Long-Term Progression and Outcomes With Aging in Patients With Lone Atrial Fibrillation

Abstract

Background-The long-term natural history of lone atrial fibrillation is unknown. Our objective was to determine the rate and predictors of progression from paroxysmal to permanent atrial fibrillation over 30 years and the long-term risk of heart failure, thromboembolism, and death compared with a control population. Methods and Results-A previously characterized Olmsted County, Minnesota, population with first episode of documented atrial fibrillation between 1950 and 1980 and no concomitant heart disease or hypertension was followed up long term. Of this unique cohort, 76 patients with paroxysmal (nϭ34), persistent (nϭ37), or permanent (nϭ5) lone atrial fibrillation at initial diagnosis met inclusion criteria (mean age at diagnosis, 44.2Ϯ11.7 years; male, 78%). Mean duration of follow-up was 25.2Ϯ9.5 years. Of 71 patients with paroxysmal or persistent atrial fibrillation, 22 had progression to permanent atrial fibrillation. Overall survival of the 76 patients with lone atrial fibrillation was 92% and 68% at 15 and 30 years, respectively, similar to 86% and 57% survival for the age-and sex-matched Minnesota population. Observed survival free of heart failure was slightly worse than expected (Pϭ0.051). Risk for stroke or transient ischemic attack was similar to the expected population risk during the initial 25 years of follow-up but increased thereafter (Pϭ0.004), although CIs were wide. All patients who had a cerebrovascular event had developed Ն1 risk factor for thromboembolism. Conclusions-Comorbidities

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Z czasem u wielu pacjentów pojawiają się długotrwałe postacie AF. U małego odsetka pacjentów (2-3%) AF pozostaje napadowe przez kilka dziesięcioleci [161]. Występowanie nawrotów napadowego AF nie jest losowe, ale pogrupowane [162].…”

Catheter Ablation of Lone Atrial Fibrillation

“…In contrast with these findings, among younger patients with paroxysmal and "truly" lone AF, 10-year-cummulative rate of progression towards permanent AF was only 19.1% (95% CI: 12.8 to 25.4%) [86]. In another long term study, paroxysmal and persistent lone AF have progressed to permanent form of the arrhythmia with 30-year cumulative probability of 29% (95% CI: 16 to 42%) [109]. While aging of the patients and subsequent development of structural heart disease and other comorbidities were associated with the risk of progression of lone AF, the progression of lone AF itself was an independent predictor of adverse events such as thromboembolism [86].…”

Atrial Fibrillation and Stroke in Elderly Patients

“…12 Further research is needed to identify initiating factors and critical mediators of thromboembolism and to delineate pathways altered by aging that potentiate the risk for AF and thromboembolism. 11,95 With better patient risk-stratification and the design of more appropriate therapeutic strategies, AF-associated thromboembolic risk could be further reduced in elderly patients.…”