Progression of Paroxysmal to Persistent Atrial Fibrillation

Study Questions:

How often do patients with paroxysmal atrial fibrillation (PAF) eventually develop persistent atrial fibrillation (PersAF)?


The data in this study were obtained by analysis of 755 patients (mean age, 61.2 years) with PAF who were enrolled in a Canadian registry and followed for a median of 6.4 years.


At 1, 5, and 10 years of follow-up, the PAF had progressed to PersAF in 8.6%, 24.3%, and 36.3% of patients, respectively. The factors independently associated with progression to PersAF were increasing age (hazard ratio [HR], 1.4 for each 10-year increment), moderate to severe mitral regurgitation (HR, 1.87) or aortic stenosis (HR, 2.4), left atrial diameter >45 mm (HR, 3.01), and left ventricular hypertrophy by echocardiographic or electrocardiographic criteria (HR, 1.47). All-cause mortality at 10 years was 30.3%.


Among patients presenting with PAF who are still alive at 10 years of follow-up, approximately 35% will have developed PersAF. The strongest predictor of progression to PersAF is a left atrial diameter >45 mm.


All of the risk factors for progression of PAF to PersAF are associated with atrial fibrosis, consistent with atrial remodeling being an important determinant of PersAF. An important issue is whether progression to PersAF is related in any way to the treatment used for the PAF. Unfortunately, this study was not able to address this issue.

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, Prevention, Valvular Heart Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Echocardiography/Ultrasound, Mitral Regurgitation

Keywords: Aortic Valve Stenosis, Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Remodeling, Hypertrophy, Left Ventricular, Electrocardiography, Echocardiography, Heart Conduction System, Mitral Valve Insufficiency, Primary Prevention, Risk Factors

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