Prevalence and risk factors of arrhythmia in Burapha Hospital patients presenting with palpitation assessed by 24-hour Holter monitoring

Authors

  • Sukrisd Koowattanatianchai Department of Medicine, Faculty of Medicine, Burapha University
  • Akaphol Kaladee School of Health Science, Sukhothai Thammathirat Open University
  • Patchara Kochaiyapatana Department of Medicine, Faculty of Medicine, Burapha University
  • Pechngam Chaivanit

Keywords:

arrhythmia, palpitation, 24-hour Holter monitoring

Abstract

Abstract
Palpitation is one of the most common cardiac symptoms frequently encountered in
medical practice. Many palpitations are caused by arrhythmia, while other causes have also been observed. This study aimed to examine the prevalence rate of arrhythmia and factors affecting the occurrence of arrhythmia in patients reporting palpitations at Burapha University Hospital. A retrospective study was employed to collect historical data on the medical records of patients with palpitations at Burapha University Hospital. These patients were diagnosed using the 24-hour Holter monitoring device during the period between January 2019 to June 2021. The data was analyzed, presented as a percentage and with 95% confidence intervals (CIs). Multivariable logistic regression analysis was utilized to ascertain statistically significant factors leading to arrhythmia, and displayed by adjusted odd ratios (ORs) and 95% CIs. The results found that the prevalence of arrhythmia was 23.7% (95% CIs = 16.7-31.9). Sick sinus syndrome appeared to be the most common variant, having an observed prevalence rate of 29.0% (95% CIs = 14.2-48.0). Other prevalent variants were premature ventricular contraction and premature atrial contraction, each of which showed a prevalence rate of 19.4% (95% CIs = 7.5-37.5). In univariate analysis, it was found that patients were over 60 years old; with hypertension, gout, coronary artery disease, and chronic kidney disease; with chest x-ray scans that showed cardiomegaly; and an estimated glomerular filtration rate < 60 ml/min/1.73m2 were significantly related to arrhythmia and with a p-value < 0.05. However, the results of multivariate analysis revealed no statistically significant relationship with the occurrence of arrhythmia. In conclusion, palpitations were attributable to arrhythmia in 25% of cases. Nevertheless, no risk factors were discovered to be statistically significant when multiple logistic regression analysis was performed.

References

Lohr JW. Hyperuricemia: medscape; 2018 [Available from: https://emedicine. medscape.com/article/241767-clinical.

Matsuura F, Yamashita S, Nakamura T, et al. Effect of visceral fat accumulation on uric acid metabolism in male obese subjects: visceral fat obesity is linked more closely to overproduction of uric acid than subcutaneous fat obesity. Metabolism 1998;47:929-33.

Feig DI, Kang D-H, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med 2008;359:1811-21.

FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American college of rheumatology guideline for the management of Gout. Arthritis Rheumatol 2020;72:879-95.

Ay M, Charli A, Jin H, et al. molecular mechanisms underlying protective effects of Quercetin against mitochondrial dysfunction and progressive dopaminergic neurodegeneration in cell culture and mitoPark transgenic mouse models of parkinson’s disease. J Neurochem 2017;14:766-82.

Zhang C, Wang R, Zhang G, et al. Mechanistic insights into the inhibition of quercetin on xanthine oxidase. Int J Biol Macromol 2018;112:405-12.

Renugadevi J, Prabu SM. Quercetin protects against oxidative stress-related renal dysfunction by cadmium in rats. Exp Toxicol Pathol 2010;62:471-81.

Shi Y, Williamson G. Quercetin lowers plasma uric acid in pre-hyperuricaemic males: a randomised, double-blinded, placebo-controlled, cross-over trial. Br J Nutr 2016;115:800-6.

Egert S, Bosy-Westphal A, Seiberl J, et al. Quercetin reduces systolic blood pressure and plasma oxidised low-density lipoprotein concentrations in overweight subjects with a high-cardiovascular disease risk phenotype: a double-blinded, placebo-controlled cross-over study. Br J Nutr 2009;102:1065-74.

Hu Q-H, Zhang X, Wang X, et al. Quercetin regulates organic ion transporter and uromodulin expression and improves renal function in hyperuricemic mice. Eur J Nutr 2012;51:593-606.

Nicholls A, Scott JT. Effect of weight-loss on plasma and urinary levels of uric acid. Lancet 1972;2:1223-4.

