Echocardiographic Predictors of Frequency of Paroxysmal Atrial Fibrillation (AF) and Its Progression to Persistent AF in Hypertensive Patients With Paroxysmal AF: Results From the Japanese Rhythm Management Trial II for Atrial Fibrillation (J-RHYTHM II Study)

Study Questions:

Do echocardiographic variables predict the progression of paroxysmal atrial fibrillation (AF) to persistent AF in patients with hypertension?


Two hundred eighty-six patients with paroxysmal AF and hypertension were enrolled in a randomized study that compared the effects of candesartan and amlodipine on AF burden. An echocardiogram was performed at baseline. Daily transtelephonic electrocardiographic recordings were obtained during 1 year of follow-up. The percentage of days with AF and the progression of paroxysmal to persistent AF were noted.


The only echocardiographic variable that was independently associated with the AF burden or with progression to persistent AF was the left atrial dimension (LAD). Every 10 mm increase in LAD was associated with a 6.5% increase in AF days, and every 1 mm increase in LAD was associated with a 7% increase in the risk of progression to persistent AF.


The authors concluded that LAD is the only independent echocardiographic predictor of progression of paroxysmal AF to persistent AF.


Because hypertension causes LA dilatation that predisposes to structural remodeling, an association between LAD and progression to persistent AF in patients with hypertension is not surprising. In addition to hypertension, other clinical characteristics that also are associated with progression of paroxysmal to persistent AF include age, diabetes, heart failure, and chronic obstructive pulmonary disease.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Echocardiography/Ultrasound, Hypertension

Keywords: Heart Failure, Dilatation, Heart Rate, Hypertension, Diabetes Mellitus, Disease Progression, Echocardiography, Lung Diseases

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