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 Malavasi¹, Igor Diemberger⁷, Laurent Fauchier⁸, Francisco Marin⁹, Michael Nabauer¹⁰, Tatjana S Potpara^{11

12}, Gheorghe-Andrei Dan¹³, Gregory Y H Lip^{2

14}, Giuseppe Boriani¹

Affiliations

¹ Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy.
² Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK.
³ Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy.
⁴ Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
⁵ Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy.
⁶ Department of Translational and Precision Medicine, Sapienza-University of Rome, 00185 Rome, Italy.
⁷ Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy.
⁸ Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, 37000 Tours, France.
⁹ Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBERCV, 30100 Murcia, Spain.
¹⁰ Department of Cardiology, Ludwig-Maximilians-University, 80539 Munich, Germany.
¹¹ School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
¹² Intensive Arrhythmia Care, Cardiology Clinic, Clinical Center of Serbia, 11000 Belgrade, Serbia.
¹³ 'Carol Davila' University of Medicine, Colentina University Hospital, 020125 Bucharest, Romania.
¹⁴ Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark.

PMID: 36769416
PMCID: PMC9917523
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 et al. J Clin Med. 2023.

. 2023 Jan 18;12(3):768.

doi: 10.3390/jcm12030768.

Authors

Affiliations

¹ Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy.
² Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK.
³ Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy.
⁴ Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
⁵ Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy.
⁶ Department of Translational and Precision Medicine, Sapienza-University of Rome, 00185 Rome, Italy.
⁷ Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy.
⁸ Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, 37000 Tours, France.
⁹ Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBERCV, 30100 Murcia, Spain.
¹⁰ Department of Cardiology, Ludwig-Maximilians-University, 80539 Munich, Germany.
¹¹ School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
¹² Intensive Arrhythmia Care, Cardiology Clinic, Clinical Center of Serbia, 11000 Belgrade, Serbia.
¹³ 'Carol Davila' University of Medicine, Colentina University Hospital, 020125 Bucharest, Romania.
¹⁴ Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark.

PMID: 36769416
PMCID: PMC9917523
DOI: 10.3390/jcm12030768

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**
Study flow diagram. AF = atrial fibrillation; CV = cardioversion.

**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.

See this image and copyright information in PMC

References

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources