title: Usefulness of frequent supraventricular extrasystoles and a high CHADS2 score to predict first-time appearance of atrial fibrillation.
abstract: Frequent supraventricular extrasystoles (SVEs) are associated with the subsequent first-time appearance of atrial fibrillation (AF) and ischemic stroke. The aim of this study was to investigate the combined role of SVEs and an AF-related risk score for ischemic stroke, the CHADS2 score, on the occurrence of new AF in patients in sinus rhythm. The Shinken Database 2004-2010 lists 3,263 patients who underwent 24-hour Holter monitoring. A total of 2,589 patients were analyzed, after excluding 674 patients previously diagnosed with AF. Frequent SVEs were defined as ≥102 beats/day (the top quartile) and the presence of a clinical background for a CHADS2 score ≥2 points as a high CHADS2 score. During the mean follow-up period of 571.4 ± 606.4 days, new AF occurred in 38 patients (9.4 per 1,000 patient-years). The incidence of new AF was 2.7 and 37.7 per 1,000 patient-years for patients with nonfrequent SVEs (<102 beats/day) and low CHADS2 scores and those with frequent SVEs and high CHADS2 scores, respectively. Multivariate Cox regression analysis showed that the hazard ratio for frequent SVEs and a high CHADS2 score compared with nonfrequent SVEs and a low CHADS2 score was 9.49 (95% confidence interval 3.20 to 28.15, p <0.001), even after adjustment for gender, age, medications, and echocardiographic parameters. In conclusion, frequent SVEs and a high CHADS2 score independently and synergistically predict the first-time appearance of AF in patients in sinus rhythm, indicating an approximately 10-fold higher risk. Patients meeting these criteria should have more aggressive early intervention for preventing AF.
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan. sinsuz-tky@umin.ac.jp
authors.forename: Shinya
authors.initials: S
authors.lastname: Suzuki
authors.forename: Koichi
authors.initials: K
authors.lastname: Sagara
authors.forename: Takayuki
authors.initials: T
authors.lastname: Otsuka
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kano
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Matsuno
authors.forename: Hideaki
authors.initials: H
authors.lastname: Takai
authors.forename: Tokuhisa
authors.initials: T
authors.lastname: Uejima
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oikawa
authors.forename: Akira
authors.initials: A
authors.lastname: Koike
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagashima
authors.forename: Hajime
authors.initials: H
authors.lastname: Kirigaya
authors.forename: Junji
authors.initials: J
authors.lastname: Yajima
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanabe
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sawada
authors.forename: Tadanori
authors.initials: T
authors.lastname: Aizawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D005117:Cardiac Complexes, Premature / Q000150:complications* / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control