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. 2023 Jan 18;12(3):768.
doi: 10.3390/jcm12030768.

Factors Associated with Progression of Atrial Fibrillation and Impact on All-Cause Mortality in a Cohort of European Patients

Marco Vitolo  1   2   3 , Marco Proietti  2   4   5 , Jacopo F Imberti  1   2   3 , Niccolò Bonini  1   2   3 , Giulio Francesco Romiti  2   6 , Davide A Mei  1   2 , Vincenzo L Malavasi  1 , Igor Diemberger  7 , Laurent Fauchier  8 , Francisco Marin  9 , Michael Nabauer  10 , Tatjana S Potpara  11   12 , Gheorghe-Andrei Dan  13 , Gregory Y H Lip  2   14 , Giuseppe Boriani  1
Affiliations

Factors Associated with Progression of Atrial Fibrillation and Impact on All-Cause Mortality in a Cohort of European Patients

Marco Vitolo et al. J Clin Med. .

Abstract

Background: Paroxysmal atrial fibrillation (AF) may often progress towards more sustained forms of the arrhythmia, but further research is needed on the factors associated with this clinical course.

Methods: We analyzed patients enrolled in a prospective cohort study of AF patients. Patients with paroxysmal AF at baseline or first-detected AF (with successful cardioversion) were included. According to rhythm status at 1 year, patients were stratified into: (i) No AF progression and (ii) AF progression. All-cause death was the primary outcome.

Results: A total of 2688 patients were included (median age 67 years, interquartile range 60-75, females 44.7%). At 1-year of follow-up, 2094 (77.9%) patients showed no AF progression, while 594 (22.1%) developed persistent or permanent AF. On multivariable logistic regression analysis, no physical activity (odds ratio [OR] 1.35, 95% CI 1.02-1.78), valvular heart disease (OR 1.63, 95% CI 1.23-2.15), left atrial diameter (OR 1.03, 95% CI 1.01-1.05), or left ventricular ejection fraction (OR 0.98, 95% CI 0.97-1.00) were independently associated with AF progression at 1 year. After the assessment at 1 year, the patients were followed for an extended follow-up of 371 days, and those with AF progression were independently associated with a higher risk for all-cause death (adjusted hazard ratio 1.77, 95% CI 1.09-2.89) compared to no-AF-progression patients.

Conclusions: In a contemporary cohort of AF patients, a substantial proportion of patients presenting with paroxysmal or first-detected AF showed progression of the AF pattern within 1 year, and clinical factors related to cardiac remodeling were associated with progression. AF progression was associated with an increased risk of all-cause mortality.

Keywords: atrial fibrillation; atrial fibrillation type; death; outcomes; progression; registry; remodeling.

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Conflict of interest statement

G.B.: small speaker fee from Bayer, Boston, Boehringer Ingelheim, Brystol Myers Squibb, Janssen and Sanofi. L.F.: consultant or speaker for Bayer, BMS/Pfizer, Boehringer Ingelheim, Medtronic, Novartis, and XO. F.M.: advisor fees Boehringer-Ingelheim; research grants Ferrer; speaker fees Boehringer-Ingelheim, Astra-Zeneca, Pfizer, and Bayer; TP: consultant for Bayer and Pfizer (no fees). G.A.D.: small speaker fees from Boehringer-Ingelheim, Pfizer, Bayer, Sanofi, and Zentiva; G.Y.H.L.: consultant and speaker for Bayer/Janssen, BMS/Pfizer, Boehringer Ingelheim, Anthem, and Daiichi-Sankyo. (No fees were directly received personally.) All the disclosures occurred outside the submitted work. The other authors have no disclosures to declare.

Figures

Figure 1
Figure 1
Study flow diagram. AF = atrial fibrillation; CV = cardioversion.
Figure 2
Figure 2
Kaplan-Meier curves for the primary endpoint (all-cause death) for patients with or without AF progression during the extended follow-up (i.e., after AF progression assessment at 1-year). aHR = adjusted hazard ratio; AF = atrial fibrillation; CI confidence interval; F-UP = follow-up; HR, hazard ratio; N = number. * The Cox regression analysis was adjusted for age, sex, heart failure, coronary artery disease, hypertension, diabetes mellitus, previous thromboembolic events, peripheral artery disease, chronic kidney disease, and use of oral anticoagulants.
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