Patient
Information
Atrial Premature Beats
Atrial
premature beats (APBs or PACs) generally fall into two broad
categories: benign atrial premature beats and pathological
atrial premature beats. Benign APBs are quite common and may
actually occur from time to time in most people, although they can
occur with great frequency in some people (even every other beat
for extended periods of time). They are particularly common in
infants and teenagers. They tend to occur at lower heart rates,
and tend to be abolished when the heart rate increases, as with
exercise. On an ECG, benign APBs generally all have the same
appearance (morphology), and one does not see them in conjunction
with more serious arrhythmias (such as atrial tachycardia).
Benign APBs are of no importance, and do not require treatment
unless they cause symptoms (palpitations).
Pathological APBs
are very rare, but can be a sign of injury or inflammation of the heart muscle.
They are particularly uncommon in children. They tend to be worse with exercise and at
higher heart rates, take multiple forms (polymorphic or multifocal) on an ECG or Holter recording and may be associated
with more serious arrhythmias.
Telling the two
types of APBs apart usually requires an ECG or a more prolonged
monitoring procedure, such as a Holter monitor, a physical
examination, evaluation of the family history, and perhaps other
tests depending on the particular circumstances and preference of
the physician. I tend to be more concerned about a child who 1) has
an irregular rhythm all, or most, of the time; 2) has shortness or
breath, dizziness or fainting during an arrhythmia, or an unexpected
fainting episode or seizure; 3) who is not growing well; or 4) has a
family history of serious arrhythmias or heart problems in young
people. When any of these conditions are true, I recommend a child
be evaluated by a pediatric cardiologist, or, if none are available,
an adult cardiologist.
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