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Long-term prognosis after cardioversion of the first episode of symptomatic atrial fibrillation: a condition believed to be benign revised

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Abstract

Aims

We evaluated the prognostic impact of a first episode of symptomatic atrial fibrillation under real life conditions.

Background

Most studies regarding the treatment and long-term outcome of patients with atrial fibrillation mainly refer to patients with recurrent episodes. In contrast, data on the prognostic implications of a first episode of atrial fibrillation are scarce.

Methods

Over a follow-up period of 5 years, we analyzed 1053 patients, initially scheduled for cardioversion of symptomatic atrial fibrillation, who were included into the prospective registry ANTIK (Ludwigshafener ANTIKoagulationsstudie).

Results

Of those, 618 patients (59%) were included with a first episode of symptomatic atrial fibrillation whereas 435 patients (41%) presented with recurrent episodes. As a consequence of referral for cardioversion of symptomatic atrial fibrillation, structural heart disease was newly diagnosed in a significantly higher proportion of patients with a first episode (27 vs 13%, OR 2.4, 95% CI 1.7–3.3) and patients with a first episode were more likely to have an EF≤40% (21 vs 15%, OR 1.5, 95% CI 1.1-2.2). After 5 years, the mortality rate for patients with a first episode was higher than for those with recurrent episodes (27 vs 16%, OR 2.0, 95% CI 1.4–2.7). In the multivariate analysis, a first episode also was independently associated with an increased longterm mortality (HR 1.4, 95% CI 1.02–1.98). In contrast to patients with recurrent episodes, a first episode was associated with a significantly higher mortality, when compared to an age-matched control group calculated from mortality tables.

Conclusion

The first episode of symptomatic atrial fibrillation intended for cardioversion serves as a marker for underlying cardiac diseases and is associated with impaired prognosis.

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Authors and Affiliations

  1. Klinikum der Stadt Ludwigshafen, Herzzentrum, Bremserstr. 79, 67063, Ludwigshafen, Germany

    Torsten Becker,  Thomas Kleemann,  Margit Strauss,  Klaus Doenges,  Jochen Senges &  Karlheinz Seidl

  2. Stiftung Institut für Herzinfarktforschung, Bremserstr. 79, 67063, Ludwigshafen, Germany

    Steffen Schneider

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  1. Torsten Becker
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  2. Thomas Kleemann
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  3. Margit Strauss
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  7. Karlheinz Seidl
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Correspondence to Torsten Becker.

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Becker, T., Kleemann, T., Strauss, M. et al. Long-term prognosis after cardioversion of the first episode of symptomatic atrial fibrillation: a condition believed to be benign revised. Clin Res Cardiol 97, 74–82 (2008). https://doi.org/10.1007/s00392-007-0584-y

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  • DOI: https://doi.org/10.1007/s00392-007-0584-y

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