with AF (HR 2.05; 95% CI 1.31-3.23, p=0.010 for EAEA+ and HR 1.90; 95% CI 1.10-2.78, p=0.020 for EAEA+/-) and overall death (HR 2.17; 95% CI 1.48-3.28, p=0.031 for EAEA+; HR 2.01; 95% CI 1.06-2.52, p=0.029 for EAEA+/-). CONCLUSION: In this population, having >30PACs/h was independently associated with a higher risk of AF and overall death but only subjects with >97PACs/h had a higher risk of ischemic stroke. In the majority of subjects with stroke and EAEA+, AF has not been detected before stroke event.
Authors: Leonor Parreira; Rita Marinheiro; Dinis Mesquita; Jose Farinha; Marta Fonseca; Pedro Amador; Duarte Chambel; Artur Lopes; Rui Caria Journal: Cardiol Res Date: 2019-10-04
Authors: Jithin K Sajeev; Anoop N Koshy; Helen Dewey; Jonathan M Kalman; Kevin Rajakariar; Mae C Tan; Maryann Street; Louise Roberts; Jennifer C Cooke; Michael Wong; Tanya Frost; Andrew W Teh Journal: BMJ Open Date: 2019-07-31 Impact factor: 2.692