TY - JOUR
T1 - Predictors of atrial ectopy and their relationship to atrial fibrillation risk
AU - Kerola, Tuomas
AU - Dewland, Thomas A.
AU - Vittinghoff, Eric
AU - Heckbert, Susan R.
AU - Stein, Phyllis K.
AU - Marcus, Gregory M.
N1 - Funding Information:
The Finnish Heart Foundation, Instrumentarium Science Foundation, Onni ja Hilja Tuovinen Foundation, Orion Research Foundation and Paavo Nurmi Foundation to T.K.; National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS) (Contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, and N01HC85086, and grants R0HL062181, U01HL080295, and U01HL130114); National Institute on Aging (NIA) (R01AG023629 and R01HL127659). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org.
Publisher Copyright:
© The Author(s) 2019.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Aims Premature atrial contractions (PACs) are known to trigger and predict atrial fibrillation (AF). We sought to identify the determinants of PACs and the degree to which PACs mediate the effects of established risk factors for AF. Methods and results Predictors of baseline PAC frequency were examined using a Holter Study among 1392 participants in the Cardiovascular Health Study, a community-based cohort of individuals aged >-65 years. Participants were then followed for their first diagnosis of AF. Independent predictors of PACs were identified, and the extent to which PACs might mediate the relationship between those predictors and AF was determined. The median hourly frequency of PACs was 2.7 (interquartile range 0.8-12.1). After multivariable adjustment, increasing age, increasing height, decreasing body mass index, and a history of myocardial infarction were each associated with more PACs. Regarding modifiable predictors, participants using beta-blockers had 21% less [95% confidence interval (95% CI) 9-30%, P= 0.001] and those performing at least moderate intensity exercise vs. lower intensity exercisers had 10% less (95% CI 1-18%, P= 0.03) PACs. Higher PAC frequency explained 34% (95% CI 22-57%, P< 0.0001) of the relationship between increasing age and AF risk and 27% (95% CI 10-75%, P= 0.004) of the relationship between taller height and AF risk. Conclusion Enhancing physical activity and use of beta-blockers may represent fruitful strategies to mitigate PAC frequency. A substantial proportion of the excess risk of AF due to increasing age and taller height may be explained by an increase in PAC frequency.
AB - Aims Premature atrial contractions (PACs) are known to trigger and predict atrial fibrillation (AF). We sought to identify the determinants of PACs and the degree to which PACs mediate the effects of established risk factors for AF. Methods and results Predictors of baseline PAC frequency were examined using a Holter Study among 1392 participants in the Cardiovascular Health Study, a community-based cohort of individuals aged >-65 years. Participants were then followed for their first diagnosis of AF. Independent predictors of PACs were identified, and the extent to which PACs might mediate the relationship between those predictors and AF was determined. The median hourly frequency of PACs was 2.7 (interquartile range 0.8-12.1). After multivariable adjustment, increasing age, increasing height, decreasing body mass index, and a history of myocardial infarction were each associated with more PACs. Regarding modifiable predictors, participants using beta-blockers had 21% less [95% confidence interval (95% CI) 9-30%, P= 0.001] and those performing at least moderate intensity exercise vs. lower intensity exercisers had 10% less (95% CI 1-18%, P= 0.03) PACs. Higher PAC frequency explained 34% (95% CI 22-57%, P< 0.0001) of the relationship between increasing age and AF risk and 27% (95% CI 10-75%, P= 0.004) of the relationship between taller height and AF risk. Conclusion Enhancing physical activity and use of beta-blockers may represent fruitful strategies to mitigate PAC frequency. A substantial proportion of the excess risk of AF due to increasing age and taller height may be explained by an increase in PAC frequency.
KW - Age
KW - Atrial ectopy
KW - Atrial fibrillation
KW - Beta-blockers
KW - Height
KW - Physical exercise
KW - Premature atrial contractions
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U2 - 10.1093/europace/euz008
DO - 10.1093/europace/euz008
M3 - Article
C2 - 30843034
AN - SCOPUS:85067109217
VL - 21
SP - 864
EP - 870
JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
SN - 1099-5129
IS - 6
ER -