Atrial ectopes and atrial fibrillation association
Keywords:Tachycardia, Ectopic Atrial
Atrial electrical instability is a recently incorporated term in medical practice to describe the broad spectrum of overlapping atrial arrhythmias. This relationship was already intuitive between atrial flutter and atrial
fibrillation (which gave birth to the so-called “fibril-flutter”), and has more recently been related to atrial tachycardias and atrial fibrillation. This relationship is extremely important, since the diagnosis of atrial fibrillation implies in strategies to prevent embolic events. With new screening methods, the diagnosis of atrial fibrillation has become more frequent (prolonged monitoring, implantable monitors, pacemaker telemetry). The presence of atrial extrasystoles and atrial tachycardia
is a challenge: despite the intuitive relationship of higher risk for atrial fibrillation and cerebrovascular events, the scientific evidence became more robust recently. This article intends to aggregate the best quality evidence available to facilitate the choice of an appropriate strategy for a patient with tachycardia and atrial extrasystoles and to adequately assess their risk.
2. Zipes DP. Specific arrhythmias: diagnosis and treatment. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia: WB Saunders; 2007.
3. Cintra FD, Leite RP, Storti LJ, et al. Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study. Arq Bras Cardiol. 2014;103(5):368-74. DOI: http://dx.doi.org/10.5935/abc.20140142.
4. Conen D, Adam M, Roche F, et al. Premature atrial contractions in the general population: frequency and risk factors. Circulation. 2012;126(19):2302-8. DOI: https://doi.org/10.1161/CIRCULATIONAHA.112.112300.
5. Inohara T, Kohsaka S, Okamura T, et al.; NIPPON DATA 80/90 Research Group. Long-term outcome of healthy participants with atrial premature complex: a 15-year follow-up of the NIPPON DATA 90 cohort. PLoS One. 2013;8(11):e80853. DOI: https://doi.org/10.1371/journal.pone.0080853.
6. Acharya T, Tringali S, Bhullar M, et al. Frequent Atrial Premature Complexes and Their Association With Risk of Atrial Fibrillation. Am J Cardiol. 2015;116(12):1852-7. DOI: 10.1016/j.amjcard.2015.09.025.
7. Gladstone DJ, Dorian P, Spring M, et al.; EMBRACE Steering Committee and Investigators. Atrial premature beats predict atrial fibrillation in cryptogenic stroke: results from the EMBRACE trial. Stroke. 2015;46(4):936-41. DOI: https://doi.org/10.1161/STROKEAHA.115.008714.
8. Hashimoto M, Yamauchi A, Inoue S. Premature atrial contraction as a predictor of postoperative atrial fibrillation. Asian Cardiovasc Thorac Ann. 2015;23(2):153-6. DOI: https://doi.org/10.1177/0218492314534845.
9. Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659-66. DOI: 10.1056/NEJM199809033391003.
10. Inada K, Matsuo S, Tokutake K, et al. Predictors of ectopic firing from the superior vena cava in patients with paroxysmal atrial fibrillation. J Interv Card Electrophysiol. 2015;42(1):27-32. DOI: 10.1007/s10840-014-9954-3.
11. Gang UJ, Nalliah CJ, Lim TW, et al. Atrial ectopy predicts late recurrence of atrial fibrillation after pulmonary vein isolation. Circ Arrhythm Electrophysiol. 2015;8(3):569-74. DOI: 10.1161/CIRCEP.114.002052.
12. Qureshi W, Shah AJ, Salahuddin T, Soliman EZ. Long-term mortality risk in individuals with atrial or ventricular premature complexes (results from the Third National Health and Nutrition Examination Survey). Am J Cardiol. 2014;114(1):59-64. DOI: 10.1016/j.amjcard.2014.04.005.
13. Lin CY, Lin YJ, Chen YY, et al. Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long-Term Outcome. J Am Heart Assoc. 2015;4(9):e002192. DOI: 10.1161/JAHA.115.002192.
14. Binici Z, Intzilakis T, Nielsen OW, Køber L, Sajadieh A. Excessive supraventricular ectopic activity and increased risk of atrial fibrillation and stroke. Circulation. 2010;121(17):1904-11. DOI: 10.1161/CIRCULATIONAHA.109.874982.
15. Thijs VN, Brachmann J, Morillo CA, et al. Predictors for atrial fibrillation detection after cryptogenic stroke: Results from CRYSTAL AF. Neurology. 2016;86(3):261-9. DOI: https://doi.org/10.1212/WNL.0000000000002282.
16. Kasner SE, Lavados P, Sharma M, et al.; NAVIGATE ESUS Steering Committee and Investigators. Characterization of Patients with Embolic Strokes of Undetermined Source in the NAVIGATE ESUS Randomized Trial. J Stroke Cerebrovasc Dis. 2018;27(6):1673-82. DOI: https://doi.org/10.1016/j.
17. Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med. 1991;324(12):781-8. DOI: 10.1056/NEJM199103213241201.