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Published on: July 20, 2022
Progression to the persistent form in asymptomatic paroxysmal atrial fibrillation
Keitaro Senoo1, Shinya Suzuki, Takayuki Otsuka
1Cardiovascular Institute.
Insights
Asymptomatic paroxysmal atrial fibrillation (AF) patients showed faster progression to persistent AF than symptomatic patients. This may be due to less aggressive treatment, including pulmonary vein isolation (PVI).
Area of Science:
- Cardiology
- Electrophysiology
- Atrial Fibrillation Research
Background:
- Investigated the progression of paroxysmal atrial fibrillation (AF) to persistent AF.
- Focused on Japanese patients, including asymptomatic individuals.
Purpose of the Study:
- To determine if asymptomatic paroxysmal AF progresses faster than symptomatic AF.
- To identify predictors of AF progression in asymptomatic patients.
Main Methods:
- Retrospective cohort study using the Shinken Database (2004-2012).
- Included 1,176 patients with paroxysmal AF, with a focus on 468 asymptomatic patients.
- Analyzed AF progression rates, clinical characteristics, and treatment modalities like pulmonary vein isolation (PVI).
Main Results:
- AF progression occurred in 6.0% of patients annually.
- Asymptomatic patients showed significantly greater AF progression (HR, 1.611; P=0.018) despite a lower-risk profile.
- Independent predictors for progression included absence of symptoms, male sex, cardiomyopathy, and absence of PVI.
Conclusions:
- Asymptomatic paroxysmal AF progresses more rapidly than symptomatic AF, contrary to expectations based on risk profiles.
- Less intensive management, particularly reduced use of PVI in asymptomatic patients, may contribute to this paradoxical finding.
- Prognosis was similar between asymptomatic and symptomatic AF patients.
Background:
This study investigated the progression of paroxysmal atrial fibrillation (AF) to the persistent form in Japanese asymptomatic AF patients.
Methods And Results:
Data were derived from a single hospital-based cohort in the Shinken Database 2004-2012 (n=19,994), in which 1,176 patients were diagnosed as having paroxysmal AF. AF progression occurred in 115 patients (6.0%/year) during the mean follow-up period (1,213±905 days). Although patients who were asymptomatic at the initial visit (n=468) had a low-risk profile compared with symptomatic patients, they had greater AF progression at follow-up (unadjusted hazard ratio, 1.611; 95% CI: 1.087-2.389; P=0.018). Absence of symptoms, male sex, and cardiomyopathy were independent predictors for AF progression in the multivariate model. It was noted that asymptomatic patients were less likely to undergo pulmonary vein isolation (PVI). In addition, the interaction term between asymptomatic AF and absence of PVI could be another independent predictor for AF progression. Prognosis was similar between asymptomatic and symptomatic patients with AF.
Conclusions:
Irrespective of low-risk profile, patients with asymptomatic paroxysmal AF had greater progression of AF compared with symptomatic patients. This paradoxical result appeared to be the result of less intensive clinical management, including invasive rhythm control.
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