Progressive Nature of Paroxysmal Atrial Fibrillation - Observations From a 14-Year Follow-Up Study -

Abstract

Background Atrial fibrillation (AF) is believed to occur first as paroxysmal, then be gradually perpetuated, and finally become chronic as the end result. However, this presumed clinical course has not been well confirmed. Methods and Results The clinical course of recurrent paroxysmal AF (PAF) from its onset was examined in 171 patients (mean follow-up period: 14.1±8.1 years). This study population consisted of patients with no structural heart disease (n=88), ischemic heart disease (n=28), dilated or hypertrophic cardiomyopathy (n=17), valvular heart disease (n=35) or other cardiac diseases. The mean age at the onset of AF was 58.3±11.8 years old. During the mean follow-up period of 14.1 years, PAF eventually developed into its chronic form in 132 patients under conventional antiarrhythmic therapy (77.2%, 5.5% of patients per year). The independent factors for early development into chronic AF were aging (hazard ratio (HR) 1.27 per 10 years, 95% confidence interval (CI) 1.06-1.47)), dilated left atrium (HR 1.39 per 10 mm, 95% CI 1.11-1.69), myocardial infarction (HR 2.33, 95% CI 1.13-4.81), and valvular diseases (HR 2.29, 95% CI 1.22-4.30). Conclusions The present long-term observations definitely and quantitatively revealed the progressive nature of PAF.

Endothelial–mesenchymal transition in human atrial fibrillation

“…In our study population, the amount of fibrotic deposition in LA was correlated with LAD, which is a strong predictor of recurrence of AF after catheter ablation or drug therapy [2,11]. Interstitial fibrosis separates cardiomyocytes, which interferes with electric continuity and slows the electrical conduction and thereby causes the progression of AF to permanent forms [3].…”

“…The first occurrence of atrial fibrillation (AF) is believed to be paroxysmal in nature; it then gradually perpetuates and finally develops into permanent AF with the progression of atrial remodeling [1,2]. Atrial fibrosis is a hallmark of atrial structural remodeling and leads to electrophysiological impairment of the atrium and persistence of AF [3].…”

Symptoms of Atrial Fibrillation in Patients With and Without Subsequent Permanent Atrial Fibrillation Based on a Retrospective Questionnaire Survey

“…4) Factors related to the development of permanent AF have been reported. 2,[5][6][7] A number of recent studies 3,[8][9][10][11] have associated AF and its treatment with quality-of-life issues.…”

“…AF usually occurs in a paroxysmal or persistent form, and then develops into a permanent form when the feasibility of restoring sinus rhythm becomes extremely low. 1,2) We believe that patients' perceptions of their symptoms may be associated with the course of AF. To clarify whether the symptoms of AF differ between patients with and without subsequent development of permanent AF, a retrospective questionnaire survey was carried out.…”

Surgical Treatment of Atrial Fibrillation via Energy Ablation

“…38 -40 If patients do remain in paroxysmal AF, however, then they are likely to progress to permanent AF over time. 41 Thus, it is desirable to perform ablation, although the ideal technique in cases of lone AF remains in doubt.…”