Premature atrial contractions (PACs), also known as atrial premature complexes (APC) or atrial premature beats (APB), are a common cardiac dysrhythmia characterized by premature heartbeats originating in the atria. While the sinoatrial node typically regulates the heartbeat during normal sinus rhythm, PACs occur when another region of the atria depolarizes before the sinoatrial node and thus triggers a premature heartbeat,[1] in contrast to escape beats, in which the normal sinoatrial node fails, leaving a non-nodal pacemaker to initiate a late beat. The exact cause of PACs is unclear; while several predisposing conditions exist, single PACs commonly occur in healthy young and elderly people. Elderly people that get PACs usually don't need any further attention besides follow ups due to unclear evidence.[2][3] PACs are often completely asymptomatic and may be noted only with Holter monitoring, but occasionally they can be perceived as a skipped beat or a jolt in the chest. In most cases, no treatment other than reassurance is needed for PACs, although medications such as beta blockers can reduce the frequency of symptomatic PACs.[4] Show
Risk factors[edit]Hypertension, or abnormally high blood pressure, often signifies an elevated level of both psychological and physiological stress. Often, hypertension goes hand in hand with various atrial fibrillations including premature atrial contractions (PACs).[5] Additional factors that may contribute to spontaneous premature atrial contractions could be:[4]
Diagnosis[edit]Premature atrial contractions are typically diagnosed with an electrocardiogram, Holter monitor, or cardiac event monitor.[citation needed] Electrocardiogram[edit]On an electrocardiogram (ECG), PACs are characterized by an abnormally shaped P wave. Since the premature beat initiates outside the sinoatrial node, the associated P wave appears different from those seen in normal sinus rhythm. Typically, the atrial impulse propagates normally through the atrioventricular node and into the cardiac ventricles, resulting in a normal, narrow QRS complex. However, if the atrial beat is premature enough, it may reach the atrioventricular node during its refractory period, in which case it will not be conducted to the ventricle and there will be no QRS complex following the P wave.[citation needed] Treatment[edit]Premature atrial contractions are often benign, requiring no treatment. Occasionally, the patient having the PAC will find these symptoms bothersome, in which case the doctor may treat the PACs. Sometimes the PACs can indicate heart disease or an increased risk for other cardiac arrhythmias. In this case, the underlying cause is treated. Often a beta blocker will be prescribed for symptomatic PACs.[6] Prognosis[edit]In otherwise healthy patients, occasional single premature atrial contractions are a common finding and most of times do not indicate any particular health risk. Rarely, in patients with other underlying structural heart problems, PACs can trigger a more serious arrhythmia such as atrial flutter or atrial fibrillation.[7] In otherwise healthy people, PACs usually disappear with adolescence.[citation needed] [edit]A supraventricular extrasystole (SVES) is an extrasystole or premature electrical impulse in the heart, generated above the level of the ventricle. This can be either a premature atrial contraction or a premature impulse from the atrioventricular node. SVES should be viewed in contrast to a premature ventricular contraction that has a ventricular origin and the associated QRS change. Instead of the electrical impulse beginning in the sinoatrial (SA) node and propagating to the atrioventricular (AV) node, the signal is conducted both to the ventricle and back to the SA node where the signal began.[8] See also[edit]
References[edit]
External links[edit]What is occasional premature supraventricular complexes?Definition: premature beat that occurs prior to the expected QRS complex and that originates between the atria and ventricles. Typical findings on ECG.
What does sinus rhythm with premature supraventricular complexes mean?Kardia Advanced Determination “Sinus with Supraventricular Ectopy (SVE)” indicates sinus rhythm with occasional irregular beats originating from the top of the heart. A common reason for this is premature atrial contractions (PACs).
Is sinus rhythm with PVCs life threatening?A PVC often feels like a skipped heartbeat or heart flutter. However, most people experience no symptoms at all. PVCs aren't dangerous in most people. Your risk of PVC complications increases if you have other health conditions, including heart disease.
How serious is sinus rhythm with premature ventricular contractions?If you have PVCs, but you are otherwise healthy, there is usually no reason for concern and no need for treatment. If you have frequent symptomatic PVCs, or PVCs with heart disease, you may need treatment.
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Sinus rhythm with occasional supraventricular premature complexes
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