INTRODUCTION: Paroxysmal atrial fibrillation (AF) may progress to persistent AF. We studied the clinical correlates and the effect of rhythm-control strategy on AF progression. METHODS: RecordAF was a worldwide prospective survey of AF management. Consecutive eligible patients with recent-onset AF were included and allocated to rate or rhythm control according to patient/physician choice. A total of 2,137 patients were followed up for 12 months. Atrial fibrillation progression was defined as a change from paroxysmal to persistent/permanent AF. RESULTS: Progression of AF occurred in 318 patients (15%) after 1 year. Patients with AF progression were older; had a higher diastolic blood pressure; and more often had a history of coronary artery disease, stroke or transient ischemic attack, hypertension, or heart failure. Patients treated with rhythm control were less likely to show progression than those treated only with rate control (164/1542 [11%] vs 154/595 [26%], P < .001). Multivariable analysis showed that history of heart failure (odds ratio [OR] 2.2, 95% CI 1.7-2.9, P < .0001), history of hypertension (OR 1.5, 95% CI 1.1-2.0, P = .01), and rate control rather than rhythm control (OR 3.2, 95% CI 2.5-4.1, P < .0001) were independent predictors of AF progression. The propensity score-adjusted OR of AF progression in patients with rate rather than rhythm control was 3.3 (95% CI 2.4-4.6, P < .0001). CONCLUSIONS: Although heart failure and hypertension are associated with AF progression, rhythm control is associated with lower risk of AF progression.
INTRODUCTION:Paroxysmal atrial fibrillation (AF) may progress to persistent AF. We studied the clinical correlates and the effect of rhythm-control strategy on AF progression. METHODS: RecordAF was a worldwide prospective survey of AF management. Consecutive eligible patients with recent-onset AF were included and allocated to rate or rhythm control according to patient/physician choice. A total of 2,137 patients were followed up for 12 months. Atrial fibrillation progression was defined as a change from paroxysmal to persistent/permanent AF. RESULTS: Progression of AF occurred in 318 patients (15%) after 1 year. Patients with AF progression were older; had a higher diastolic blood pressure; and more often had a history of coronary artery disease, stroke or transient ischemic attack, hypertension, or heart failure. Patients treated with rhythm control were less likely to show progression than those treated only with rate control (164/1542 [11%] vs 154/595 [26%], P < .001). Multivariable analysis showed that history of heart failure (odds ratio [OR] 2.2, 95% CI 1.7-2.9, P < .0001), history of hypertension (OR 1.5, 95% CI 1.1-2.0, P = .01), and rate control rather than rhythm control (OR 3.2, 95% CI 2.5-4.1, P < .0001) were independent predictors of AF progression. The propensity score-adjusted OR of AF progression in patients with rate rather than rhythm control was 3.3 (95% CI 2.4-4.6, P < .0001). CONCLUSIONS: Although heart failure and hypertension are associated with AF progression, rhythm control is associated with lower risk of AF progression.
Authors: Vincenzo Livio Malavasi; Elisa Fantecchi; Virginia Tordoni; Laura Melara; Andrea Barbieri; Marco Vitolo; Gregory Y H Lip; Giuseppe Boriani Journal: Intern Emerg Med Date: 2020-11-07 Impact factor: 3.397
Authors: Jürgen H Prochaska; Sebastian Göbel; Markus Nagler; Torben Knöpfler; Lisa Eggebrecht; Heidrun Lamparter; Marina Panova-Noeva; Karsten Keller; Meike Coldewey; Christoph Bickel; Michael Lauterbach; Roland Hardt; Christine Espinola-Klein; Hugo Ten Cate; Thomas Rostock; Thomas Münzel; Philipp S Wild Journal: Clin Res Cardiol Date: 2018-06-09 Impact factor: 5.460
Authors: Evan L Thacker; Paul N Jensen; Bruce M Psaty; Barbara McKnight; W T Longstreth; Sascha Dublin; Katherine M Newton; Nicholas L Smith; David S Siscovick; Susan R Heckbert Journal: Ann Pharmacother Date: 2015-01-27 Impact factor: 3.154
Authors: Tyler W Barrett; Wesley H Self; Brian S Wasserman; Candace D McNaughton; Dawood Darbar Journal: Am J Emerg Med Date: 2013-03-09 Impact factor: 2.469