From the Research
Premature atrial contractions (PACs) noted on a heart monitor should be managed by first determining if the patient is symptomatic, and if so, addressing modifiable triggers and considering pharmacological options such as beta-blockers or calcium channel blockers, as outlined in the most recent study 1. The management approach for PACs involves several key steps:
- Determining if the patient is symptomatic, as asymptomatic PACs often require no specific treatment
- Addressing modifiable triggers such as reducing caffeine, alcohol, and nicotine consumption, managing stress, and ensuring adequate sleep
- Treating underlying conditions like hyperthyroidism, electrolyte abnormalities, or heart failure
- Considering pharmacological options such as beta-blockers (e.g., metoprolol 25-100 mg twice daily) or calcium channel blockers (e.g., diltiazem 120-360 mg daily in divided doses) for patients with persistent bothersome symptoms
- Monitoring for progression to more complex arrhythmias, as frequent PACs (>1000/day) can sometimes be a precursor to atrial fibrillation, especially in patients with structural heart disease, as noted in the study 1. It is essential to prioritize the patient's symptoms, quality of life, and potential risks associated with PACs, and to consider the most recent and highest-quality evidence when making management decisions, such as those outlined in the study 1.