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?


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.


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.


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.


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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