Supraventricular Arrhythmia Prematurity, and Risk of Incident Atrial Fibrillation

BACKGROUND: Atrial fibrillation (AF) is common in the elderly population. Premature atrial contractions and non-sustained supraventricular tachycardias are more common among individuals at higher risk of incident AF. OBJECTIVE: The aim of this study was to systematically evaluate a range of premature atrial complexes and their characteristics including the degree of prematurity and coupling interval to determine how individual characteristics of premature atrial contractions are associated with future AF risk. METHODS: Repeated 30-second one-lead ECG recordings were analyzed from participants in the STROKESTOP I study. Premature atrial contractions and non-sustained supraventricular tachycardias (nSVTs) were identified and the characteristics of each premature atrial contraction, including the degree of prematurity and coupling interval, were analyzed. Patients were subsequently followed for a total of 7 years using national health registries to determine who developed incident AF. RESULTS: In total, 6 145 participants were included. Among these, 740 (12.0%) developed AF during a follow-up of 7.0 years based on national patient registry data. Supraventricular arrhythmias, including premature atrial contractions, were common and more frequently found among individuals who developed AF (71.08% vs 51.21%, p <0.05). Incident AF risk was highest for participants with nSVTs (adjusted hazard ratio (HR) 4.70, 95% CI 3.43-6.43). A shorter coupling interval of any arrhythmia was associated with an increased risk of incident AF, with an adjusted HR of 0.87 (0.81-0.93), p <0.05 CONCLUSION: Supraventricular arrhythmias are frequent in older individuals and are associated with incident AF. Increasing prematurity of premature atrial contractions is associated with future AF risk.