Pediatric premature atrial contractions: Clinical characteristics, diagnosis, and management-A literature review

Premature Atrial Contractions (PACs) are among the most prevalent arrhythmias in the pediatric population, occurring from the fetal period through adolescence. While typically benign in children with structurally normal hearts, PACs carry significant clinical implications for patients with Congenital Heart Disease (CHD), genetic cardiomyopathies, and specific syndromic conditions. This review aims to clarify the clinical characteristics, diagnostic criteria, and management strategies for pediatric PACs.

A comprehensive review of the current literature was conducted regarding the epidemiology, etiology, diagnosis, and management of PACs in pediatric patients. This review synthesizes data from recent meta-analyses, observational studies, and clinical guidelines to establish age-stratified reference limits and risk stratification protocols.

In healthy school-aged children, the prevalence of PACs ranges from 0.11% to 0.515%, with significantly higher rates observed during the neonatal period. Recent meta-analysis data defines age-stratified reference limits for 24-h ambulatory electrocardiographic (Holter) monitoring: a maximum of 150 PACs per day for neonates and infants (0-12 months) and 50 PACs per day for older children. While fetal PACs generally resolve spontaneously, blocked PACs may rarely progress to sustained tachyarrhythmias. Diagnosis primarily relies on 12‑lead electrocardiography (ECG) and Holter monitoring. Clinically, frequent or non-conducted PACs may cause "pseudo-bradycardia," occasionally requiring pharmacological intervention with agents such as propafenone. The incidence of PACs is notably increased in children with CHD or following interventional procedures.

PACs are predominantly benign in children with structurally normal heartsyet comprehensive evaluation is mandated for patients with symptomatic frequent PACs concurrent structural heart disease or significant electrocardiographic abnormalities. Management should be guided by age-specific reference limits and the underlying cardiac substrate.