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Atrial extrasystoles after exercise predict atrial fibrillation in patients with left ventricular hypertrophy
  1. R J Folkeringa,
  2. J Hartgers,
  3. R G Tieleman,
  4. A P Gorgels,
  5. W R M Dassen,
  6. H J G M Crijns
  1. Department of Cardiology, University Hospital Maastricht, Maastricht, the Netherlands
  1. Correspondence to:
    Dr Richard J Folkeringa
    P Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, Netherlands; rfol{at}

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Prediction of atrial fibrillation (AF) is usually based on anatomical and functional characterisation of the atrial substrate, such as left atrial diameter, ejection fraction, and P wave duration.1 In this respect, triggers such as atrial extrasystoles are often neglected.2 Atrial extrasystoles may occur during or shortly after exercise as a result of acute atrial stretch, especially in patients with left ventricular hypertrophy (LVH) and diastolic dysfunction. As LVH may induce the atrial substrate and atrial extrasystoles are the trigger for AF, we reasoned that these exercise induced atrial extrasystoles may predict AF in patients with LVH.


Patients with LVH (interventricular septal diameter ⩾ 11 mm) and ejection fraction ⩾ 55% who underwent an exercise test between 1994 and 2004 were studied. Patients with prior AF or flutter or pacemaker rhythm, patients without at least one follow up ECG, and those with an incomplete exercise test were excluded. Of 864 screened patients 258 were selected.

The exercise tests (Case Exercise Testing System; GE Medical Systems, Milwaukee, USA) were performed according to standard protocols.3 Each test was manually reviewed for atrial extrasystoles and supraventricular tachycardia (SVT; three or more consecutive supraventricular extrasystoles).

Follow up ECG data were retrieved from an electronic storage system containing all ECGs recorded in our institution since 1994. The follow up period lasted from the date of the exercise test …

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  • Competing interest statement: We declare that we have used only original data and that these data are not under review elsewhere or published before. In addition, none of the authors have competing interests.

  • Ethical statement: Since the exercise tests were analysed in retrospect for the purpose of this observational study, the need for ethical approval was waived.