Open AccessFrequent atrial premature complexes during exercise: A potent predictor of atrial fibrillation
Author(s) -
Hwang Jin Kyung,
Gwag Hye Bin,
Park SeungJung,
On Young Keun,
Kim June Soo,
Park KyoungMin
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22895
Subject(s) - medicine , atrial fibrillation , cardiology , hazard ratio , chronotropic , treadmill , atrial flutter , confidence interval , incidence (geometry) , premature atrial contraction , heart rate , blood pressure , physics , optics
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.