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Atrial fibrillation pattern and factors affecting the progression to permanent atrial fibrillation

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Abstract

Atrial fibrillation (AF) may progress from a non-permanent to a permanent form, and improvement in prediction may help in decision-making. In- and outpatients with non-permanent AF were enrolled in a prospective study and followed every 6 months. At baseline, 314 out of 523 patients (60%) had non-permanent AF (25.5% paroxysmal AF, 52.5% persistent, 2% first diagnosed AF). They were mostly males (188, 59.9%), median age 71 years [interquartile range (IQ) 62–77], median CHA2DS2VASc 3 (IQ 1–4), median HATCH score 1 (IQ 1–2). During a follow-up of 701 (IQ 437–902) days, 66 patients (21%) developed permanent AF. CHA2DS2VASc and HATCH scores were incrementally associated with AF progression (p for trend CHA2DS2VASc < 0.001, HATCH p = 0.001). Cox multivariable proportional hazard regression analysis showed that age [hazard ratio (HR) 1.042; 95%CI 1.005–1.080; p = 0.025], moderate–severe left atrial (LA) enlargement at echo (HR 2.072, 95%CI, 1.121–3.831; p = 0.020), antiarrhythmics drugs (HR 0.087, 95%CI 0.011–0.659, p = 0.018), EHRA score > 2 (HR 0.358, 95%CI 0.162–0.791, p = 0.011) and valvular disease (HR 2.196, 95%CI 1.072–4.499, p = 0.032) were significantly associated with AF progression. Adding “moderate–severe LA dilation” to clinical scores, eg. HATCH score (HATCH-LA) with 2 points (Cox multivariable regression analysis) improved prediction of AF progression vs. HATCH score (p = 0.0225). In patients without permanent AF, progression of AF was independently associated with age, LA dilation, AF symptoms severity, antiarrhythmic drugs and valvular disease. Adding LA dilation (moderate–severe volume increase) to clinical scores improved prediction of progression to permanent AF.

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Authors and Affiliations

  1. Cardiology Division, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo 71, 41121, Modena, Italy

    Vincenzo Livio Malavasi, Elisa Fantecchi, Virginia Tordoni, Laura Melara, Andrea Barbieri, Marco Vitolo & Giuseppe Boriani

  2. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK

    Marco Vitolo & Gregory Y. H. Lip

  3. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Gregory Y. H. Lip

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  1. Vincenzo Livio Malavasi
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  2. Elisa Fantecchi
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  3. Virginia Tordoni
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  4. Laura Melara
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  5. Andrea Barbieri
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Correspondence to Giuseppe Boriani.

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Conflict of interest

GB has received speaker’s fees from Boehringer Ingelheim, Boston, Biotronik, Medtronic. GYHL has served as a consultant for Bayer Healthcare Pharmaceuticals/Janssen, Bristol-Myers Squibb/Pfizer, Biotronik, Boehringer Ingelheim, Daiichi Sankyo Pharma, Medtronic, and Microlife; and as a speaker for Bayer Healthcare Pharmaceuticals, Bristol-Myers Squibb/Pfizer, Boehringer Ingelheim, Daiichi Sankyo Pharma, Medtronic, Microlife, and Roche; no fees were received personally. The other authors report no conflicts to disclose.

Human and animal rights statement

This prospective single-centre observational study was approved by the Local Ethical Committee for Medical Research in compliance with the ethical standards of the institutional and national regulations. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Gregory YH Lip and Giuseppe Boriani are joint senior authors.

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Malavasi, V.L., Fantecchi, E., Tordoni, V. et al. Atrial fibrillation pattern and factors affecting the progression to permanent atrial fibrillation. Intern Emerg Med 16, 1131–1140 (2021). https://doi.org/10.1007/s11739-020-02551-5

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