Authors: Qureshi W et al., Am J Cardiol 2014 Jul 1; 114:59
An incidental finding on a screening electrocardiogram might be worth taking seriously.
To evaluate the prognostic implications of atrial premature complexes (APCs) and ventricular premature complexes (VPCs) detected on a single 12-lead electrocardiogram (ECG) in healthy individuals, investigators analyzed NHANES III data for 7504 adults (mean age, 60; 47% women; 49% white) without cardiovascular disease who had good-quality ECGs showing sinus rhythm without conduction abnormalities. At baseline, 89 participants (1.2%) had APCs and 110 (1.5%) had VPCs. Compared with participants without premature ectopic beats, those with premature complexes were more likely to be older, male, and white and to have higher systolic blood pressure and greater prevalence of pulmonary disease and left ventricular hypertrophy; participants with APCs were more likely to have cancer.
During a mean follow-up of 13 years, 2386 participants died. All-cause mortality, cardiovascular mortality, and ischemic heart disease (IHD) mortality were all higher in both the APC and VPC groups than in the group without premature complexes. In analysis adjusted for demographics, comorbid conditions, and ECG indexes, APCs were associated with significant increases in risk of 41% for all-cause mortality, 64% for cardiovascular mortality, and 106% for IHD mortality. VPCs were not an independent risk factor for any type of mortality after adjustment.
Electrocardiograms are frequently obtained for screening purposes in the general population. Though rarely present, premature ectopic beats may have prognostic significance, according to this study. Clinicians may be prudent to step up vigilance in caring for patients who have premature ectopic beats on routine ECGs.
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