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Original article

Vol. 148 No. 3738 (2018)

Prevalence and predictors of atrial fibrillation type among individuals with recent onset of atrial fibrillation

  • Francisco J. Ruperti Repilado
  • Laura Doerig
  • Steffen Blum
  • Stefanie Aeschbacher
  • Philipp Krisai
  • Peter Ammann
  • Paul Erne
  • Giorgio Moschovitis
  • Marcello di Valentino
  • Dipen Shah
  • Jürg Schläpfer
  • Samuel Stempfel
  • Michael Kühne
  • Christian Sticherling
  • Stefan Osswald
  • David Conen
DOI
https://doi.org/10.4414/smw.2018.14652
Cite this as:
Swiss Med Wkly. 2018;148:w14652
Published
23.09.2018

Summary

OBJECTIVE

Atrial fibrillation (AF) is considered to be a progressive disease, starting with intermittent episodes that progress over time to more sustained events. However, little is known about the prevalence of and predictors for AF type among patients with recent-onset AF. We aimed to address these issues among a selected population of patients with AF.

METHODS

The Basel atrial fibrillation cohort (BEAT-AF) study is an ongoing prospective multicentre cohort study among patients with AF. At baseline, we obtained information on the date of AF diagnosis, AF type, comorbidities, medication and lifestyle factors. For this analysis, 486 (31.4%) out of 1550 participants with recent-onset AF (defined as AF duration <24 months) were included. Predictors for AF type (non-paroxysmal vs paroxysmal) were obtained using multivariable adjusted logistic regression models.

RESULTS

Mean age was 67 (59–75) years and 136 (28%) were women. Recent-onset paroxysmal AF was observed in 301 (62%) participants, 185 (38%) had non-paroxysmal AF – persistent AF in 148 (30.4%) and permanent AF in 37 (7.6%). In multivariable models, odds ratios for having non-paroxysmal AF around AF diagnosis were 1.03 per year increasing in age (95% confidence interval [CI] 1.01–1.05, p = 0.01); 2.70 (1.5–4.68, p = 0.0004) for history of heart failure; 3.82 (1.05–13.87, p = 0.04) for a history of hyperthyroidism and 1.04 (1.02–1.05, p <0.0001) per beat increase in heart rate.

CONCLUSION

We found a substantial proportion of AF patients with the non-paroxysmal form shortly after diagnosis. Predictors for non-paroxysmal AF were increasing age, history of heart failure or hyperthyroidism, and a higher heart rate.

