Premature atrial contraction: Difference between revisions
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{{Short description|Skipped beat with atrial origin}} |
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{{redirect|Skipped beat}} |
{{redirect|Skipped beat}} |
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{{Cleanup rewrite|date=December 2024}} |
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{{Infobox medical condition |
{{Infobox medical condition |
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| name = Premature atrial contraction |
| name = Premature atrial contraction |
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| synonyms = Supraventricular extra systole (SVES) |
| synonyms = Supraventricular extra systole (SVES), supraventricular ectopy (SVE) |
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| image = PAC.png |
| image = PAC.png |
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| caption = Two PACs |
| caption = Two PACs with a compensatory pause seen on an [[ECG]] rhythm strip. A "''skipped beat''" occurs and rhythm resumes 2 P-to-P intervals after the last normal sinus beat. |
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<!-- Definition and symptoms --> |
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'''Premature atrial contraction''' ('''PAC'''), also known as '''atrial premature complexes''' ('''APC''') or '''atrial premature beats''' ('''APB'''), are a common [[arrhythmia]] characterized by premature heartbeats originating in the [[atrium (heart)|atria]]. While the [[sinoatrial node]] typically regulates the heartbeat during normal [[sinus rhythm]], PACs occur when [[ectopic beat|another region of the atria depolarizes]] before the sinoatrial node and thus triggers a premature heartbeat,<ref>{{cite patent|title=Apparatus and method for antitachycardia pacing using a virtual electrode|pubdate=Jan 26, 1993|inventor-last=Nickolls|inventor2-last=Lu|inventor3-last=Collins|inventor-first=Peter|inventor2-first=Richard M. T.|inventor3-first=Kenneth A.|country=US|number=5181511}}</ref> in contrast to escape beats, in which the normal [[sinoatrial node]] fails, leaving a non-nodal pacemaker to initiate a late beat. |
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<!-- Cause and diagnosis --> |
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| ⚫ | The exact cause of PACs is unclear; while several predisposing conditions exist, single isolated PACs commonly occur in healthy young and elderly people. Elderly people that get PACs usually don't need any further attention besides follow ups due to unclear evidence.<ref name="med-students">{{cite journal |vauthors=Brodsky M, Wu D, Denes P, Kanakis C, Rosen KM |title=Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease |journal=Am. J. Cardiol. |volume=39 |issue=3 |pages=390–95 |date=March 1977 |pmid=65912 |doi= 10.1016/S0002-9149(77)80094-5}}</ref><ref name="aviators">{{cite journal |vauthors=Folarin VA, Fitzsimmons PJ, Kruyer WB |title=Holter monitor findings in asymptomatic male military aviators without structural heart disease |journal=Aviat Space Environ Med |volume=72 |issue=9 |pages=836–38 |date=September 2001 |pmid=11565820 }}</ref> |
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<!-- Treatment and epidemiology --> |
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PACs are often completely [[asymptomatic]] and may be noted only with [[Holter monitor]]ing, but occasionally they can be perceived as a skipped beat or a jolt in the chest. In most cases, no treatment other than reassurance is needed for PACs, although medications such as [[beta blocker]]s can reduce the frequency of symptomatic PACs.<ref name=":0" /> |
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== Epidemiology == |
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Premature atrial contractions (PACs) are common in the general population, and increase with age.<ref name="pmid28846809">{{cite journal | vauthors = Huang B, Huang F, Chen M | title=Relation of premature atrial complexes with stroke and death: Systematic review and meta-analysis | journal= [[Clinical Cardiology]] | volume=40 | issue=11 | pages=962–969 | year=2017 | doi= 10.1002/clc.22780 | pmc=6490370 | pmid=28846809}}</ref> Over 99% of individuals in the general population will have at least one PAC in a 24 hour period.<ref name="pmid36353376">{{cite journal | vauthors = Guichard J, Guasch E, Mont L | title=Premature atrial contractions: A predictor of atrial fibrillation and a relevant marker of atrial cardiomyopathy | journal= [[Frontiers Media#List of journals|Frontiers in Physiology]] | volume=13 | pages=971691 | year=2022 | doi= 10.3389/fphys.2022.971691 | doi-access=free | pmc=9638131 | pmid=36353376}}</ref> Many PACs can indicate increased risk of [[atrial fibrillation]] and/or [[Stroke|ischemic stroke]].