Related Experiment Videos
Lone atrial fibrillation: prognostic differences between paroxysmal and chronic forms after 10 years of follow-up
S Scardi1, C Mazzone, C Pandullo
1Department of Cardiology, Cardiovascular Center, Trieste, Italy.
Insights
Lone atrial fibrillation (LAF) in young patients has an excellent prognosis if paroxysmal. However, chronic LAF in younger individuals carries a higher risk of embolic events and mortality, challenging the notion of LAF being benign.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Lone atrial fibrillation (LAF) is atrial fibrillation without other heart disease.
- Prognostic significance and embolic risk in LAF are debated.
Purpose of the Study:
- To evaluate the long-term prognosis and embolic risk in young patients (<50 years) diagnosed with lone atrial fibrillation.
- To differentiate outcomes between paroxysmal and chronic LAF in this cohort.
Main Methods:
- Retrospective analysis of 145 patients younger than 50 years with incident LAF.
- Follow-up for thromboembolic complications and mortality over a mean of 10 years.
- Stratification into paroxysmal (n=96) and chronic (n=49) LAF groups.
Main Results:
- Paroxysmal LAF group: 1 ischemic stroke, 2 TIAs, 1 MI.
- Chronic LAF group: 7 patients (16.3%) experienced 8 embolic events (including intestinal embolism).
- Chronic LAF group: 2 patients (6.1%) died suddenly, and 1 developed heart failure.
Conclusions:
- Young patients with paroxysmal LAF have an excellent prognosis.
- Chronic LAF in young individuals is associated with significant risks of embolic complications and mortality.
- LAF is not universally benign; specific high-risk subgroups require better identification.
Background:
Lone atrial fibrillation (LAF) is defined by the presence of atrial fibrillation unassociated with other evidence of organic heart disease. There are conflicting data concerning the prognostic importance, rate of embolic complications, and survival in subjects affected by this arrhythmia.
Methods And Results:
One hundred forty-five patients younger than 50 years at the time of the first diagnosis were identified; 96 had paroxysmal and 49 had chronic LAF. They were followed up with clinical and echocardiographic controls, and we recorded every thromboembolic complication and death. During the follow-up (10 +/- 8 years) among patients with paroxysmal LAF, 1 (1%) had an ischemic stroke, 2 a transient ischemic attack, and 1 a myocardial infarction. In the group with chronic LAF, 1 patient had moderate heart failure, 2 myocardial infarction, and 1 transient ischemic attack. In this group, 8 embolic complications in 7 (16.3%) patients were observed. One patient with intestinal embolism died during surgery; 2 (6.1%) patients died suddenly.
Conclusions:
The prognosis of young patients with paroxysmal LAF appears to be excellent, whereas patients with chronic LAF are at increased risk of embolic complications and higher mortality rates. Our results suggest that LAF is not always a benign disorder, as suggested by previous studies. Subgroups with substantially increased risk for thromboembolic events caused by LAF should be better identified.