Long-term prognosis after cardioversion of the first episode of symptomatic atrial fibrillation: a condition believed to be benign revised
- First Online:
- 44 Downloads
We evaluated the prognostic impact of a first episode of symptomatic atrial fibrillation under real life conditions.
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.
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).
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.
The first episode of symptomatic atrial fibrillation intended for cardioversion serves as a marker for underlying cardiac diseases and is associated with impaired prognosis.
Key wordsatrial fibrillation first episode prognosis risk marker
Unable to display preview. Download preview PDF.
- 1.Albers GW, Diener HC, Frison L, Grind M, Nevinson M, Partridge S, Halperin JL, Horrow J, Olsson SB, Petersen P, Vahanian A; SPORTIF Executive Steering Committee for the SPORTIF V Investigators (2005) Ximelagatran vs Warfarin for stroke prevention in patients with nonvalvular atrial fibrillation: a randomized trial (SPORTIF V). JAMA 293:690–698PubMedCrossRefGoogle Scholar
- 9.Dries DL, Exner DV, Gersh BJ, Domanski MJ, Waclawiw MA, Stevenson LW (1998) Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular dysfunction: a retrospective analysis of the SOLVD trials. J Am Coll Cardiol 32:965–703CrossRefGoogle Scholar
- 11.Flaker GC, Belew K, Beckman K, Vidaillet H, Kron J, Safford R, Mickel M, Barrell P (2005) AFFIRM Investigators. Asymptomatic atrial fibrillation: demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation on Rhythm Management (AFFIRM) study. Am Heart J 149:657–663PubMedCrossRefGoogle Scholar
- 12.FusterV, Rydén LE, Cannorn DS, Crijns HJ, Curtis AB et al (2006) ACC/AHA/ ESC guidelines for the management of patients with atrial fibrillation. A report of the American college of cardiology/ American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to revise the 2001 guidelines for the management of patients with atrial fibrillation). J Am Coll Cardiol 48:e149–246CrossRefGoogle Scholar
- 13.Fuster V, Rydén LE, Gibbons RJ, Antman EM, Klein WW et al (2001) ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. A report of the American College of Cardiology/ American heart association taskforce on practice guidelines and the European society of cardiology committee for practice guidelines and policy conferences (committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American society for pacing and electrophysiology. J Am Coll Cardiol 38:1266i–1266ixxCrossRefGoogle Scholar
- 17.Kettering K, Greil GF, Busch M, Miller S, Sieverding L, Schreieck J (2006) Catheter ablation of atrial fibrillation: ongoing atrial fibrillation inside a single pulmonary vein after successful electrical disconnection and restoration of sinus rhythm in both atria. Clin Res Cardiol 95:663–667PubMedCrossRefGoogle Scholar
- 25.Ostranderld JR, Brandt RL, Kjelsberg MO, Epstein FH (1965) Electrocardiographic findings among the adult population of a total natural community, Tecumseh, Michigan. Circulation 31:888–898Google Scholar
- 26.Prystowsky EN, Benson DW Jr, Fuster V, Hart RG, Kay GN, Myerburg RJ, Naccarelli GV, Wyse DG (1996) Management of patients with atrial fibrillation. A statement for healthcare professionals. From the subcommittee on electrocardiography and electrophysiology. American Heart Association. Circulation 93:1262–1277PubMedGoogle Scholar
- 30.Steinberg JS, Sadaniantz A, Kron J, Krahn A, Denny DM, Daubert J, Campbell WB, Havranek E, Murray K, Olshansky B, O’Neill G, Sami M, Schmidt S, Storm R, Zabalgoitia M, Miller J, Chandler M, Nasco EM, Greene HL and the AFFIRM Investigators (2004) Analysis of cause-specific mortality in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation 109:1973–1980PubMedCrossRefGoogle Scholar
- 33.Van Gelder IC, Hagens VE, Bosker HA, Kingma JH, Kamp O, Kingma T, Said SA, Darmanata JI, Timmermans AJ, Tijssen JG, Crijns HJ for the RACE Study group (2002) A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation (RACE). N Engl J Med 347:1834–1840PubMedCrossRefGoogle Scholar
- 36.Wang TJ, Larson MG, Levy D, Ramachandran SV, Leip EP, Wolf PA, D’Agostino RB, Murabito JM, Kannel WB, Benjamin EJ (2003) Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality. The Framingham Heart Study. Circulation 107:2920–2925PubMedCrossRefGoogle Scholar
- 38.Statistisches Bundesamt (2006) Periodensterbetafeln für Deutschland: Allgemeine und abgekürzte Sterbetafeln von 1871/1881–2002/2004, Wiesbaden. http://www-ec.destatis.de/csp/ shop/sfg/vollanzeige.csp?ID=1017978Google Scholar