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 (n=34), persistent (n=37), or permanent (n=5) lone atrial fibrillation at initial diagnosis met inclusion criteria (mean age at diagnosis, 44.2+/-11.7 years; male, 78%). Mean duration of follow-up was 25.2+/-9.5 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 (P=0.051). 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 (P=0.004), although CIs were wide. All patients who had a cerebrovascular event had developed > or = 1 risk factor for thromboembolism. CONCLUSIONS: Comorbidities significantly modulate progression and complications of atrial fibrillation. Age or development of hypertension increases thromboembolic risk.
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 (n=34), persistent (n=37), or permanent (n=5) lone atrial fibrillation at initial diagnosis met inclusion criteria (mean age at diagnosis, 44.2+/-11.7 years; male, 78%). Mean duration of follow-up was 25.2+/-9.5 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 (P=0.051). 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 (P=0.004), although CIs were wide. All patients who had a cerebrovascular event had developed > or = 1 risk factor for thromboembolism. CONCLUSIONS: Comorbidities significantly modulate progression and complications of atrial fibrillation. Age or development of hypertension increases thromboembolic risk.
Authors: Tiia Istolahti; Antti Eranti; Heini Huhtala; Leo-Pekka Lyytikäinen; Mika Kähönen; Terho Lehtimäki; Markku Eskola; Ismo Anttila; Antti Jula; Antoni Bayés de Luna; Kjell Nikus; Jussi Hernesniemi Journal: Ann Med Date: 2020-03-14 Impact factor: 4.709
Authors: Patrick T Ellinor; Kathryn L Lunetta; Nicole L Glazer; Arne Pfeufer; Alvaro Alonso; Mina K Chung; Moritz F Sinner; Paul I W de Bakker; Martina Mueller; Steven A Lubitz; Ervin Fox; Dawood Darbar; Nicholas L Smith; Jonathan D Smith; Renate B Schnabel; Elsayed Z Soliman; Kenneth M Rice; David R Van Wagoner; Britt-M Beckmann; Charlotte van Noord; Ke Wang; Georg B Ehret; Jerome I Rotter; Stanley L Hazen; Gerhard Steinbeck; Albert V Smith; Lenore J Launer; Tamara B Harris; Seiko Makino; Mari Nelis; David J Milan; Siegfried Perz; Tõnu Esko; Anna Köttgen; Susanne Moebus; Christopher Newton-Cheh; Man Li; Stefan Möhlenkamp; Thomas J Wang; W H Linda Kao; Ramachandran S Vasan; Markus M Nöthen; Calum A MacRae; Bruno H Ch Stricker; Albert Hofman; André G Uitterlinden; Daniel Levy; Eric Boerwinkle; Andres Metspalu; Eric J Topol; Aravinda Chakravarti; Vilmundur Gudnason; Bruce M Psaty; Dan M Roden; Thomas Meitinger; H-Erich Wichmann; Jacqueline C M Witteman; John Barnard; Dan E Arking; Emelia J Benjamin; Susan R Heckbert; Stefan Kääb Journal: Nat Genet Date: 2010-02-21 Impact factor: 38.330