From the Research
Beta-blockers should be considered as a first-line treatment for premature atrial contractions (PACs) due to their ability to reduce long-term mortality, as evidenced by a recent study published in 2022 1. The treatment for PACs depends on symptom severity, and for asymptomatic patients, no specific treatment is needed as PACs are generally benign. For symptomatic patients, lifestyle modifications are first-line, including:
- reducing caffeine, alcohol, and nicotine intake
- managing stress
- getting adequate sleep If symptoms persist, beta-blockers like metoprolol (25-100 mg twice daily) or calcium channel blockers such as diltiazem (120-360 mg daily) can be effective. The study published in 2022 1 found that beta-blockers consistently decreased long-term mortality in high-burden and low-burden patients, with a hazard ratio of 0.521 and 0.601, respectively. While other treatment options like antiarrhythmic medications and catheter ablation may be considered for patients with frequent PACs causing significant symptoms, beta-blockers are the preferred initial treatment due to their mortality benefits, as supported by the most recent and highest quality study 1. In rare cases where PACs significantly impact quality of life despite medical therapy, catheter ablation might be an option, as shown in a study published in 2022 2, which found that radiofrequency catheter ablation was feasible, safe, and effective in eliminating isolated frequent, symptomatic, and drug-refractory PACs in patients with a structurally normal heart.