Long-term Prognosis of Paroxysmal Atrial Fibrillation and Predictors for Progression to Persistnt or Chronic Atrial Fibrillation in the Korean Population

Abstract

Little is known about the long-term prognosis of or predictors for the different clinical types of atrial fibrillation (AF) in Korean populations. The aim of this study was to validate a risk stratification to assess the probability of AF progression from paroxysmal AF (PAF) to persistent AF (PeAF) or permanent AF. A total of 434 patients with PAF were consecutively enrolled (mean age; 71.7 ± 10.7 yr, 60.6% male). PeAF was defined as episodes that are sustained > 7 days and not self-terminating, while permanent AF was defined as an ongoing long-term episode. Atrial arrhythmia during follow-up was defined as atrial premature complex, atrial tachycardia, and atrial flutter. During a mean follow-up of 72.7 ± 58.3 months, 168 patients (38.7%) with PAF progressed to PeAF or permanent AF. The mean annual AF progression was 10.7% per year. In univariate analysis, age at diagnosis, body mass index, atrial arrhythmia during follow-up, left ventricular ejection fraction, concentric left ventricular hypertrophy, left atrial diameter (LAD), and severe mitral regurgitation (MR) were significantly associated with AF progression. In multivariate analysis, age at diagnosis (P = 0.009), atrial arrhythmia during follow-up (P = 0.015), LAD (P = 0.002) and MR grade (P = 0.026) were independent risk factors for AF progression. Patients with younger age at diagnosis, atrial arrhythmia during follow-up, larger left atrial chamber size, and severe MR grade are more likely to progress to PeAF or permanent AF, suggesting more intensive medical therapy with close clinical follow-up would be required in those patients.

Impact of moderate to severe renal impairment on long-term clinical outcomes in patients with atrial fibrillation

“…During the follow-up period, the onset of persistent AF was defined as the first time in which all ECGs indicated AF after !3 consecutive ECGs at intervals of !1 week after the initial observation. Permanent AF was defined as AF that was present for at least 6 months without intervening spontaneous episodes of sinus rhythm for which cardioversion was unsuccessful and subsequently not attempted [19,20]. When an ECG could not be obtained 3 times during the period, physicians made a clinical decision regarding the onset time of AF progression.…”

“…When an ECG could not be obtained 3 times during the period, physicians made a clinical decision regarding the onset time of AF progression. When electrical cardioversion was performed after >7 days from AF onset, it was considered AF progression [20].…”

Current Predictors of Atrial Fibrillation Progression

“…Появление систолической дисфункции ЛЖ определяет быстрое прогрессирование ФП у больных ХСН. [19]. LVH and increased arterial stiffness, revealed in our study, testify to target organ damage in HT and promote the cardiovascular system remodeling by the way of the early vascular aging syndrome and the hypertensive heart disease development.…”

“…Im и соавт. основными факторами прогрессирования аритмии были названы: возраст старше 75 лет, наличие предсердной аритмии на протяжении всего периода наблюдения, высокий индекс массы тела, низкая ФВ ЛЖ, наличие ГЛЖ и выраженная митральная регургитация [19].…”

Dual‐chamber implantable cardioverter–defibrillator. Is it useful in patient with permanent atrial fibrillation?

“…Patients suffering from paroxysmal AF progress to more frequent and long-lasting episodes and into persistent and permanent stages. Numerous recordings have documented that this progression is associated not only with the evolution time [6][7][8][9] but also with the existence of other comorbidities as indicated by the HATCH score [10,11]. This evolution occurs along with structural changes at the atrial level that include chamber dilatation and substitution of the myocardial tissue with fibrotic tissue that causes the situation to be irreversible [12].…”