References

  1. Krijthe BP, Kunst A, Benjamin EJ, Lip GY, Franco OH, Hofman A, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34(35):2746–51. doi:.https://doi.org/10.1093/eurheartj/eht280
  2. Conen D, Chae CU, Glynn RJ, Tedrow UB, Everett BM, Buring JE, et al. Risk of death and cardiovascular events in initially healthy women with new-onset atrial fibrillation. JAMA. 2011;305(20):2080–7. doi:.https://doi.org/10.1001/jama.2011.659
  3. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, et al.; ESC Committee for Practice Guidelines. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace. 2010;12(10):1360–420. doi:.. Corrected in: Europace. 2011;13(7):1058.https://doi.org/10.1093/europace/euq350
  4. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Jr, et al.; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):2071–104. doi:.. Corrected in: Circulation. 2014;130(23):e270-1. doi:https://doi.org/10.1161/CIR.0000000000000142https://doi.org/10.1161/CIR.0000000000000040
  5. de Vos CB, Pisters R, Nieuwlaat R, Prins MH, Tieleman RG, Coelen RJ, et al. Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. J Am Coll Cardiol. 2010;55(8):725–31. doi:.https://doi.org/10.1016/j.jacc.2009.11.040
  6. Al-Khatib SM, Thomas L, Wallentin L, Lopes RD, Gersh B, Garcia D, et al. Outcomes of apixaban vs. warfarin by type and duration of atrial fibrillation: results from the ARISTOTLE trial. Eur Heart J. 2013;34(31):2464–71. doi:.https://doi.org/10.1093/eurheartj/eht135
  7. Lubitz SA, Moser C, Sullivan L, Rienstra M, Fontes JD, Villalon ML, et al. Atrial fibrillation patterns and risks of subsequent stroke, heart failure, or death in the community. J Am Heart Assoc. 2013;2(5):e000126. doi:.https://doi.org/10.1161/JAHA.113.000126
  8. Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res. 2002;54(2):230–46. doi:.https://doi.org/10.1016/S0008-6363(02)00258-4
  9. Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation. 1995;92(7):1954–68. doi:.https://doi.org/10.1161/01.CIR.92.7.1954
  10. Jahangir A, Lee V, Friedman PA, Trusty JM, Hodge DO, Kopecky SL, et al. Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study. Circulation. 2007;115(24):3050–6. doi:.https://doi.org/10.1161/CIRCULATIONAHA.106.644484
  11. Veasey RA, Sugihara C, Sandhu K, Dhillon G, Freemantle N, Furniss SS, et al. The natural history of atrial fibrillation in patients with permanent pacemakers: is atrial fibrillation a progressive disease? J Interv Card Electrophysiol. 2015;44(1):23–30. doi:.https://doi.org/10.1007/s10840-015-0029-x
  12. Kerr CR, Humphries KH, Talajic M, Klein GJ, Connolly SJ, Green M, et al. Progression to chronic atrial fibrillation after the initial diagnosis of paroxysmal atrial fibrillation: results from the Canadian Registry of Atrial Fibrillation. Am Heart J. 2005;149(3):489–96. doi:.https://doi.org/10.1016/j.ahj.2004.09.053
  13. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41. doi:.https://doi.org/10.1159/000180580
  14. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al.; European Association for Cardiovascular Prevention & Rehabilitation (EACPR); ESC Committee for Practice Guidelines (CPG). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012;33(13):1635–701. doi:.https://doi.org/10.1093/eurheartj/ehs092
  15. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25, 25 Pt B):2960–84. doi:.. Corrected in: J Am Coll Cardiol. 2014;63(25):3027–8https://doi.org/10.1016/j.jacc.2013.11.003
  16. Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J. 1949;37(2):161–86. doi:.https://doi.org/10.1016/0002-8703(49)90562-1
  17. Sandhu RK, Conen D, Tedrow UB, Fitzgerald KC, Pradhan AD, Ridker PM, et al. Predisposing factors associated with development of persistent compared with paroxysmal atrial fibrillation. J Am Heart Assoc. 2014;3(3):e000916. doi:.https://doi.org/10.1161/JAHA.114.000916
  18. Kato T, Yamashita T, Sagara K, Iinuma H, Fu LT. Progressive nature of paroxysmal atrial fibrillation. Observations from a 14-year follow-up study. Circ J. 2004;68(6):568–72. doi:.https://doi.org/10.1253/circj.68.568
  19. Tsang TS, Barnes ME, Miyasaka Y, Cha SS, Bailey KR, Verzosa GC, et al. Obesity as a risk factor for the progression of paroxysmal to permanent atrial fibrillation: a longitudinal cohort study of 21 years. Eur Heart J. 2008;29(18):2227–33. doi:.https://doi.org/10.1093/eurheartj/ehn324
  20. Holmqvist F, Kim S, Steinberg BA, Reiffel JA, Mahaffey KW, Gersh BJ, et al.; ORBIT-AF Investigators. Heart rate is associated with progression of atrial fibrillation, independent of rhythm. Heart. 2015;101(11):894–9. doi:.https://doi.org/10.1136/heartjnl-2014-307043
  21. Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271(11):840–4. doi:.https://doi.org/10.1001/jama.1994.03510350050036
  22. Conen D, Glynn RJ, Sandhu RK, Tedrow UB, Albert CM. Risk factors for incident atrial fibrillation with and without left atrial enlargement in women. Int J Cardiol. 2013;168(3):1894–9. doi:.https://doi.org/10.1016/j.ijcard.2012.12.060
  23. Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994;331(19):1249–52. doi:.https://doi.org/10.1056/NEJM199411103311901
  24. Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study. Arch Intern Med. 2004;164(15):1675–8. doi:.https://doi.org/10.1001/archinte.164.15.1675
  25. Tedrow UB, Conen D, Ridker PM, Cook NR, Koplan BA, Manson JE, et al. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women’s health study). J Am Coll Cardiol. 2010;55(21):2319–27. doi:.https://doi.org/10.1016/j.jacc.2010.02.029
  26. Schoen T, Pradhan AD, Albert CM, Conen D. Type 2 diabetes mellitus and risk of incident atrial fibrillation in women. J Am Coll Cardiol. 2012;60(15):1421–8. doi:.https://doi.org/10.1016/j.jacc.2012.06.030
  27. Conen D, Albert CM. Alcohol consumption and risk of atrial fibrillation. J Am Coll Cardiol. 2011;57(25):2545, author reply 2545–6. doi:.https://doi.org/10.1016/j.jacc.2011.02.034
  28. Conen D, Tedrow UB, Cook NR, Moorthy MV, Buring JE, Albert CM. Alcohol consumption and risk of incident atrial fibrillation in women. JAMA. 2008;300(21):2489–96. doi:.https://doi.org/10.1001/jama.2008.755
  29. Heeringa J, Kors JA, Hofman A, van Rooij FJ, Witteman JC. Cigarette smoking and risk of atrial fibrillation: the Rotterdam Study. Am Heart J. 2008;156(6):1163–9. doi:.https://doi.org/10.1016/j.ahj.2008.08.003
  30. Aizer A, Gaziano JM, Cook NR, Manson JE, Buring JE, Albert CM. Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol. 2009;103(11):1572–7. doi:.https://doi.org/10.1016/j.amjcard.2009.01.374