Log in to MyACC
Paroxysmal to Sustained AF and Increased Adverse Events
Study Questions:
What is the impact on adverse clinical events among patients with atrial fibrillation (AF) who progress from paroxysmal to persistent?
Methods:
The authors studied the Fushimi AF Registry, a community-based prospective survey of AF patients in Kyoto, Japan. They analyzed 4,045 patients, including 1,974 patients with paroxysmal AF and 2,070 patients with sustained AF. Association between AF progression and adverse events was analyzed using a multivariable Cox model.
Results:
Over a mean follow-up of 1,105 days, 252 patients progressed from paroxysmal to sustained AF (4.22 per 100 person-years). Progression was associated with an increased risk of ischemic stroke or systemic embolism as compared to paroxysmal AF patients without progression (adjusted hazard ratio [aHR], 4.10; 95% confidence interval [CI], 1.95-8.24), and as compared to patients with sustained AF during the entire study period (aHR, 2.20; 95% CI, 1.11-4.00). After the period of progression, the risk of ischemic stroke or systemic embolism was similar to patients with stable sustained AF (aHR, 1.54; 95% CI, 0.78-2.75). Progression was also associated with a higher risk of heart failure hospitalization as compared to nonprogressed paroxysmal AF patients (aHR, 2.0; 95% CI, 1.55-4.52) and stable sustained AF patients (aHR, 1.81; 95% CI, 1.08-2.88).
Conclusions:
The authors concluded that progression of AF is associated with an increased risk of clinical adverse events during the period of arrhythmia progression among Japanese AF patients.
Perspective:
Many clinicians do not incorporate the type of AF (paroxysmal, persistent, or permanent) when considering preventative treatments against AF-related stroke. This study suggests that the period of progression between paroxysmal and sustained AF may represent a uniquely high-risk period for stroke, systemic embolism, and heart failure hospitalization risk. However, it may also point to an underlying pathophysiology that is contributing to both the progression of AF and the increased risk of adverse events. With regard to stroke and systemic embolism prevention, almost all patients with AF (regardless of type) should receive preventative anticoagulation therapy.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Brain Ischemia, Embolism, Heart Failure, Risk, Secondary Prevention, Stroke, Vascular Diseases
< Back to Listings
