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Investigators from multiple institutions conducted a retrospective study to describe clinical characteristics of children without cardiac disease who were noted to have excessive premature atrial contractions (PACs) on Holter monitor evaluation, assess change in PAC frequency over time, and identify predictors of change in frequency. Study participants were youths 1-20 years old, evaluated at 1 of 2 pediatric cardiology centers in Jacksonville, FL, between 2010 and 2020, with excessive PACs (defined as >50 PACs per 24 hours), identified with Holter monitoring. Patients with congenital or non-congenital heart disease and those with a preexisting arrhythmia disorder were excluded. Patient characteristics, including demographics, indication for Holter evaluation, findings on Holter monitoring (eg, atrial triplets), percentage of PACs, presence of medical conditions including attention deficit hyperactivity disorder and asthma (and medications for these conditions), and participation in athletics, were collected. For those participants with a follow-up Holter monitor evaluation, change in PAC frequency was assessed using a t-test. A significant reduction in PAC frequency was defined as a decrease of 20% from baseline to follow-up. Multivariate repeated measures mixed regression models were used to identify predictors of change in PAC frequency in study participants.
Data were analyzed on 343 children with excessive PACs at baseline. Median age of these patients was 8.3 years (interquartile range, 4.1, 14), 53% were male, and median percent PACs was 3.6%. The most common reason for evaluation was irregular heart rhythm (noted in 56.2% of participants), followed by murmur (20.9%) and sports screen (8.7%). A total of 39 children (11.3%) were diagnosed with ADHD, all of whom were on medication, and 33 patients (9.6%) had asthma; 99 patients (28.9%) participated in athletic activities. Echocardiograms were obtained on 338 participants, and no structural or congenital heart disease was identified. There were 188 children (54.8%) with follow-up Holter monitoring, performed at a median of 2.2 years after the baseline evaluation. Among these participants, percent PACs decreased from 4.2% at baseline to 0.5% at follow-up (P <0.001). A decrease of at least 20% was noted in 166 (88.3%) children. Overall, the decrease in PAC frequency was significantly greater in males than females (P = 0.0006), and among those involved in athletics at baseline compared to those not participating in athletics (P = 0.034). Conversely, a significant increase in PAC frequency was noted in patients with atrial triplets at baseline (P <0.0001). Stimulant medications were discontinued between baseline and follow-up in 25 participants with ADHD. In these patients, PAC frequency decreased significantly more than those not on stimulant medications (P <0.0001).
The authors conclude that in asymptomatic children found to have excessive PACs, PAC frequency usually decreased over time.
Dr Goldberg has disclosed no financial relationship relevant to...
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