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QUARTERLY FOCUS ISSUE: HEART RHYTHM DISORDER: CLINICAL RESEARCH: ATRIAL FIBRILLATION

Progression From Paroxysmal to Persistent Atrial Fibrillation

Clinical Correlates and Prognosis

Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands

Manuscript received August 13, 2009; revised manuscript received November 23, 2009, accepted November 30, 2009.

^_* Reprint requests and correspondence: Dr. Cees B. de Vos, Department of Cardiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands (Email: cees.de.vos{at}mumc.nl).

Objectives: We investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population.

Background: Progression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF.

Methods: We included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified.

Results: Progression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score >5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events.

Conclusions: A substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future.

Key Words: atrial fibrillation • epidemiology • prediction • progression • prognosis

Abbreviations and Acronyms   AF = atrial fibrillation   AUC = area under the curve   COPD = chronic obstructive pulmonary disease   TIA = transient ischemic attack

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