<ref name="pmid36353376" /> The threshold for number of PACs which substantially raises the risk atrial fibrillation is debatable, but some estimates range between in excess of 500 and 720 PACs per day.<ref name="pmid34337573">{{cite journal | vauthors = Larsen BS, Aplin M, Sajadieh A | title=Excessive supraventricular ectopic activity and risk of incident atrial fibrillation in a consecutive population referred to ambulatory cardiac monitoring | journal= Heart Rhythm O2 | volume=2 | issue=3 | pages=231–238 | year=2021 | doi= 10.1016/j.hroo.2021.04.002 | pmc=8322818 | pmid=34337573}}</ref> |
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== Risk factors == |
== Risk factors == |
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[[Hypertension]], or abnormally high blood pressure, often signifies an elevated level of both [[Psychological stress|psychological]] and [[Stress (biology)|physiological stress]]. Often, hypertension goes hand in hand with various atrial fibrillations including |
[[Hypertension]], or abnormally high blood pressure, often signifies an elevated level of both [[Psychological stress|psychological]] and [[Stress (biology)|physiological stress]]. Often, hypertension goes hand in hand with various [[Atrial fibrillation|atrial fibrillations]] including PACs.<ref>{{Cite journal|last=Healy|first=Jeff|year=2003|title=Atrial fibrillation: hypertension as a causative agent, risk factor for complications, and potential therapeutic target|journal=The American Journal of Cardiology|volume=91|issue=10|pages=9–14|doi=10.1016/S0002-9149(03)00227-3|pmid=12781903}}</ref> Additional factors that may contribute to spontaneous premature atrial contractions could be:<ref name=":0">{{Cite journal|last1=Lin|first1=Chin-Yu|last2=Lin|first2=Yenn-Jiang|last3=Chen|first3=Yun-Yu|last4=Chang|first4=Shih-Lin|last5=Lo|first5=Li-Wei|last6=Chao|first6=Tze-Fan|last7=Chung|first7=Fa-Po|last8=Hu|first8=Yu-Feng|last9=Chong|first9=Eric|date=2015-08-27|title=Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long-Term Outcome|journal=Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease|volume=4|issue=9|doi=10.1161/JAHA.115.002192|issn=2047-9980|pmc=4599506|pmid=26316525|page=e002192}}</ref> |
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* Increased age |
* Increased age |
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* Abnormal body height |
* Abnormal body height |
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* Family history of heart disease |
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* History of cardiovascular disease (CV) |
* History of cardiovascular disease (CV) |
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* Abnormal [[ |
* Abnormal [[atrial natriuretic peptide]] (ANP) levels |
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* Elevated cholesterol |
* Elevated cholesterol |
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==Diagnosis== |
==Diagnosis== |
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[[File:NSR and Ectopic beats (PVC and PAC).svg|thumb|Normal sinus rhythm and ectopic beats - premature ventricular contractions (PVC) and premature atrial contractions (PAC) shown on an [[EKG]]]] |
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Premature atrial contractions are typically diagnosed with an [[electrocardiogram]], [[Holter monitor]], |
Premature atrial contractions are typically diagnosed with an [[electrocardiogram]], [[Holter monitor]], [[long-term continuous monitor]], [[cardiac event monitor]], or with a [[smartwatch]] with an ECG functionality.{{citation needed|date=February 2021}} |
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===Electrocardiogram=== |
===Electrocardiogram=== |
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On an electrocardiogram (ECG), PACs are characterized by an abnormally shaped [[P wave (electrocardiography)|P wave]]. Since the premature beat initiates outside the [[sinoatrial node]], the associated P wave appears different from those seen in [[normal sinus rhythm]]. Typically, the atrial impulse propagates normally through the [[atrioventricular node]] and into the [[cardiac ventricle]]s, resulting in a normal, narrow [[QRS complex]]. However, if the atrial beat is premature enough, it may reach the atrioventricular node during its refractory period, in which case it will not be conducted to the ventricle and there will be no QRS complex following the P wave.{{citation needed|date=February 2021}} |
