Atrial fibrillation patterns are associated with arrhythmia progression and clinical outcomes
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Atrial fibrillation patterns are associated with arrhythmia progression and clinical outcomes. / B Schnabel, Renate; Pecen, Ladislav; Engler, Daniel; Lucerna, Markus; Sellal, Jean Marc; Ojeda, Francisco M; De Caterina, Raffaele; Kirchhof, Paulus.
In: HEART, Vol. 104, No. 19, 10.2018, p. 1608-1614.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Atrial fibrillation patterns are associated with arrhythmia progression and clinical outcomes
AU - B Schnabel, Renate
AU - Pecen, Ladislav
AU - Engler, Daniel
AU - Lucerna, Markus
AU - Sellal, Jean Marc
AU - Ojeda, Francisco M
AU - De Caterina, Raffaele
AU - Kirchhof, Paulus
N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
PY - 2018/10
Y1 - 2018/10
N2 - OBJECTIVES: Determinants of atrial fibrillation (AF) patterns and of progression of earlier forms to permanent AF, and their relationship with outcome are still poorly understood.METHODS: We examined AF patterns (paroxysmal, persistent and permanent), rate and predictors of AF progression, and outcomes in the PREFER (PREvention oF thromboembolic events-European Registry) in AF. The primary analysis was performed in the PREFER in AF prolongation dataset (n=3223 patients with AF with a complete 1-year follow-up, mean age 72±9 years, 40% women). Sensitivity analyses were performed using the PREFER in the AF study (n=6390 patients).RESULTS: AF progressed to more persistent types in 506 patients (17%). Permanent AF was associated with development of heart failure at 1 year (OR 1.80, 95% CI 1.06 to 3.07, p=0.03) compared with paroxysmal AF, which was confirmed in the entire cohort. In multivariable-adjusted models, sinus rhythm at baseline, AF duration, cardioversion, hyperthyroidism, valvular heart disease, diabetes mellitus and heart failure were predictors of AF progression (area under the receiver operating characteristic curve 0.60, 95% CI 0.57 to 0.63). Results were similar when we restricted analyses to patients with AF duration <1 year. AF progression showed an association with coronary events over 1 year (OR 2.27, 95% CI 1.22 to 4.19, p=0.0074).CONCLUSIONS: Permanent AF at baseline was associated with incident heart failure. A substantial proportion of well-managed patients with AF showed AF progression over 1 year. AF progression itself was not strongly related to outcome and may indicate the need to refine the current classification of AF types to enhance clinical utility.
AB - OBJECTIVES: Determinants of atrial fibrillation (AF) patterns and of progression of earlier forms to permanent AF, and their relationship with outcome are still poorly understood.METHODS: We examined AF patterns (paroxysmal, persistent and permanent), rate and predictors of AF progression, and outcomes in the PREFER (PREvention oF thromboembolic events-European Registry) in AF. The primary analysis was performed in the PREFER in AF prolongation dataset (n=3223 patients with AF with a complete 1-year follow-up, mean age 72±9 years, 40% women). Sensitivity analyses were performed using the PREFER in the AF study (n=6390 patients).RESULTS: AF progressed to more persistent types in 506 patients (17%). Permanent AF was associated with development of heart failure at 1 year (OR 1.80, 95% CI 1.06 to 3.07, p=0.03) compared with paroxysmal AF, which was confirmed in the entire cohort. In multivariable-adjusted models, sinus rhythm at baseline, AF duration, cardioversion, hyperthyroidism, valvular heart disease, diabetes mellitus and heart failure were predictors of AF progression (area under the receiver operating characteristic curve 0.60, 95% CI 0.57 to 0.63). Results were similar when we restricted analyses to patients with AF duration <1 year. AF progression showed an association with coronary events over 1 year (OR 2.27, 95% CI 1.22 to 4.19, p=0.0074).CONCLUSIONS: Permanent AF at baseline was associated with incident heart failure. A substantial proportion of well-managed patients with AF showed AF progression over 1 year. AF progression itself was not strongly related to outcome and may indicate the need to refine the current classification of AF types to enhance clinical utility.
KW - Aged
KW - Aged, 80 and over
KW - Atrial Fibrillation/classification
KW - Diabetes Mellitus/diagnosis
KW - Disease Progression
KW - Europe/epidemiology
KW - Female
KW - Heart Failure/diagnosis
KW - Heart Rate
KW - Heart Valve Diseases/diagnosis
KW - Humans
KW - Hyperthyroidism/diagnosis
KW - Male
KW - Middle Aged
KW - Outcome Assessment, Health Care
KW - Patient Care Management/methods
KW - Registries/statistics & numerical data
KW - Risk Factors
KW - Thromboembolism/etiology
U2 - 10.1136/heartjnl-2017-312569
DO - 10.1136/heartjnl-2017-312569
M3 - SCORING: Journal article
C2 - 29550771
VL - 104
SP - 1608
EP - 1614
JO - HEART
JF - HEART
SN - 1355-6037
IS - 19
ER -
