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abstract
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Background The incidence and predictors of atrial fibrillation (AF)
progression are currently not well defined, and clinical AF
progression partly overlaps with rhythm control interventions
(RCIs). Methods and Results We assessed AF type and intercurrent
RCIs during yearly follow-ups in 2869 prospectively followed
patients with paroxysmal or persistent AF. Clinical AF progression
was defined as progression from paroxysmal to nonparoxysmal or from
persistent to permanent AF. An RCI was defined as pulmonary vein
isolation, electrical cardioversion, or new treatment with
amiodarone. During a median follow-up of 3 years, the incidence
of clinical AF progression was 5.2 per 100 patient-years, and
10.9 per 100 patient-years for any RCI. Significant predictors
for AF progression were body mass index (hazard ratio [HR], 1.03;
95% CI, 1.01-1.05), heart rate (HR per 5 beats/min increase,
1.05; 95% CI, 1.02-1.08), age (HR per 5-year increase 1.19; 95% CI,
1.13-1.27), systolic blood pressure (HR per 5 mm Hg
increase, 1.03; 95% CI, 1.00-1.05), history of hyperthyroidism (HR,
1.71; 95% CI, 1.16-2.52), stroke (HR, 1.50; 95% CI, 1.19-1.88), and
heart failure (HR, 1.69; 95% CI, 1.34-2.13). Regular physical
activity (HR, 0.80; 95% CI, 0.66-0.98) and previous pulmonary vein
isolation (HR, 0.69; 95% CI, 0.53-0.90) showed an inverse
association. Significant predictive factors for RCIs were physical
activity (HR, 1.42; 95% CI, 1.20-1.68), AF-related symptoms (HR,
1.84; 95% CI, 1.47-2.30), age (HR per 5-year increase, 0.88; 95% CI,
0.85-0.92), and paroxysmal AF (HR, 0.61; 95% CI, 0.51-0.73).
Conclusions Cardiovascular risk factors and comorbidities were key
predictors of clinical AF progression. A healthy lifestyle may
therefore reduce the risk of AF progression.
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citation
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Blum S, Aeschbacher S, Meyre P, Zwimpfer L, Reichlin T, Beer J H,
Ammann P, Auricchio A, Kobza R, Erne P, Moschovitis G, Di Valentino
M, Shah D, Schläpfer J, Henz S, Meyer-Zürn C, Roten L,
Schwenkglenks M, Sticherling C, Kühne M, Osswald S, Conen D,
Swiss‐AF Investigators . Incidence and Predictors of Atrial
Fibrillation Progression. J Am Heart Assoc 2019; 8:e012554.
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