On an electrocardiogram (ECG), PACs are characterized by an abnormally shaped [[P wave (electrocardiography)|P wave]] in different ECG leads. Since the premature beat initiates outside the [[sinoatrial node]], the associated P wave appears different from those seen in [[normal sinus rhythm]]. Typically, the atrial impulse propagates normally through the [[atrioventricular node]] and into the [[cardiac ventricle]]s, resulting in a normal, narrow [[QRS complex]]. However, if the atrial beat is premature enough, it may reach the atrioventricular node during its refractory period, in which case it will not be conducted to the ventricle and there will be no QRS complex following the P wave.{{citation needed|date=February 2021}} |
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In some people, PACs occur in a predictable pattern. Two PACs in a row are called doublets and three PACs in a row are triplets. Depending whether there are one, two, or three normal (sinus) beats between each PACs, the rhythm is called atrial bigeminy, trigeminy, or quadrigeminy. If 3 or more consecutive PACs occur in a row and at a frequency of 100 or more beats per minute, it may be called [[atrial tachycardia]]. |
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==Treatment== |
==Treatment== |
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==Prognosis== |
==Prognosis== |
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In otherwise healthy patients, occasional premature atrial contractions are a common finding and do not indicate any particular health risk. Rarely, in patients with other underlying structural heart problems, PACs can trigger a more serious arrhythmia such as [[atrial flutter]] or [[atrial fibrillation]].<ref>{{Cite journal|last1=Jensen|first1=Thomas J.|last2=Haarbo|first2=Jens|last3=Pehrson|first3=Steen M.|last4=Thomsen|first4=Bloch|date=2004-04-01|title=Impact of premature atrial contractions in atrial fibrillation|journal=Pacing and Clinical Electrophysiology|volume=27|issue=4|pages=447–52|doi=10.1111/j.1540-8159.2004.00462.x|issn=0147-8389|pmid=15078396|s2cid=32364061}}</ref> In otherwise healthy people, PACs usually disappear with adolescence.{{citation needed|date=February 2021}} |
In otherwise healthy patients, occasional single premature atrial contractions are a common finding and most of times do not indicate any particular health risk. Rarely, in patients with other underlying structural heart problems, PACs can trigger a more serious arrhythmia such as [[atrial flutter]] or [[atrial fibrillation]].<ref>{{Cite journal|last1=Jensen|first1=Thomas J.|last2=Haarbo|first2=Jens|last3=Pehrson|first3=Steen M.|last4=Thomsen|first4=Bloch|date=2004-04-01|title=Impact of premature atrial contractions in atrial fibrillation|journal=Pacing and Clinical Electrophysiology|volume=27|issue=4|pages=447–52|doi=10.1111/j.1540-8159.2004.00462.x|issn=0147-8389|pmid=15078396|s2cid=32364061}}</ref> In otherwise healthy people, PACs usually disappear with adolescence.{{citation needed|date=February 2021}} |
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== Supraventricular extrasystole == |
== Supraventricular extrasystole == |
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| MeshID = D018880 |
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{{Circulatory system pathology}} |
{{Circulatory system pathology}} |
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[[Category:Cardiac arrhythmia]] |
[[Category:Cardiac arrhythmia]] |
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[[de:Supraventrikuläre Extrasystole]] |
[[de:Supraventrikuläre Extrasystole]] |
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Latest revision as of 23:10, 14 December 2024
 | This article may need to be rewritten to comply with Wikipedia's quality standards. (December 2024) |
| Premature atrial contraction | |
|---|---|
| Other names | Supraventricular extra systole (SVES), supraventricular ectopy (SVE) |
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| Two PACs with a compensatory pause seen on an ECG rhythm strip. A "skipped beat" occurs and rhythm resumes 2 P-to-P intervals after the last normal sinus beat. | |
| Specialty | Cardiology, electrophysiology  |
Premature atrial contraction (PAC), also known as atrial premature complexes (APC) or atrial premature beats (APB), are a common arrhythmia characterized by premature heartbeats originating in the atria. While the sinoatrial node typically regulates the heartbeat during normal sinus rhythm, PACs occur when another region of the atria depolarizes before the sinoatrial node and thus triggers a premature heartbeat,[1] in contrast to escape beats, in which the normal sinoatrial node fails, leaving a non-nodal pacemaker to initiate a late beat.
