Patients with metabolic syndrome and premature atrial contractions: predicting the atrial fbrillation onset

Aim. To develop an algorithm for the prediction of the atrial fbrillation onset in patients with metabolic syndrome (MS) and premature atrial contractions (PACs) in a prospective study.

Materials and Methods. We enrolled 1,726 MS patients (age range 45-75 years) with ≥ 100 PACs per day. We measured cardiac chamber volumes, left ventricle contractility, parameters of the atrial electrocardiogram, P-wave dispersion, and the origin of PACs, further calculating the potential index of atrial fbrillation (PI) according to the CHARGEAF (RCHARGE-AF) model. The follow-up was 1-5 years. Maintenance of sinus rhythm or development of atrial fbrillation (AF) were the study endpoints.

Results. Paroxysmal or persistent AF was registered in 218 (12.41%) patients. Elderly patients with MS and RCHARGE-AF score ≥ 0.72 units or predictors of AF development of AF (e.g., PACs or atrial enlargement) belonged to AF risk group. Development of AF in patients with MS correlated (OR > 3) with left atrial end-diastolic volume index > 34 mL/m2 with its average increase of +5% per year (OR = 3.3), RCHARGE-AF ≥ 0.72 (OR = 4.2), and PI < 8 units followed by an average regression of -20%/ year (OR = 14.8). The accuracy of predicting atrial fbrillation within 3-5 years before its onset was ≈ 60%, reaching ≥ 86% for the 3-year time frame.

Conclusion. Our forecasting algorithm can identify the risk groups and predict the development of AF in patients with MS and PACs.

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