The Presence of Ectopic Atrial Rhythm Predicts Adverse Cardiovascular Outcomes in a Large Hospital-based Population

Abstract Background Whether ectopic atrial rhythm (EAR) is a high-risk cardiovascular phenotype (e.g., the manifestation of a diseased sinoatrial node) or just a benign accelerated ectopic pacemaker remains unclear. Objective We aimed to analyze the cardiovascular outcomes and underlying mechanisms in patients with EAR. Methods From a 12-lead electrocardiogram (ECG) hospital-based ECG database, a total of 2896 adults with EAR were propensity-matched at 1:5 with 14480 subjects with sinus rhythm (SR). The patients were retrospectively followed up for cardiovascular mortality (the primary outcome) and permanent pacemaker implantation (the secondary outcome). Heart rate variability (HRV) was analyzed to compare autonomic function between patients with EAR and SR. Results The prevalence of EAR was 1.13%, which increased with age. Compared with the matched patients, those with EAR had higher risk of cardiovascular mortality [adjusted hazard ratio (HR): 1.93, 95% confidence interval (CI): 1.52–2.44, P Conclusion Patients with EAR increased risk of cardiovascular mortality and permanent pacemaker implantation, associated with the autonomic imbalance.