Frequent atrial premature complexes during exercise: A potent predictor of atrial fibrillation

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 41; no. 4; pp. 458 - 464
• Main Authors: Hwang, Jin Kyung, Gwag, Hye Bin, Park, Seung‐Jung, On, Young Keun, Kim, June Soo, Park, Kyoung‐Min
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01.04.2018; John Wiley & Sons, Inc
• Subjects: Action Potentials; Adult; Aged; Atrial Fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - physiopathology; Atrial Flutter - diagnosis; Atrial Flutter - epidemiology; Atrial Flutter - physiopathology; Atrial Premature Complexes; Atrial Premature Complexes - diagnosis; Atrial Premature Complexes - epidemiology; Atrial Premature Complexes - physiopathology; Cardiac arrhythmia; Chi-Square Distribution; Chronotropic Incompetence; Clinical Investigations; Echocardiography; Electrocardiography; Exercise; Exercise Test; Female; Fitness equipment; Heart Rate; Humans; Incidence; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Prevalence; Prognosis; Proportional Hazards Models; Registries; Retrospective Studies; Risk Factors; Seoul - epidemiology; Time Factors; Treadmill; Chronotropic Incompetence; Exercise; Treadmill; Atrial Fibrillation; Atrial Premature Complexes
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.22895

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.