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Europace. 2019 Jun 1;21(6):864-870. doi: 10.1093/europace/euz008.

Predictors of atrial ectopy and their relationship to atrial fibrillation risk.

Author information

Division of Cardiology, Electrophysiology Section, University of California, San Francisco, 505 Parnassus Avenue, M-1180B, Box 0124, San Francisco, CA, USA.
The Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, 505 Parnassus Avenue, M-1180B, Box 0124, San Francisco, CA, USA.
Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, 1730 Minor Ave, Suite 1360, Seattle, WA, USA.
School of Medicine, Washington University, HRV Lab, 660 South Euclid Avenue, Campus Box 8215, St. Louis, MO, USA.



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.


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.


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.


Age; Atrial ectopy; Atrial fibrillation; Beta-blockers; Height; Physical exercise; Premature atrial contractions

[Available on 2020-06-01]

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