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Temporal patterns of premature atrial complexes predict atrial fibrillation occurrence in bradycardia patients continuously monitored through pacemaker diagnostics

  • Giuseppe BorianiEmail author
  • Giovanni Luca Botto
  • Paolo Pieragnoli
  • Renato Ricci
  • Mauro Biffi
  • Massimiliano Marini
  • Antonio Sagone
  • Andrea Avella
  • Carlo Pignalberi
  • Matteo Ziacchi
  • Giuseppe Ricciardi
  • Ester Tartaglione
  • Andrea Grammatico
  • Maurizio Gasparini
IM - ORIGINAL
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Abstract

The frequency of premature atrial complexes (PACs) has been related with atrial fibrillation (AF) occurrence and adverse prognosis. Research objective was to evaluate whether temporal patterns of PACs are directly associated with AF onset in pacemaker patients with continuous monitoring of the atrial rhythm. Overall, 193 pacemaker patients (49% female, 72 ± 9 years old), enrolled in a national registry, were analyzed. Frequency of daily PACs was measured in a 14-day initial observation period, during which patients were in sinus rhythm. In the following period, temporal occurrence and frequency of daily PACs and eventual onset of AF were derived by pacemaker diagnostics. In the run-in period, median PACs frequency was 614 PACs/day (interquartile range 70–3056). Subsequently, in a median follow-up of 6 months, AF occurred in 109 patients, in particular in 37/96 (38.5%) patients with a PAC rate < 614 PACs/day and in 72/97 (74.2%) patients with PAC rate ≥ 614 PACs/day (p < 0.001). In patients with AF occurrence, the number of daily PACs, normalized by dividing for the average of PACs in ten preceding days, progressively increased in the 5 days preceding AF. Cox model predictive analysis showed that the risk of AF was significantly higher in patients with a relative increase of the daily PACs higher than 30% compared with PACs average number in ten preceding days [hazard ratio (95% confidence interval) 3.67 (2.40–5.59), p < 0.001]. PACs frequency increases in the 5 days preceding AF onset. A relative increase of the daily PACs is significantly associated with the risk of AF occurrence.

Keywords

Atrial fibrillation Monitoring Pacemaker Premature atrial complexes 

Notes

Acknowledgements

The data management and statistical analysis were sponsored by Medtronic plc. The sponsor had no role in the collection of clinical data, in the interpretation of data, and in the decision to submit the article for publication.

Compliance with ethical standards

Conflict of interest

G. Boriani and M. Ziacchi received speaker’s fees from Biotronik, Boston Scientific, and Medtronic. A. Avella received proctorship fees from Boston Scientific. E. Tartaglione and A. Grammatico are employees of Medtronic plc. Other authors have no conflicts of interest.

Statements on human and animal rights

The study conforms with the principles outlined in the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution's human research committee.

Informed consent

Informed consent was obtained from all the individual participants included in the study.

Participating centers

L. Padeletti, P. Pieragnoli, G Ricciardi Careggi Hospital, Firenze; M. Santini, R. Ricci, C. Pignalberi San Filippo Neri Hospital, Roma; G.L. Botto, A. Sagone, S.Anna Hospital, Como; G. Boriani, M Biffi, M Ziacchi S.Orsola-Malpighi Hospital, Bologna; A. Capucci, GQ Villani, Civile Hospital, Piacenza; S. Favale, Policlinico Hospital, Bari; A. Spampinato, M. Martelli, Villa Tiberia Hospital, Roma; P. Rizzon, G. Luzzi, Policlinico Hospital, Bari; A. Galati, M. Accogli, Panico Hospital, Tricase; G. Inama, O. Durin, Landolina M Maggiore Hospital, Crema; F. Solimene, F. Coltorti, Clinica Montevergine Hospital, Mercogliano; M. Disertori, M. Del Greco, Santa Chiara Hospital, Trento; G. Molon, S.Cuore Hospital, Negrar; G. Senatore, Civile Hospital, Ciriè; F. Ferri, Fatebenefratelli Villa S. Pietro Hospital, Roma; A. Vicentini, A. Fusco, Pederzoli Hospital, Peschiera; P. Della Bella, F. Giraldi, Cardiologico Hospital, Milano; F. Zolezzi, Civile Hospital, Vigevano; A. Proclemer, D. Facchin, S.Maria della Misericordia Hospital, Udine; M. Gasparini, Istituto Clinico Humanitas, Milano; L. Chiarandà, G. Muscio, Muscatello Hospital, Augusta; V. Indelicato, Civile Hospital, Sciacca; L. Zamparelli, S. De Vivo, Monaldi Hospital, Napoli; V. Spadola, G. Piccione, Civile Hospital, Ragusa; P. Dini, E. Adinolfi, S.Camillo Hospital, Roma; N. DiGiovanni, V. Guzzo, Aiello Hospital, Mazara del Vallo; A.S. Montenero, Multimedica Hospital, Milano; M. Gulizia, G. Francese, S.Luigi-S. Currò Hospital, Catania; F. Drago, M. Silvetti, Bambino Gesù Hospital, Roma; G. Vergara, D. Catanzariti, S.Maria del Carmine Hospital, Rovereto; D. Malfitano, Gravina Hospital, Caltagirone; R. Evola, R. Foti, S.Vincenzo Hospital, Taormina; E. Adornato, A. Pangallo, Melacrino e Bianchi Hospital, Reggio Calabria; S. Orazi, F. Evangelista, S. Camillo de Lellis Hospital, Rieti; F. Lisi, A. Coppola, Cannizzaro Hospital, Catania; S. Mangiameli, G. Doria, Garibaldi Hospital, Catania; A. Battaglia, O. Pensabene, Villa Sofia Hospital, Palermo; R. Favilli, Le Scotte Hospital, Siena; W.G. Rahue, M. Tomaino, S. Maurizio Hospital, Bolzano; V. Ziacchi, Civile Hospital, Desenzano.

