Atrial Premature Complexes during Exercise Stress Testing and the Risk for the Development Atrial Fibrillation in Patients Undergoing Cardiac Rehabilitation

Background: Atrial fibrillation (AF) is associated with increased morbidity and mortality, hence identification. We sought to determine whether atrial premature complexes (APCs) detected during a standard exercise stress test (EST) in patients undergoing cardiac rehabilitation are associated with an increased risk of AF.

Design and Methods: The present study population comprised 6523 consecutive patients without prior AF who participated in a cardiac rehabilitation (CR) program in a tertiary medical center between 2009 – 2016. Multivariate analysis was used to identify the association between APCs during the baseline EST at CR and the risk for the development of AF over a mean follow-up period of 2.5 years.

Results: A total of 213 (3.7%) patients had APCs during their EST. Despite being older (mean age 63±13 years old vs. 58±13; p-value <0.001; respectively), no other statistically significant differences were documented. Kaplan Meier survival analysis showed that the rate of AF development during follow-up was significantly higher among patients with APCs at the baseline EST (11%) as compared with those without APCs (5%; log-rank p-value2-fold increased risk for AF as compared with those without APCs. The risk for AF was (HR 2.1; 95% CI 1.36-3.25; P-value<0.001).

Conclusion: Our findings suggest that APCs detected during EST among patients participating in CR program independently predict AF and can be used to improve risk stratification in this population