Distribution and Risk Profile of Paroxysmal, Persistent, and Permanent Atrial Fibrillation in Routine Clinical Practice: Insight From the RealiseAF International Registry

Study Questions:

What are the characteristics of atrial fibrillation (AF) encountered in clinical practice?


This was an international, cross-sectional, observational survey of 9,816 patients with AF seen by cardiologists or internists at 831 sites in 26 countries between October 2009 and May 2010.


The AF was paroxysmal in 26.5% of patients (mean age 65 years), persistent in 23.8% (mean age 66 years), and permanent in 49.6% (mean age 68 years). Among patients who met criteria for anticoagulation (CHADS2 score >1), the percentages receiving an oral anticoagulant were 38%, 54%, and 59% for the patients with paroxysmal, persistent, and permanent AF, respectively. A rhythm-control strategy was used in 74%, 56%, and 7% of patients with paroxysmal, persistent, and permanent AF, respectively. The most commonly used rhythm-control agents used for paroxysmal AF were amiodarone (30%) and propafenone (10%), and the most commonly used rhythm-control agent for persistent AF was amiodarone (33%). Approximately 60% of patients with the three categories of AF were symptomatic. The resting ventricular rate during AF was >80/minute in 20%, 41%, and 50% of patients with paroxysmal, persistent, and permanent AF, respectively.


AF is paroxysmal in only approximately one-fourth of patients encountered in clinical practice. A large proportion of patients with AF are undertreated for stroke prevention and heart rate control.


The underutilization of oral anticoagulants has been documented in multiple prior studies, and continues to be a worldwide problem. With the increasing availability of oral anticoagulants associated with less inconvenience than warfarin, it remains to be seen whether a higher proportion of patients will receive appropriate stroke prevention therapy.

Clinical Topics: Anticoagulation Management

Keywords: Registries, Stroke, Cross-Sectional Studies, Warfarin, Propafenone, Heart Rate, Heart Ventricles

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