The exact cause of PACs is unclear; while several predisposing conditions exist, single isolated PACs commonly occur in healthy young and elderly people. Elderly people that get PACs usually don't need any further attention besides follow ups due to unclear evidence.[2][3]
PACs are often completely asymptomatic and may be noted only with Holter monitoring, but occasionally they can be perceived as a skipped beat or a jolt in the chest. In most cases, no treatment other than reassurance is needed for PACs, although medications such as beta blockers can reduce the frequency of symptomatic PACs.[4]
Epidemiology
[edit]Premature atrial contractions (PACs) are common in the general population, and increase with age.[5] Over 99% of individuals in the general population will have at least one PAC in a 24 hour period.[6] Many PACs can indicate increased risk of atrial fibrillation and/or ischemic stroke.[6] The threshold for number of PACs which substantially raises the risk atrial fibrillation is debatable, but some estimates range between in excess of 500 and 720 PACs per day.[7]
Risk factors
[edit]Hypertension, or abnormally high blood pressure, often signifies an elevated level of both psychological and physiological stress. Often, hypertension goes hand in hand with various atrial fibrillations including PACs.[8] Additional factors that may contribute to spontaneous premature atrial contractions could be:[4]
- Increased age
- Abnormal body height
- Family history of heart disease
- History of cardiovascular disease (CV)
- Abnormal atrial natriuretic peptide (ANP) levels
- Elevated cholesterol
Diagnosis
[edit].svg)
Premature atrial contractions are typically diagnosed with an electrocardiogram, Holter monitor, long-term continuous monitor, cardiac event monitor, or with a smartwatch with an ECG functionality.[citation needed]
Electrocardiogram
[edit]On an electrocardiogram (ECG), PACs are characterized by an abnormally shaped P wave in different ECG leads. Since the premature beat initiates outside the sinoatrial node, the associated P wave appears different from those seen in normal sinus rhythm. Typically, the atrial impulse propagates normally through the atrioventricular node and into the cardiac ventricles, resulting in a normal, narrow QRS complex. However, if the atrial beat is premature enough, it may reach the atrioventricular node during its refractory period, in which case it will not be conducted to the ventricle and there will be no QRS complex following the P wave.[citation needed]
In some people, PACs occur in a predictable pattern. Two PACs in a row are called doublets and three PACs in a row are triplets. Depending whether there are one, two, or three normal (sinus) beats between each PACs, the rhythm is called atrial bigeminy, trigeminy, or quadrigeminy. If 3 or more consecutive PACs occur in a row and at a frequency of 100 or more beats per minute, it may be called atrial tachycardia.