References

  1. 1.
    Camm AJ, Evans KE, Ward DE, Martin A (1980) The rhythm of the heart in active elderly subjects. Am Heart J 99:598–603CrossRefGoogle Scholar
  2. 2.
    Fleg JL, Kennedy HL (1982) Cardiac arrhythmias in a healthy elderly population: detection by 24-hour ambulatory electrocardiography. Chest 81:302–307CrossRefGoogle Scholar
  3. 3.
    Wustmann K, Kucera JP, Zanchi A et al (2008) Activation of electrical triggers of atrial fibrillation in hyperthyroidism. J Clin Endocrinol Metab 93:2104–2108CrossRefGoogle Scholar
  4. 4.
    Killip T, Gault J (1965) Mode of onset of atrial fibrillation in man. Am Heart J 70:172–179CrossRefGoogle Scholar
  5. 5.
    Frost L, Molgaard H, Christiansen E, Jacobsen C, Allermand H, Thomsen P (1995) Low vagal tone and supraventricular ectopic activity predict atrial fibrillation and flutter after coronary artery bypass grafting. Eur Heart J 16:825–831CrossRefGoogle Scholar
  6. 6.
    Haissaguerre M, Jais P, Shah DC et al (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666CrossRefGoogle Scholar
  7. 7.
    Waktare JE, Hnatkova K, Sopher SM et al (2001) The role of atrial ectopics in initiating paroxysmal atrial fibrillation. Eur Heart J 22:333–339CrossRefGoogle Scholar
  8. 8.
    Tse HF, Sin PY, Siu CW, Tsang V, Lam CL, Lau CP (2005) Successful pulmonary vein isolation using transvenous catheter cryoablation improves quality-of-life in patients with atrial fibrillation. Pacing Clin Electrophysiol 28:421–424CrossRefGoogle Scholar
  9. 9.
    Yamane T, Date T, Kanzaki Y et al (2006) Behavior of atrial ectopic beats before and after pulmonary vein isolation in patients with atrial fibrillation: a reduction in the number and arrhythmogenicity of ectopic firings. Heart Rhythm 3:1421–1427CrossRefGoogle Scholar
  10. 10.
    Engstrom G, Hedblad B, Juul-Moller S, Tyden P, Janzon L (2000) Cardiac arrhythmias and stroke: increased risk in men with high frequency of atrial ectopic beats. Stroke 31:2925–2929CrossRefGoogle Scholar
  11. 11.
    Wallmann D, Tuller D, Kucher N, Fuhrer J, Arnold M, Delacretaz E (2003) Frequent atrial premature contractions as a surrogate marker for paroxysmal atrial fibrillation in patients with acute ischaemic stroke. Heart 89:1247–1248CrossRefGoogle Scholar
  12. 12.
    Wallmann D, Tuller D, Wustmann K et al (2007) Frequent atrial premature beats predict paroxysmal atrial fibrillation in stroke patients: an opportunity for a new diagnostic strategy. Stroke 38:2292–2294CrossRefGoogle Scholar
  13. 13.
    Binici Z, Intzilakis T, Nielsen O, Kober L, Sajadieh A (2010) Excessive supraventricular ectopic activity and increased risk of atrial fibrillation and stroke. Circulation 121:1904–1910CrossRefGoogle Scholar
  14. 14.
    Chong BH, Pong V, Lam KF et al (2012) Frequent premature atrial complexes predict new occurrence of atrial fibrillation and adverse cardiovascular events. Europace 14:942–947CrossRefGoogle Scholar
  15. 15.
    Camm AJ, Kirchhof P, Lip GY et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery. Eur Heart J 31:2369–429Google Scholar
  16. 16.
    Boriani G, Proietti M, Laroche C et al. EORP-AF Pilot General Registry Investigators (2018) Changes to oral anticoagulant therapy and risk of death over a 3-year follow-up of a contemporary cohort of European patients with atrial fibrillation final report of the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) pilot general registry. Int J Cardiol 271:68–74Google Scholar
  17. 17.
    Freedman B, Camm J, Calkins H et al (2017) Screening for atrial fibrillation: a report of the AF-SCREEN international collaboration. Circulation 135:1851–1867CrossRefGoogle Scholar
  18. 18.
    Boriani G, Botto GL, Padeletti L et al (2011) Improving stroke risk stratification using the CHADS2 and CHA2DS2-VASc risk scores in patients with paroxysmal atrial fibrillation by continuous arrhythmia burden monitoring. Stroke 42:1768–1770CrossRefGoogle Scholar
  19. 19.
    Vardas PE, Auricchio A, Blanc JJ et al. European Society of Cardiology, European Heart Rhythm Association (2007) Guidelines for cardiac pacing and cardiac resynchronization therapy. The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association. Europace 9:959–98Google Scholar
  20. 20.
    Dijkman B, Wellens HJ (2000) Dual chamber arrhythmia detection in the implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 11:1105–1115CrossRefGoogle Scholar
  21. 21.
    Boriani G, Glotzer TV, Ziegler PD et al (2018) Detection of new atrial fibrillation in patients with cardiac implanted electronic devices and factors associated with transition to higher device-detected atrial fibrillation burden. Heart Rhythm 15:376–383CrossRefGoogle Scholar
  22. 22.
    Prasitlumkum N, Rattanawong P, Limpruttidham N et al (2018) Frequent premature atrial complexed as a predictor of atrial fibrillation: systematic review and meta-analysis. J Electrocardiol 51:760–767CrossRefGoogle Scholar
  23. 23.
    Chang KW, Hsu JC, Toomu A, Fox S, Maisel AS (2017) Clinical applications of biomarkers in atrial fibrillation. Am J Med 130:1351–1357CrossRefGoogle Scholar
  24. 24.
    Nattel S, Guasch E, Savelieva I et al (2014) Early management of atrial fibrillation to prevent cardiovascular complications. Eur Heart J 35:1448–1456CrossRefGoogle Scholar
  25. 25.
    Acharya T, Tringali S, Bhullar M et al (2015) Frequent atrial premature complexes and their association with risk of atrial fibrillation. Am J Cardiol 116:1852–1857CrossRefGoogle Scholar
  26. 26.
    John AG, Hirsch GA, Stoddard MF (2018) Frequent premature atrial contractions impair left atrial contractile function and promote adverse left atrial remodeling. Echocardiography 35:1310–1317CrossRefGoogle Scholar
  27. 27.
    Evans A, Perez I, Yu G, Kalra L (2000) Secondary stroke prevention in atrial fibrillation: lessons from clinical practice. Stroke 31:2106–2111CrossRefGoogle Scholar
  28. 28.
    Hart RG (2003) Atrial fibrillation and stroke prevention. N Engl J Med 349:1015–1016CrossRefGoogle Scholar
  29. 29.
    Hart RG, Halperin JL, Pearce LA et al (2003) Lessons from the stroke prevention in atrial fibrillation trials. Ann Intern Med 138:831–838CrossRefGoogle Scholar
  30. 30.
    van Walraven C, Hart RG, Singer DE, Koudstaal PJ, Connolly S (2003) Oral anticoagulants vs. aspirin for stroke prevention in patients with non-valvular atrial fibrillation: the verdict is in. Card Electrophysiol Rev 7:374–8Google Scholar

Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  • Giuseppe Boriani
    • 1
    Email author
  • Giovanni Luca Botto
    • 2
  • Paolo Pieragnoli
    • 3
  • Renato Ricci
    • 4
  • Mauro Biffi
    • 5
  • Massimiliano Marini
    • 6
  • Antonio Sagone
    • 7
  • Andrea Avella
    • 8
  • Carlo Pignalberi
    • 4
  • Matteo Ziacchi
    • 5
  • Giuseppe Ricciardi
    • 3
  • Ester Tartaglione
    • 9
  • Andrea Grammatico
    • 9
  • Maurizio Gasparini
    • 10
  1. 1.Cardiology Division, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio Emilia, Modena University HospitalModenaItaly
  2. 2.Cardiology DepartmentRho HospitalRhoItaly
  3. 3.University Hospital of FlorenceFlorenceItaly
  4. 4.Department of CardiologySan Filippo Neri HospitalRomeItaly
  5. 5.Department of Experimental, Diagnostic and Specialty MedicineUniversity of Bologna, S.Orsola-Malpighi University HospitalBolognaItaly
  6. 6.Cardiology DepartmentSanta Chiara HospitalTrentoItaly
  7. 7.Cardiology DepartmentMultimedica HospitalMilanItaly
  8. 8.Cardiology Division, Cardiac Arrhythmia UnitSt. Camillo-Forlanini HospitalRomeItaly
  9. 9.Medtronic Core Clinical SolutionsRomeItaly
  10. 10.Electrophysiology and Pacing UnitHumanitas Clinical and Research Hospital, IRCCSRozzanoItaly

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