The Study Of Relationship Between Premature Atrial Contractions And Atrial Fibrillation Incidence Based On The Traditional Chinese Medicine Concept Of "Preventive Treatment Of Disease"

ObjectiveAtrial fibrillation (AF) is one of the most common kinds of arrhythmia. Patients with AF may have disturbing symptoms and develop complications such as ischemic stroke, myocardial infarction as well as heart failure. Once the atrial remodeling formed, it is difficult to reverse. Premature atrial contractions (PACs) is the potential manifestation of early atrial remodeling. Therefore, in order to provide information to early AF prevention, this study is aimed to systematically review the researches about PACs predicting AF incidence and explore the relationship between PACs and AF related serum biomarkers based on the traditional Chinese medicine concept of "preventive treatment of disease".MethodsThrough detailed literature reviewing, the relationship of AF, PACs, and AF related serum biomarkers as well as traditional Chinese medicine concept of "preventive treatment of disease" were discussed. Then, the systematic review and meta-analysis of premature atrial contractions predict atrial fibrillation was performed. Cohort studies which provide adjustment of hazard ratio (HR) and definition of frequent PACs were applied in meta-analysis. Baseline characteristics of included studies were extracted and the quality of studies was assessed through Newcastle-Ottawa Scale by two reviewers. Sensitive analysis, meta-regression and subgroup analysis were performed to identify the source of heterogeneity if necessary. Finally, A retrospective study was performed to analyze the data of diseases history, holter, echocardiogram and blood tests.Results1. Based on basic and clinical researches, atrial fibrillation should be treatment early to prevent it occurring and developing, moreover, multiple risk factors of AF were concluded including PACs. In addition, AF is associated with serum biomarkers such as CRP and uric acid. It is important to discuss the relationship among PACs, AF and AF related serum biomarkers based on the traditional Chinese medicine concept of "preventive treatment of disease”. 2. In the systematic review, eleven studies were applied in systematic review and quality assessment. Six studies including 9519 subjects and 782 cases of AF were applied in the meta-analysis. Overall, frequent PACs was correlated with a significantly greater risk of AF incidence (HR=3.13 [95%CI 1.92-5.11], P=0.007). However, the heterogeneity of combined studies was relatively high (I2=68.8%). To identify the source of heterogeneity, sensitive analysis, meta-regression and subgroup analysis were performed and found that study population difference, distinguished follow-up duration and various definitions of frequent PACs contributed to the heterogeneity.3. In the retrospective study, there were 122 subjects included. Among the selected population, the median of PACs number distribution is 24/24h, which is defined as “frequent" PACs in present study. Patients with "frequent" PACs have higher CRP level (7.1±14.8 mg/L vs 2.7±5.2mg/L, P=0.013), higher uric acid level (410.0±115.8μmol/L vs 363.5±96.3μmol/L, P=0.018), larger left atrial diameter (35.0±5.7 mm vs 32.0±4.8 mm, P=0.002), larger right atrial vertical diameter (47.8±6.7 mm vs 45.3±5.2mm, P=0.011) and larger right atrial horizonal diameter (36.8±5.1 vs 34.2±3.9mm, P=0.002), suggested that the potential pathological anatomical change was existed in patient with "frequent" PACs. Meanwhile, age, sex, patient history and medication showed no statistical significance between two groups (P>0.05). In addition, the proportion of Qi-deficiency, Yin-deficiency and blood stasis were higher in "frequent" PACs group, had statistical significance (P＜0.05)ConclusionPACs is evident associated with AF, and is also associated with AF-related serum biomarkers. According to the traditional Chinese medicine concept of "preventive treatment of disease", AF is state of illness and relatively PACs is state of approaching illness. PACs with AF-related serum biomarkers elevation may be the early manifestation of atrial remodeling. Hence, PACs with elevated AF-related serum biomarkers should attract public attention. With the guidance of "preventive treatment of disease" concept and Traditional Chinese Medicine, to develop more effective medication to improve atrial remodeling is meaningful. Early intervention of PACs has potential benefit of preventing AF.