Highlights
- •The aim was to evaluate the prognostic impact of atrial fibrillation (AF) type on clinical outcomes.
- •Clinical risk profile was worse in the non-paroxysmal AF group.
- •Cardiovascular events were more common in the non-paroxysmal AF group.
- •Even when adjusted for risk factors, AF type was associated with clinical outcomes.
Abstract
Background
The type of atrial fibrillation (AF) (paroxysmal or non-paroxysmal) is important in
determining its therapeutic management. However, the prognostic impact of AF type
on the incidence of cardiovascular events remains uncertain.
Methods
We investigated patients with AF who were selected from an observational, multicenter,
prospective registry (RAFFINE) comprising 4 university hospitals and 50 general hospitals/clinics
in Japan between 2013 and 2015. In this subanalysis study, patients were divided into
two groups according to their AF pattern at the time of enrollment. The primary outcome
was the composite of death, ischemic stroke, and heart-failure-related hospitalization.
Results
Among 3845 patients, 1472 (38.3 %) and 2373 (61.7 %) had paroxysmal and non-paroxysmal
type AF, respectively. Patients with non-paroxysmal AF were older and had higher CHADS2 score and prevalence of comorbidities. During median follow-up of 3.7 years, 681
(17.7 %) primary endpoints were identified. Cumulative incidences of the primary endpoint
were significantly higher in the non-paroxysmal AF group; however, rates of bleeding
events were not significantly different between the groups. Multivariate Cox hazard
analysis showed that non-paroxysmal AF had significantly higher risk of cardiovascular
events compared with paroxysmal AF (hazard ratio, 1.38; 95 % confidence interval,
1.17–1.64; p = 0.0002).
Conclusions
Non-paroxysmal AF was significantly associated with cardiovascular events. Long-term
clinical outcomes might be improved if transition from paroxysmal to non-paroxysmal
AF can be prevented.
Graphical abstract
Graphical Abstract
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European heart rhythm association (EHRA) of the ESC.Eur Heart J. 2021; 42: 373-498
- Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies.BMJ (Clin Res Ed). 2016; 532h7013
- Atrial fibrillation.N Engl J Med. 2021; 384: 353-361
- Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes.Circ Res. 2017; 120: 1501-1517
- Impact of atrial fibrillation on the risk of death: the Framingham heart study.Circulation. 1998; 98: 946-952
- Atrial fibrillation as an independent risk factor for stroke: the Framingham study.Stroke. 1991; 22: 983-988
- Incidence and predictors of atrial fibrillation progression.J Am Heart Assoc. 2019; 8e012554
- Validation of clinical classification schemes for predicting stroke: results from the National Registry of atrial fibrillation.JAMA. 2001; 285: 2864-2870
- Use of the CHA(2)DS(2)-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation.Circulation. 2012; 126: 860-865
- Registry of japanese patients with atrial fibrillation focused on anticoagulant therapy in the new era: the RAFFINE registry study design and baseline characteristics.J Cardiol. 2018; 71: 590-596
- Trends of anticoagulant use and outcomes of patients with non-valvular atrial fibrillation: findings from the RAFFINE registry.J Cardiol. 2022; 80: 41-48
- 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the american College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society.J Am Coll Cardiol. 2014; 64: e1-e76
- Stroke in paroxysmal atrial fibrillation: report from the Stockholm cohort of atrial fibrillation.Eur Heart J. 2010; 31: 967-975
- 'Real-world' management and outcomes of patients with paroxysmal vs. Non-paroxysmal atrial fibrillation in Europe: the EURObservational research programme-atrial fibrillation (EORP-AF) general pilot registry.Europace. 2016; 18: 648-657
- Outcomes of apixaban vs. Warfarin by type and duration of atrial fibrillation: results from the ARISTOTLE trial.Eur Heart J. 2013; 34: 2464-2471
- Higher risk of death and stroke in patients with persistent vs. Paroxysmal atrial fibrillation: results from the ROCKET-AF trial.Eur Heart J. 2015; 36: 288-296
- Stroke and mortality risk in patients with various patterns of atrial fibrillation: results from the ENGAGE AF-TIMI 48 trial (Effective anticoagulation with factor Xa next generation in atrial fibrillation-thrombolysis in myocardial infarction 48).Circ Arrhyth Electrophysiol. 2017; 10e004267
- Age-dependent prognostic impact of paroxysmal versus sustained atrial fibrillation on the incidence of cardiac death and heart failure hospitalization (the fushimi AF Registry).Am J Cardiol. 2019; 124: 1420-1429
- Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.Lancet. 2014; 383: 955-962
- Clinical effectiveness of direct oral anticoagulants vs warfarin in older patients with atrial fibrillation and ischemic stroke: findings from the patient-centered research into outcomes stroke patients prefer and effectiveness research (PROSPER) study.JAMA Neurol. 2019; 76: 1192-1202
- 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons.Circulation. 2019; 140: e125-e151
- Progression to the persistent form in asymptomatic paroxysmal atrial fibrillation.Circ J. 2014; 78: 1121-1126
- Progression from paroxysmal to sustained atrial fibrillation is associated with increased adverse events.Stroke. 2018; 49: 2301-2308
- Early rhythm-control therapy in patients with atrial fibrillation.N Engl J Med. 2020; 383: 1305-1316
Article info
Publication history
Published online: January 17, 2023
Accepted:
December 17,
2022
Received in revised form:
December 11,
2022
Received:
October 5,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
