title: Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long-Term Outcome.
abstract: BACKGROUND
  The prognostic significance of premature atrial complex (PAC) burden is not fully elucidated. We aimed to investigate the relationship between the burden of PACs and long-term outcome.
  
  
  RESULTS
  We investigated the clinical characteristics of 5371 consecutive patients without atrial fibrillation (AF) or a permanent pacemaker (PPM) at baseline who underwent 24-hour electrocardiography monitoring between January 1, 2002, and December 31, 2004. Clinical event data were retrieved from the Bureau of National Health Insurance of Taiwan. During a mean follow-up duration of 10±1 years, there were 1209 deaths, 1166 cardiovascular-related hospitalizations, 3104 hospitalizations for any reason, 418 cases of new-onset AF, and 132 PPM implantations. The optimal cut-off of PAC burden for predicting mortality was 76 beats per day, with a sensitivity of 63.1% and a specificity of 63.5%. In multivariate analysis, a PAC burden >76 beats per day was an independent predictor of mortality (hazard ratio: 1.384, 95% CI: 1.230 to 1.558), cardiovascular hospitalization (hazard ratio: 1.284, 95% CI: 1.137 to 1.451), new-onset AF (hazard ratio: 1.757, 95% CI: 1.427 to 2.163), and PPM implantation (hazard ratio: 2.821, 95% CI: 1.898 to 4.192). Patients with frequent PAC had increased risk of mortality attributable to myocardial infarction, heart failure, and sudden cardiac death. Frequent PACs increased risk of PPM implantation owing to sick sinus syndrome, high-degree atrioventricular block, and/or AF.
  
  
  CONCLUSIONS
  The burden of PACs is independently associated with mortality, cardiovascular hospitalization, new-onset AF, and PPM implantation in the long term.
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C.Y.L., Y.J.L., Y.Y.C., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., S.A.C.) Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (C.Y.L., Y.J.L., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., J.L.H., S.A.C.).
authors: Chin-Yu
authors: CY
authors: Lin
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C.Y.L., Y.J.L., Y.Y.C., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., S.A.C.) Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (C.Y.L., Y.J.L., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., J.L.H., S.A.C.).
authors: Yenn-Jiang
authors: YJ
authors: Lin
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C.Y.L., Y.J.L., Y.Y.C., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., S.A.C.) Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Y.Y.C.).
authors: Yun-Yu
authors: YY
authors: Chen
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C.Y.L., Y.J.L., Y.Y.C., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., S.A.C.) Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (C.Y.L., Y.J.L., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., J.L.H., S.A.C.).
authors: Shih-Lin
authors: SL
authors: Chang
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C.Y.L., Y.J.L., Y.Y.C., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., S.A.C.) Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (C.Y.L., Y.J.L., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., J.L.H., S.A.C.).
authors: Li-Wei
authors: LW
authors: Lo
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C.Y.L., Y.J.L., Y.Y.C., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., S.A.C.) Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (C.Y.L., Y.J.L., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., J.L.H., S.A.C.).
authors: Tze-Fan
authors: TF
authors: Chao
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C.Y.L., Y.J.L., Y.Y.C., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., S.A.C.) Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (C.Y.L., Y.J.L., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., J.L.H., S.A.C.).
authors: Fa-Po
authors: FP
authors: Chung
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C.Y.L., Y.J.L., Y.Y.C., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., S.A.C.) Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (C.Y.L., Y.J.L., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., J.L.H., S.A.C.).
authors: Yu-Feng
authors: YF
authors: Hu
authors: Division of Cardiology, Department of Medicine, Alexandra Hospital, Jurong Health, Singapore, Singapore (E.C.).
authors: Eric
authors: E
authors: Chong
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C.Y.L., Y.J.L., Y.Y.C., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., S.A.C.) Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (C.Y.L., Y.J.L., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., J.L.H., S.A.C.).
authors: Hao-Min
authors: HM
authors: Cheng
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C.Y.L., Y.J.L., Y.Y.C., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., S.A.C.) Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (C.Y.L., Y.J.L., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., J.L.H., S.A.C.).
authors: Ta-Chuan
authors: TC
authors: Tuan
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C.Y.L., Y.J.L., Y.Y.C., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., S.A.C.) Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (C.Y.L., Y.J.L., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., J.L.H., S.A.C.).
authors: Jo-Nan
authors: JN
authors: Liao
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C.Y.L., Y.J.L., Y.Y.C., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., S.A.C.) Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (C.Y.L., Y.J.L., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., J.L.H., S.A.C.).
authors: Chuen-Wang
authors: CW
authors: Chiou
authors: Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (C.Y.L., Y.J.L., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., J.L.H., S.A.C.) Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan (J.L.H.).
authors: Jin-Long
authors: JL
authors: Huang
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C.Y.L., Y.J.L., Y.Y.C., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., S.A.C.) Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (C.Y.L., Y.J.L., S.L.C., L.W.L., T.F.C., F.P.C., Y.F.H., H.M.C., T.C.T., J.N.L., C.W.C., J.L.H., S.A.C.).
authors: Shih-Ann
authors: SA
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018880:Atrial Premature Complexes / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000401:mortality; D018450:Disease Progression; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; permanent pacemaker; premature atrial complex; sick sinus syndrome