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Predictors of Progression of Recently Diagnosed Atrial Fibrillation in REgistry on Cardiac Rhythm DisORDers Assessing the Control of Atrial Fibrillation (RecordAF)–United States Cohort
Study Questions:
How often does recent-onset atrial fibrillation (AF) progress to a more sustained form?
Methods:
The subjects of this study were 955 patients (mean age 69 years) with a history of paroxysmal (61%) or persistent (39%) AF for <1 year enrolled in a prospective, community-based registry (RecordAF). AF progression was defined as transition from paroxysmal to persistent AF or from persistent to permanent AF. The duration of follow-up was 1 year.
Results:
At entry into the registry, 60% of patients were treated with a rate-control strategy and 40% with a rhythm-control strategy. The same treatment strategy was used during follow-up in approximately 70% of patients in both groups. AF progression occurred significantly more often in the rate-control group (27.6%) than in the rhythm-control group (5.8%). AF progression was significantly less likely in patients presenting with paroxysmal AF (8.9%) than in patients presenting with persistent AF (41%). The strongest independent predictors of AF progression were AF present upon entry into the registry (odds ratio [OR], 5.4) and a rate-control strategy (OR, 3.76). Other independent predictors of AF progression were older age, persistent AF at entry, and history of stroke.
Conclusions:
The authors concluded that AF is more likely to progress if it is persistent compared to paroxysmal, and if the patient is managed with a rate-control strategy as opposed to a rhythm-control strategy.
Perspective:
Although the treatment strategy was not randomized and there may have been a treatment selection bias in this registry-based study, the results suggest that a rhythm-control strategy can prevent progression of AF.
Keywords: Registries, Stroke, United States
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