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August 31, 2026European Heart Journal OpenOpen Access

Determinants and Prognostic Value of Atrial and Ventricular Ectopic Burden in Adults Without Structural Heart Disease

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Why the study?

The independent long-term prognostic significance of atrial and ventricular ectopy in low-risk populations without structural heart disease remains a subject of ongoing clinical debate.

Does high atrial or ventricular ectopic burden predict major adverse cardiovascular events in asymptomatic adults without structural heart disease?

Population

931 asymptomatic individuals without structural heart disease

Comparison

High vs low atrial and ventricular ectopic burden

Design

Cohort study

Follow-up

Median 8 years (IQR 5-11 years)

Key result

High ventricular ectopic burden was a strong independent predictor of major adverse cardiovascular events in asymptomatic adults without structural heart disease (HR 3.06; 95% CI 2.06-4.56; P<0.001).

Authors

AMAmit MosesRVRotem Givoli VilenskyNMNoam Makmal

Discussion

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Member takes

Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

DADr. Amit MosesInternal Medicine Resident

“These findings are a powerful reminder that the heart often whispers before it shouts. Subtle signs, such as frequent irregular heartbeats and complex arrhythmias, give us an early warning of future risk before symptoms occur. This could allow early intervention to alter the trajectory of disease, allowing us to move to a new era of anticipatory heart medicine.”

Chaim Sheba Medical Center Ramat Gan, IsraelDr. Amit Moses
DADr. Amit MosesInternal Medicine Resident

“Our findings suggest that risk of arrhythmia begins to increase well before typical retirement age. They strongly support the need to screen older adults for arrhythmias, beginning at around age 50, to allow for timely intervention and improved long-term outcomes.”

Chaim Sheba Medical Center Ramat Gan, IsraelDr. Amit Moses

Overview

May inform risk stratification in asymptomatic adults; extends observational data but leaves open need for prospective validation.

Key Points

  • To determine the clinical predictors of atrial and ventricular ectopic burden and assess their independent long-term associations with major adverse cardiovascular events in adults without structural heart disease.
  • Analyzed 24-hour Holter monitoring recordings from 931 asymptomatic adults (mean age 52 ± 7 years; 13% female) without structural heart disease.
  • Tracked major adverse cardiovascular events (composite of acute coronary syndrome, stroke, new-onset heart failure, or cardiovascular death) in 840 participants over a median follow-up of 8 years (IQR 5–11 years).
  • High ventricular ectopic burden independently conferred a threefold increase in major adverse cardiovascular events (HR 3.06, 95% CI 2.06–4.56; p < 0.001), showing a graded risk across burden tertiles (HR per tertile increase 2.02, 95% CI 1.60–2.53; p < 0.001).
  • High atrial ectopic burden was independently associated with older age, male sex, lower eGFR, and lower cardiorespiratory fitness, but did not significantly predict cardiovascular events after multivariable adjustment (HR per tertile increase 1.21, 95% CI 0.98–1.50; p = 0.076).
  • The primary major adverse cardiovascular event endpoint occurred in 149 (18%) participants during the median 8-year follow-up.

Study Design

Type

Cohort (n=931)

Structured PICO

Does high atrial or ventricular ectopic burden predict major adverse cardiovascular events in asymptomatic adults without structural heart disease?

P
Population
931 asymptomatic adults without structural heart disease who completed a baseline 24-hour Holter recording, followed for a median of 8 years.
E
Exposure
High atrial ectopic burden (AEB) and ventricular ectopic burden (VEB) assessed via 24-hour Holter recording
C
Comparator
Lower ectopic burden (tertile-based or below median)
O
Outcome
Major adverse cardiovascular events (MACE), a composite of acute coronary syndrome, cerebrovascular accident, new-onset heart failure or cardiovascular mortality at median 8 years follow-upcomposite

Main Result

Hazard Ratio: 3.06 (95% CI 2.06–4.56)

p-value: p=<0.001

In asymptomatic adults without structural heart disease, high ventricular ectopic burden is a strong independent predictor of long-term cardiovascular risk, whereas atrial ectopic burden is not.

Cite This Study

Moses et al. (2026) conducted a cohort in Asymptomatic adults without structural heart disease (n=931). High ventricular ectopic burden (VEB) vs. Low ventricular ectopic burden was evaluated on Major adverse cardiovascular events (MACE) (composite of acute coronary syndrome, cerebrovascular accident, new-onset heart failure or cardiovascular mortality) (HR 3.06, 95% CI 2.06-4.56, p=<0.001). High ventricular ectopic burden was a strong independent predictor of major adverse cardiovascular events in asymptomatic adults without structural heart disease (HR 3.06; 95% CI 2.06-4.56; P<0.001).

synapsesocial.com/papers/6a953aec6af7ed2fcaea0c83https://doi.org/10.1093/ehjopen/oeag133
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Aging and arrhythmias: identifying early risk factors in healthy individuals2025
  2. 2Higher burden of supraventricular ectopic complexes early after catheter ablation for atrial fibrillation is associated with increased risk of recurrent atrial fibrillation2016 · 23 citations
  3. 3Excessive supraventricular ectopic activity and risk of incident atrial fibrillation in a consecutive population referred to ambulatory cardiac monitoring2021 · 7 citations
  4. 4Association between excessive supraventricular ectopy and subclinical cerebrovascular disease: a population‐based study2019 · 12 citations
  5. 5Arrhythmia Risk Assessment Using Heart Rate Variability Parameters in Patients with Frequent Ventricular Ectopic Beats without Structural Heart Disease2014 · 19 citations