PAC / PVC when are they too many?

Any input is appreciated on what is acceptable and what is not.

Quote
IrishPeteAZ
Any input is appreciated on what is acceptable and what is not.

"Excessive atrial ectopic activity was defined as ≥30 PAC per hour or a single run of ≥20. Over a median follow-up period of 76 months, it was found that excessive PAC were associated with a >60% increase in the risk of death or stroke, and a 2.7-fold increase in the development of AF."

[www.emjreviews.com]

"...Conclusions: In a large cohort of patients with recent ischemic stroke or TIA, burden of PACs or nonsustained AF less than 30 seconds were not associated to higher risk of recurrent stroke/TIA or death..."

From - Observational Study J Stroke Cerebrovasc Dis
. 2020 Feb;29(2):104490. doi: 10.1016/j.jstrokecerebrovasdis.2019.104490. Epub 2019 Dec 12.
Burden of Premature Atrial Complexes and Risk of Recurrent Stroke and Death in Patients with Mild to Moderate Ischemic Stroke
Michala Herskind Sejr 1, Ole May 2, Dorte Damgaard 3, Niels Henrik Bruun 4, Jens Cosedis Nielsen 5
Affiliations expand
PMID: 31839547 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104490

So, that much is good news.

For simple burden, no previous stroke or TIA:

"...Methods and Results
We investigated the clinical characteristics of 5371 consecutive patients without atrial fibrillation (AF) or a permanent pacemaker (PPM) at baseline who underwent 24-hour electrocardiography monitoring between January 1, 2002, and December 31, 2004. Clinical event data were retrieved from the Bureau of National Health Insurance of Taiwan. During a mean follow-up duration of 10±1 years, there were 1209 deaths, 1166 cardiovascular-related hospitalizations, 3104 hospitalizations for any reason, 418 cases of new-onset AF, and 132 PPM implantations. The optimal cut-off of PAC burden for predicting mortality was 76 beats per day, with a sensitivity of 63.1% and a specificity of 63.5%. In multivariate analysis, a PAC burden >76 beats per day was an independent predictor of mortality (hazard ratio: 1.384, 95% CI: 1.230 to 1.558), cardiovascular hospitalization (hazard ratio: 1.284, 95% CI: 1.137 to 1.451), new-onset AF (hazard ratio: 1.757, 95% CI: 1.427 to 2.163), and PPM implantation (hazard ratio: 2.821, 95% CI: 1.898 to 4.192). Patients with frequent PAC had increased risk of mortality attributable to myocardial infarction, heart failure, and sudden cardiac death. Frequent PACs increased risk of PPM implantation owing to sick sinus syndrome, high-degree atrioventricular block, and/or AF.

Conclusions
The burden of PACs is independently associated with mortality, cardiovascular hospitalization, new-onset AF, and PPM implantation in the long term..."

From: [www.ncbi.nlm.nih.gov]#

PAC/PVC occurrence were once considered to be "benign". More recent studies have shown that high burdens particularly in patients with afib need to be addressed. The challenge is to find an EP skilled enough to track down these locations of extra beats becuase this is quite challenging. For afib patients, it is not uncommon that these extra beats trigger afib - that is the case for me. My most recent visit with a EP told me that eliminating every area may not be possible, however, the burden can hopefully be decreased to improve risk of going into AFIB and improving quality of life.