Excessive supraventricular ectopic activity predicts AF, stroke
MedWire News: The appearance of excessive supraventricular ectopic activity (ESVEA) in healthy people predicts stroke, death, and onset of atrial fibrillation (AF), show study results.
Zeynep Binici (Copenhagen University Hospital of Amager and Bispebjerg, Denmark) and colleagues believe that their findings may have a “significant impact on clinical practice.”
The results emerge from the Copenhagen Holter Study, in which 678 healthy men and women aged between 55 and 75 years underwent 48-hour ambulatory electrocardiography (ECG).
ESVEA was defined as 30 or more supraventricular ectopic complexes (SVEC) per hour, which occurred in 70 people, or as any episode with runs of at least 20 SVEC, which occurred in 42 people.
During a median follow-up of 6.3 years, 12.8% of people with ESVEA versus 4.3% of those without developed AF, 18.8% versus 4.9% suffered stroke, and 37.2% versus 18.9% died.
The primary endpoint of death or stroke was 1.64 times more likely to occur in people with ESVEA than in those without, after accounting for vascular risk factors. Hospital admissions for AF were 2.78-fold more likely and stroke admissions 2.79 times more likely among people with ESVEA relative to those without.
Also, each increase of 10 SVEC per hour was associated with an adjusted 25% increase in the risk for death or stroke and a 27% increase in all-cause mortality risk, and with a 49% increase in AF risk (adjusted for age and gender only). Increasing length of runs of SVEC also predicted these outcomes.
“The manner in which to treat patients with ESVEA to reduce the associated risk for AF, death, or stroke is currently not apparent,” say Binici et al in the journal Circulation.
“Appropriate risk factor modification may be effective and, in patients with hypertension, antihypertensive regimens, including blockade of the renin-angiotensin system, may reduce the incidence of AF.”
They add: “Newer drugs that maintain sinus rhythm in AF can also be tested in patients with ESVEA.”
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By Eleanor McDermid