Early atrial ectopic beats and atrial conduction delay predict atrial fibrillation

Šinkovec, Matjaž (author), Antolič, Bor (author), Rauber, Martin (author), Ambrožič, Jana (author), Cvijić, Marta (author), Klemen, Luka (author), Žižek, David (author), Toplišek, Janez (author), Pernat, Andrej (author)

Background: Atrial fibrillation/flutter (AF/AFl) is commonly diagnosed arrhythmia, associated with increased morbidity and mortality. Therefore, we have to improve our early AF/AFl diagnostics. Several studies indicated association between conduction delay, excessive atrial ectopic beats (AEBs) and AF/AFl onset. Association with some other AEB features is less clear. Objective: To validate the role of early AEBs from Holter-ECG in relation to documented AF/AFl events. Methods and Results: We enrolled 14 consecutive patients (6 female, median 60.5 years) with documented AF/AFl during or within 6 months after Holter-ECG (AF-group). Control group consisted of 10 clinically similar consecutive patients (5 female, median 64.5 years), without any evidence of AF/AFl, but with comparable burden of AEBs. Holter-ECGs were examined with 3-channel Holter system (Schiller, Darwin2 software). 24-hour data were analyzed for number and/or burden (%) of: a) AF/AFl, b) AEBs, c) early-AEBs (coupling interval cut-off <530 ms), d) AEB pairs, triplets, runs, and e) bigeminy. In addition, P-wave duration (cut-off <130 ms), PQ, QRS, and QTc were measured. AF-group had higher burden of early-AEBs (p<0.03) and longer P-waves (p<0.05) than controls. In both groups, non-conducted and aberrantly-conducted early-AEBs, AEBs in bigeminy, pairs, triplets and runs were found, as-well-as no difference for PQ, QRS, and QTc (p=NS). The majority of 243 AF/AFl events started during day-time and in 83% with early-AEBs. Before AF onset, outbursts of early-AEBs were encountered in 58% of patients.

• Language: English
• Keywords: atrijska fibrilacija, motnje srčnega ritma, preddvorni ektopični utripi, elektrokardiogram, holtersko monitoriranje
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2025
• Number of pages: Str. 3–15
• Numbering: Letn. 94, št. 1/2
• PID: 20.500.12556/RUL-184186
• UDC: 616.12-008.313
• ISSN on article: 1318-0347
• DOI: 10.6016/ZdravVestn.3532
• COBISS.SI-ID: 227806723
• Publication date in RUL: 01.07.2026

Record is a part of a journal

• Title: Zdravniški vestnik : glasilo Slovenskega zdravniškega društva
• Publisher: Slovensko zdravniško društvo
• ISSN: 1318-0347
• COBISS.SI-ID: 32893696

Licences

• License: CC BY-NC 4.0, Creative Commons Attribution-NonCommercial 4.0 International
• Link: http://creativecommons.org/licenses/by-nc/4.0/
• Description: A creative commons license that bans commercial use, but the users don’t have to license their derivative works on the same terms.

Secondary language

• Language: Slovenian
• Title: Zgodnji preddvorni ektopični utripi in upočasnjen preddvorni prevod napovedujejo preddvorno fibrilacijo

Abstract

Izhodišča: Preddvorna fibrilacija/undulacija (AF/AU) je pogosta motnja srčnega ritma, ki je povezana z višjo umrljivostjo in obolevnostjo. Zato jo je treba čim prej diagnosticirati. Rezultati več raziskav kažejo na povezavo med upočasnjenim preddvornim prevodom, velikim številom preddvornih ektopičnih utripov (AES) in pojavom AF/AU. Manj jasna je povezava z nekaterimi drugimi značilnostmi AES. Cilj raziskave: Vrednotiti smo želeli pomen zgodnjih AES pri holterskem elektrokardiogramu (EKG) v povezavi z zabeleže-nimi epizodami AF/AU. Metode in rezultati: V pilotsko raziskavo smo vključili 14 zaporednih bolnikov (6 žensk, mediana starost 60,5 leta) z doku-mentirano AF/AU v zapisu holterskega EKG ali do 6 mesecev po njem (skupina z AF/AU). V kontrolni skupini je bilo 10 zapo-rednih bolnikov s podobno klinično sliko (5 žensk, mediana starost 64,5 leat) brez AF/AU v anamnezi, vendar s podobnim bremenom AES. Holterski EKG smo beležili s 3-kanalnim sistemom (Schiller, Darwin2 software). V 24-urnih zapisih EKG smo analizirali število in/ali breme (%) naslednjih parametrov: a) AF/AU, b) AES, c) zgodnjih AES (vezni interval < 530 ms), d) AES v parih, tripletih in salvah in e) prisotnost bigeminije; poleg tega pa še trajanje vala P (normalna vrednost < 130 ms), PQ, QRS in QTc. Skupina z AF/AU je imela večje breme zgodnjih AES (p< 0,03) in daljši val P (p< 0,05) kot kontrolna skupina. V obeh skupinah smo zabeležili neprevedene in aberantno prevedene AES, AES v bigeminiji, parih, tripletih in salvah. Prav tako ni bilo razlike v trajanju PQ, QRS in QTc (p=NS). Večina od 243 primerov AF/AU se je sprožila v dnevnem času, v 83 % z zgodnjo AES. Pri 58 % smo zabeležili pred pojavom AF/AU porast števila zgodnjih AES.Zaključek: Večje breme zgodnjih AES v holterskem EKG in daljše trajanje vala P napovedujejo pojav AF/AU.

• Keywords: atrial fibrillation, atrial ectopic beats, electrocardiogram, holter-monitoring

Projects

• Funder: Univerzitetni klinični center Ljubljana
• Project number: 20210004
• Name: Vpliv različnih intenzivnosti električnega draženja kožne veje vagusa na srčno-žilne odzive pri zdravih preiskovancih