Treatment
[edit]Premature atrial contractions are often benign, requiring no treatment. Occasionally, the patient having the PAC will find these symptoms bothersome, in which case the doctor may treat the PACs. Sometimes the PACs can indicate heart disease or an increased risk for other cardiac arrhythmias. In this case, the underlying cause is treated. Often a beta blocker will be prescribed for symptomatic PACs.[9]
Prognosis
[edit]In otherwise healthy patients, occasional single premature atrial contractions are a common finding and most of times do not indicate any particular health risk. Rarely, in patients with other underlying structural heart problems, PACs can trigger a more serious arrhythmia such as atrial flutter or atrial fibrillation.[10] In otherwise healthy people, PACs usually disappear with adolescence.[citation needed]
Supraventricular extrasystole
[edit]A supraventricular extrasystole (SVES) is an extrasystole or premature electrical impulse in the heart, generated above the level of the ventricle. This can be either a premature atrial contraction or a premature impulse from the atrioventricular node. SVES should be viewed in contrast to a premature ventricular contraction that has a ventricular origin and the associated QRS change. Instead of the electrical impulse beginning in the sinoatrial (SA) node and propagating to the atrioventricular (AV) node, the signal is conducted both to the ventricle and back to the SA node where the signal began.[11]
See also
[edit]References
[edit]- ^ US 5181511, Nickolls, Peter; Lu, Richard M. T. & Collins, Kenneth A., "Apparatus and method for antitachycardia pacing using a virtual electrode", published Jan 26, 1993
- ^ Brodsky M, Wu D, Denes P, Kanakis C, Rosen KM (March 1977). "Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease". Am. J. Cardiol. 39 (3): 390–95. doi:10.1016/S0002-9149(77)80094-5. PMID 65912.
- ^ Folarin VA, Fitzsimmons PJ, Kruyer WB (September 2001). "Holter monitor findings in asymptomatic male military aviators without structural heart disease". Aviat Space Environ Med. 72 (9): 836–38. PMID 11565820.
- ^ a b Lin, Chin-Yu; Lin, Yenn-Jiang; Chen, Yun-Yu; Chang, Shih-Lin; Lo, Li-Wei; Chao, Tze-Fan; Chung, Fa-Po; Hu, Yu-Feng; Chong, Eric (2015-08-27). "Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long-Term Outcome". Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease. 4 (9): e002192. doi:10.1161/JAHA.115.002192. ISSN 2047-9980. PMC 4599506. PMID 26316525.
- ^ Huang B, Huang F, Chen M (2017). "Relation of premature atrial complexes with stroke and death: Systematic review and meta-analysis". Clinical Cardiology. 40 (11): 962–969. doi:10.1002/clc.22780. PMC 6490370. PMID 28846809.
- ^ a b Guichard J, Guasch E, Mont L (2022). "Premature atrial contractions: A predictor of atrial fibrillation and a relevant marker of atrial cardiomyopathy". Frontiers in Physiology. 13: 971691. doi:10.3389/fphys.2022.971691. PMC 9638131. PMID 36353376.
- ^ Larsen BS, Aplin M, Sajadieh A (2021). "Excessive supraventricular ectopic activity and risk of incident atrial fibrillation in a consecutive population referred to ambulatory cardiac monitoring". Heart Rhythm O2. 2 (3): 231–238. doi:10.1016/j.hroo.2021.04.002. PMC 8322818. PMID 34337573.
- ^ Healy, Jeff (2003). "Atrial fibrillation: hypertension as a causative agent, risk factor for complications, and potential therapeutic target". The American Journal of Cardiology. 91 (10): 9–14. doi:10.1016/S0002-9149(03)00227-3. PMID 12781903.
- ^ Hueston, Kesh A. Hebbar|William J. (2002-06-15). "Management of Common Arrhythmias: Part I. Supraventricular Arrhythmias". American Family Physician. 65 (12): 2479–86. PMID 12086237. Retrieved 2017-03-29.
- ^ Jensen, Thomas J.; Haarbo, Jens; Pehrson, Steen M.; Thomsen, Bloch (2004-04-01). "Impact of premature atrial contractions in atrial fibrillation". Pacing and Clinical Electrophysiology. 27 (4): 447–52. doi:10.1111/j.1540-8159.2004.00462.x. ISSN 0147-8389. PMID 15078396. S2CID 32364061.
- ^ Ernst, Mutschler (1995). Drug actions : basic principles and therapeutic aspects. Medpharm Scientific Publishers. ISBN 978-0849377747. OCLC 28854659.[page needed]