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


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.


Atrial fibrillation Monitoring Pacemaker Premature atrial complexes 



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.


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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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