Serban MC, Sahebkar A, Zanchetti A, et al. Effects of Quercetin on blood pressure: A systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc 2016;5:1-16.

Allan VA. Diagnostic approach to palpitations. Am Fam Physician 2005; 71:743-50.

Weber BE, Wishwa N. Kapoor. Evaluation and outcomes of patients with palpitation. Am J Med 1996;100:138-48.

Antzelevitch C, Burashnikov A. Overview of basic mechanisms of cardiac arrhythmia. Card Electrophysiol Clin 2011;3:23-45.

Chignon JM, Lepine JP, Ades J. Panic disorder in cardiac outpatients. Am J Psychiatry 1993;150:780-5.

Barsky AJ, Cleary PD, Coeytaux RR, et al. Psychiatric disorders in medical outpatients complaining of palpitations. J Gen Intern Med 1994;9:306-13.

Shekelle PG, Hardy ML, Morton SC, et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA 2003;289:1537-45.

Wolfe RR, Driscoll DJ, Gersony WM, et al. Arrhythmias in patients with valvular aortic stenosis, valvar pulmonary stenosis, and ventricular septal defect. Results of 24-hour ECG monitoring. Circulation

;87:89-101.

Clementy N, Fourquet A, Andre C, et al. Benefits of an early management of palpitations. Medicine 2018;97:e11466.

Jensen PN, Gronroos NN, Chen LY, et al. Incidence of and risk factors for sick sinus syndrome in the general population. J Am Coll Cardiol 2014;64:531-38.

Adan V, Crown LA. Diagnosis and treatment of Sick sinus syndrome. Am Fam Physician 2003;67:1725-32.

Alonso A, Jensen PN, Lopez FL, et al. Association of Sick Sinus Syndrome with Incident Cardiovascular disease and mortality: The atherosclerosis risk in communities study and cardiovascular health study. PLoS ONE 2014;9:e109662.

Sanders P, Morton JB, Davidson NC, et al. Electrical remodeling of the atria in congestive heart failure: electrophysiological and electroanatomic mapping in humans. Circulation 2003;108:1461-8.

Sanders P, Morton JB, Kistler PM, et al. Electrophysiological and electroanatomic characterization of the atria in sinus node disease: evidence of diffuse atrial remodeling. Circulation 2004;109:1514-22.

Kistler PM, Sanders P, Fynn SP, et al. Electrophysiologic and electroanatomic changes in the human atrium associated with age. J Am Coll Cardiol 2004;44:109-16.

Kakkar AK, Mueller I, Bassand JP, et al. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational,

prospective GARFIELD registry. PLoS One 2013;8:e63479.

Chiang CE, Naditch-Brule L, Murin J, et al. Distribution and risk profile of paroxysmal, persistent, and permanent atrial fibrillation in routine clinical practice: insight from the real-life global survey evaluating

patients with atrial fibrillation international registry. Circ Arrhythmia Electrophysiol 2012;5:632.

Alexopoulos A, Perpinia A, Michelakakis N, et al. Evaluation of left ventricular hypertrophy in patients requiring permanent pacing. Ther Adv Cardiovasc Dis 2010;4:295-9.

Kuo YJ, Tsai TH, Chang HP, et al. The risk of atrial fibrillation in patients with gout: a nationwide population-based study. Sci Rep 2016;6:32220.

Prystowsky EN. Screening and therapy for patients with nonsustained ventricular tachycardia. Am J Cardiol 2000;86:34K-39K.

Polikar R, Feld GK, Dittrich HC, et al. Effect of thyroid replacement therapy on the frequency of benign atrial and ventricular arrhythmias. J Am Coll Cardiol 1989;14: 999-1002.

Sawin CT, Geller A, Wolf P, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med 1994;331:1249-52.

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Published

2022-04-29

How to Cite

1.
Koowattanatianchai S, Kaladee A, Kochaiyapatana P, Chaivanit P. Prevalence and risk factors of arrhythmia in Burapha Hospital patients presenting with palpitation assessed by 24-hour Holter monitoring. J Med Health Sci [Internet]. 2022 Apr. 29 [cited 2024 Jul. 1];29(1):26-37. Available from: https://he01.tci-thaijo.org/index.php/jmhs/article/view/256118

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Original article (บทความวิจัย)