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Fibrillation cycle length predicts cardiovascular events in patients with long-standing persistent atrial fibrillation

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Abstract

Background

Atrial fibrillation (AF) is associated with an increased risk of heart failure (HF), stroke, and death. Although fibrillation cycle length (FCL) is used as a surrogate for atrial refractoriness, its impact on outcomes remains unclear. This study aimed to identify predictors of cardiovascular events, including FCL, in patients with long-standing persistent AF.

Methods

The study included 190 consecutive patients with long-standing persistent AF (mean age 74 years, 74% male). Patients with valvular AF or hemodialysis-dependent end-stage renal disease and those on anti-arrhythmic drugs were excluded. The primary composite outcome was occurrence of cardiovascular events (myocardial infarction, HF), cerebrovascular events (stroke, transient ischemic attack), and all-cause death. FCL was calculated by fast Fourier transformation analysis of fibrillation waves in the surface electrocardiogram.

Results

Over a median follow-up of 2.6 years, the primary outcome occurred in 31 patients (cardiovascular events, n = 18; cerebrovascular events, n = 8; all-cause death, n = 5). In multivariate analysis, longer FCL and history of HF were independent predictors of these outcomes. In a Cox proportional hazards model adjusted for age, sex, and history of HF, patients with an FCL > 160 ms (cut-off determined by receiver-operating characteristic curve analysis) were at increased risk of the outcome (hazard ratio 12.9; 95% confidence interval 4.99–44.10; p < 0.001).

Conclusions

FCL was independently associated with cardiovascular outcomes in patients with long-standing persistent AF.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan

    Hironori Nakamura, Shinichi Niwano, Hidehira Fukaya, Jun Kishihara, Akira Satoh, Jun Oikawa, Tomoharu Yoshizawa, Naruya Ishizue, Tazuru Igarashi, Tamami Fujiishi, Ryo Nishinarita, Ai Horiguchi & Junya Ako

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  1. Hironori Nakamura
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  2. Shinichi Niwano
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  3. Hidehira Fukaya
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Correspondence to Hironori Nakamura.

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Conflict of interest

Junya Ako is a member of Circulation Journal’s editorial team.

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This study was approved by the ethics committee of Kitasato University Hospital (approval number B 11-46).

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Nakamura, H., Niwano, S., Fukaya, H. et al. Fibrillation cycle length predicts cardiovascular events in patients with long-standing persistent atrial fibrillation. Heart Vessels 37, 1027–1033 (2022). https://doi.org/10.1007/s00380-021-01993-x

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  • DOI: https://doi.org/10.1007/s00380-021-01993-x

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