Jin Kyung Hwang1, Hye Bin Gwag2, Seung-Jung Park2, Young Keun On2, June Soo Kim2, Kyoung-Min Park2. 1. Division of Cardiology, Department of Medicine, Veterans Health Service Medical Center, Seoul, Korea. 2. Division of Cardiology, Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Republic of Korea.
Abstract
BACKGROUND: The clinical significance of atrial premature complexes (APCs) during exercise is unclear. HYPOTHESIS: Frequent APCs during exercise provides prognostic information. METHODS: A total of 998 patients were divided into 2 groups based on the presence of frequent APCs during treadmill testing (>5 beats per stage): the FAPC group (n = 128) vs the non-FAPC group (n = 870). The primary outcome was new-onset atrial fibrillation or flutter (AF/AFL) during follow-up period (356.2 ± 131.1 days). RESULTS: Mean age was 56.0 ± 10.2 years in the FAPC group and 52.6 ± 12.0 years in the non-FAPC group (P = 0.001). Baseline electrocardiographic and echocardiographic findings were not significantly different between the 2 groups. During exercise, maximal heart rate did not differ between the 2 groups. Chronotropic incompetence was more prevalent in the FAPC group than in the non-FAPC group (P = 0.04). During follow-up, the FAPC group had a higher incidence of AF/AFL than did the non-FAPC group (7 patients [5.5%] vs 5 patients [0.6%]; P < 0.001). Treadmill-induced frequent APCs (adjusted hazard ratio [HR]: 15.23, 95% confidence interval: 4.59-50.56, P < 0.001), chronotropic incompetence (adjusted HR: 19.95, 95% CI: 6.02-66.10, P < 0.001), and palpitation as a reason for treadmill testing (adjusted HR: 5.72, 95% CI: 1.64-20.00, P = 0.01) were independent risk factors that predicted new-onset AF/AFL. CONCLUSIONS: Frequent APCs during treadmill testing was associated with development of AF/AFL in this study. Close monitoring for further AF/AFL development is needed in these patients.
BACKGROUND: The clinical significance of atrial premature complexes (APCs) during exercise is unclear. HYPOTHESIS: Frequent APCs during exercise provides prognostic information. METHODS: A total of 998 patients were divided into 2 groups based on the presence of frequent APCs during treadmill testing (>5 beats per stage): the FAPC group (n = 128) vs the non-FAPC group (n = 870). The primary outcome was new-onset atrial fibrillation or flutter (AF/AFL) during follow-up period (356.2 ± 131.1 days). RESULTS: Mean age was 56.0 ± 10.2 years in the FAPC group and 52.6 ± 12.0 years in the non-FAPC group (P = 0.001). Baseline electrocardiographic and echocardiographic findings were not significantly different between the 2 groups. During exercise, maximal heart rate did not differ between the 2 groups. Chronotropic incompetence was more prevalent in the FAPC group than in the non-FAPC group (P = 0.04). During follow-up, the FAPC group had a higher incidence of AF/AFL than did the non-FAPC group (7 patients [5.5%] vs 5 patients [0.6%]; P < 0.001). Treadmill-induced frequent APCs (adjusted hazard ratio [HR]: 15.23, 95% confidence interval: 4.59-50.56, P < 0.001), chronotropic incompetence (adjusted HR: 19.95, 95% CI: 6.02-66.10, P < 0.001), and palpitation as a reason for treadmill testing (adjusted HR: 5.72, 95% CI: 1.64-20.00, P = 0.01) were independent risk factors that predicted new-onset AF/AFL. CONCLUSIONS: Frequent APCs during treadmill testing was associated with development of AF/AFL in this study. Close monitoring for further AF/AFL development is needed in these patients.
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