The association between frequent premature atrial contractions and recurrent stroke in a population of ischemic stroke

Objective: Premature atrial contractions (PACs) are a prevalent cardiac occurrence. Recent research indicates that PACs are linked to atrial fibrillation (AF), ischemic stroke, and mortality. We aimed to investigate the association of PACs and the risk of recurrent stroke in patients with ischemic stroke in sinus rhythm. 
Methods: The study was conducted as a cross-sectional study. 24-hour standard three-lead Holter ECG monitoring was performed for seven days and analyzed. Patients were separated into two groups based on the results of Holter ECG monitoring: those with subclinical AF and those with frequent PACs. Frequent PACs were characterized as more than fourteen PACs per hour and >3 PAC runs each 24 hours. Subclinical AF was defined as atrial fibrillation, atrial flutter, or atrial tachycardia events detected by implantable or wearable cardiac devices in people without AF symptoms and in whom clinical AF was not previously detected. 
Results: 150 patients, consisting of 82 men (54.7% of the total) and 68 women (45.3%), with an average age of 60.9±13.5 years, were enrolled in the research. Based on the Holter findings, patients were separated into subclinical AF (n=54) and frequent PACs (n=96).During hospitalization, recurrent ischemic stroke was detected in 6 patients (11%) in the subclinical AF arm and 26 patients (26%) in the frequent PACs arm (p=0.03). Six patients died of whom 4 died after a recurrent stroke event in the hospital. In univariate analysis age [OR: 1.03, 95%CI (1-1.07), p=0.02], dyslipidemia [OR: 2.68, 95%CI (1.16-6.18), p=0.021] and frequent PACs [OR: 2.97, 95%CI (1.13-7.76), p=0.026] were found significant predictors of recurrent stroke. Furthermore, in multivariate logistic regression analysis only frequent PACs [OR: 2.69, 95%CI (1-7.17), p=0.048] was found independent predictors of recurrent stroke. 
Conclusion: Frequent PACs on Holter analysis were significantly associated with recurrent ischemic stroke.