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Excessive Supraventricular Ectopic Activity and Adverse Cardiovascular Outcomes: a Systematic Review and Meta-analysis

  • Evidence-Based Medicine, Clinical Trials and Their Interpretations (L. Roever, Section Editor)
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Abstract

Purpose of Review

Excessive supraventricular ectopic activity (ESVEA), in the form of frequent premature atrial contractions (PACs) and runs of PACs, is commonly observed in clinical practice and is frequently considered to be benign. Yet, recent studies have demonstrated a link between ESVEA and adverse cardiovascular outcomes. The aim of this meta-analysis was to examine the association between ESVEA and the risk of atrial fibrillation (AF), stroke, and mortality.

Recent Findings

A systematic search was performed in PubMed, EMBASE, and the Cochrane Library up to December 2017 to identify studies assessing adverse cardiovascular outcomes in patients with ESVEA, recorded on ambulatory electrocardiography. ESVEA was defined as a burden of PACs > 30 PACs/h or any runs of ≥20 PACs. The risk estimates for EVSEA and each clinical endpoint were pooled and analyzed separately.

Results

Five studies comprising 7545 participants were included in this meta-analysis. The pooled analysis showed that ESVEA doubled the risk of AF (HR 2.19, 95% CI 1.70–2.82). ESVEA was also associated with a higher incidence of stroke (HR 2.23, 95% CI 1.24–4.02). Finally, ESVEA was associated with higher all-cause mortality (HR 1.61, 95% CI 1.25–2.07).

Summary

Our meta-analysis found that ESVEA is closely associated with AF, stroke, and all-cause mortality. Further studies are required to examine the implication of therapeutic strategies in patients with ESVEA, in order to prevent potential subsequent adverse cardiovascular outcomes.

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Funding

This work was supported by the National Natural Science Foundation of China (81970270, 81570298, 30900618, and 81270245 to T.L.), the Tianjin Natural Science Foundation (16JCZDJC34900 to T.L.), and the Croucher Foundation of Hong Kong (Clinical Assistant Professorship to GT).

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Authors and Affiliations

  1. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China

    Lei Meng, Jinli He, Gary Tse, Wenwei Qi, Zhiwei Zhang, Enzhao Liu, Gang Xu, Guangping Li & Tong Liu

  2. Third Cardiology Department, Hippokrateion Hospital, Aristotle University Medical School, Thessaloniki, Greece

    Georgios Tsiaousis, Antonios P. Antoniadis & Nikolaos Fragakis

  3. First Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece

    Panagiotis Korantzopoulos

  4. Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece

    Konstantinos P. Letsas

  5. Divisions of Cardiology, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada

    Adrian Baranchuk

  6. Departments of Cardiovascular Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China

    Yunlong Xia

  7. Department of Clinical Research, Federal University of Uberlândia, Uberlândia, MG, Brazil

    Leonardo Roever

  8. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, England, UK

    Gregory YH Lip

  9. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Gregory YH Lip

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  1. Lei Meng
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Lei Meng, Georgios Tsiaousis, Jinli He, Gary Tse, Konstantinos P. Letsas, Adrian Baranchuk, Wenwei Qi, Zhiwei Zhang, Enzhao Liu, Gang Xu, Yunlong Xia, Guangping Li, Leonardo Roever, Nikolaos Fragakis, and Tong Liu each declare that they have no conflict of interest. Antonios P. Antoniadis reports personal fees from PromoPharma SA, outside the submitted work Panagiotis Korantzopoulos reports personal fees from MEDTRONIC, personal fees from PFIZER, personal fees from BAYER, and personal fees from BOEHRINGER-INGELHEIM, outside the submitted work. Gregory YH Lip has served as a consultant for Bayer/Janssen, Bristol-Myers Squibb/Pfzer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi Sankyo, and as a speaker for Bayer, Bristol-Myers Squibb/Pfzer, Medtronic, Boehringer Ingelheim, and Daiichi Sankyo.

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Meng, L., Tsiaousis, G., He, J. et al. Excessive Supraventricular Ectopic Activity and Adverse Cardiovascular Outcomes: a Systematic Review and Meta-analysis. Curr Atheroscler Rep 22, 14 (2020). https://doi.org/10.1007/s11883-020-0832-4

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