Incidence and Predictors of Atrial Fibrillation Progression

Abstract

Background The incidence and predictors of atrial fibrillation ( AF ) progression are currently not well defined, and clinical AF progression partly overlaps with rhythm control interventions ( RCI s). Methods and Results We assessed AF type and intercurrent RCI s during yearly follow‐ups in 2869 prospectively followed patients with paroxysmal or persistent AF . Clinical AF progression was defined as progression from paroxysmal to nonparoxysmal or from persistent to permanent AF . An RCI was defined as pulmonary vein isolation, electrical cardioversion, or new treatment with amiodarone. During a median follow‐up of 3 years, the incidence of clinical AF progression was 5.2 per 100 patient‐years, and 10.9 per 100 patient‐years for any RCI . Significant predictors for AF progression were body mass index (hazard ratio [ HR ], 1.03; 95% CI, 1.01–1.05), heart rate ( HR per 5 beats/min increase, 1.05; 95% CI , 1.02–1.08), age ( HR per 5‐year increase 1.19; 95% CI, 1.13–1.27), systolic blood pressure ( HR per 5 mm Hg increase, 1.03; 95% CI , 1.00–1.05), history of hyperthyroidism ( HR , 1.71; 95% CI , 1.16–2.52), stroke ( HR , 1.50; 95% CI , 1.19–1.88), and heart failure ( HR , 1.69; 95% CI , 1.34–2.13). Regular physical activity ( HR , 0.80; 95% CI , 0.66–0.98) and previous pulmonary vein isolation ( HR , 0.69; 95% CI , 0.53–0.90) showed an inverse association. Significant predictive factors for RCI s were physical activity ( HR , 1.42; 95% CI , 1.20–1.68), AF ‐related symptoms ( HR , 1.84; 95% CI , 1.47–2.30), age ( HR per 5‐year increase, 0.88; 95% CI , 0.85–0.92), and paroxysmal AF ( HR , 0.61; 95% CI , 0.51–0.73). Conclusions Cardiovascular risk factors and comorbidities were key predictors of clinical AF progression. A healthy lifestyle may therefore reduce the risk of AF progression.