From the Research
Premature atrial contractions (PACs) are significant as they can be associated with an increased risk of developing atrial fibrillation, especially in older adults or those with structural heart disease, as noted in the most recent study 1. The significance of PACs varies depending on frequency and underlying cardiac health. In patients without heart disease, occasional PACs typically require no treatment and can be considered a normal variant. However, frequent PACs (more than 100 per day) may indicate increased risk for developing atrial fibrillation. Some key points to consider about PACs include:
- They are common and often asymptomatic in healthy individuals
- Frequent PACs may be associated with increased risk of atrial fibrillation
- PACs can sometimes cause symptoms like palpitations, skipped beats, or chest discomfort
- For symptomatic patients, lifestyle modifications are first-line interventions, including reducing caffeine, alcohol, and nicotine consumption, managing stress, and improving sleep quality
- If symptoms are troublesome, medications such as beta-blockers or calcium channel blockers may be prescribed, as suggested by 1. The underlying mechanism of PACs involves early electrical impulses originating from ectopic foci in the atria, disrupting the normal sinus rhythm. While most PACs are harmless, their presence in high numbers or in certain clinical contexts may warrant cardiac evaluation to rule out underlying structural heart disease or electrolyte abnormalities, as indicated by 2 and 3. In terms of treatment, catheter ablation is a promising approach for severely symptomatic patients with PACs, as shown in studies 2, 3, and 4. Overall, the management of PACs should prioritize lifestyle modifications and, if necessary, medication or catheter ablation, with the goal of reducing symptoms and preventing complications such as atrial fibrillation, as recommended by the most recent and highest quality study 1.