Atrial fibrillation pattern and factors affecting the progression to permanent atrial fibrillation
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Atrial fibrillation pattern and factors affecting the progression to permanent atrial fibrillation Vincenzo Livio Malavasi1 · Elisa Fantecchi1 · Virginia Tordoni1 · Laura Melara1 · Andrea Barbieri1 · Marco Vitolo1,2 · Gregory Y. H. Lip2,3 · Giuseppe Boriani1 Received: 22 August 2020 / Accepted: 22 October 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract Atrial fibrillation (AF) may progress from a non-permanent to a permanent form, and improvement in prediction may help in decision-making. In- and outpatients with non-permanent AF were enrolled in a prospective study and followed every 6 months. At baseline, 314 out of 523 patients (60%) had non-permanent AF (25.5% paroxysmal AF, 52.5% persistent, 2% first diagnosed AF). They were mostly males (188, 59.9%), median age 71 years [interquartile range (IQ) 62–77], median CHA2DS2VASc 3 (IQ 1–4), median HATCH score 1 (IQ 1–2). During a follow-up of 701 (IQ 437–902) days, 66 patients (21%) developed permanent AF. C HA2DS2VASc and HATCH scores were incrementally associated with AF progression (p for trend CHA2DS2VASc 2 (HR 0.358, 95%CI 0.162–0.791, p = 0.011) and valvular disease (HR 2.196, 95%CI 1.072–4.499, p = 0.032) were significantly associated with AF progression. Adding “moderate–severe LA dilation” to clinical scores, eg. HATCH score (HATCH-LA) with 2 points (Cox multivariable regression analysis) improved prediction of AF progression vs. HATCH score (p = 0.0225). In patients without permanent AF, progression of AF was independently associated with age, LA dilation, AF symptoms severity, antiarrhythmic drugs and valvular disease. Adding LA dilation (moderate–severe volume increase) to clinical scores improved prediction of progression to permanent AF. Keywords Atrial fibrillation · Progression · Left atrial dilation · HATCH score
Introduction Gregory YH Lip and Giuseppe Boriani are joint senior authors. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11739-020-02551-5) contains supplementary material, which is available to authorized users. * Giuseppe Boriani [email protected] 1
Cardiology Division, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo 71, 41121 Modena, Italy
2
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
3
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Atrial fibrillation (AF) shows a natural progression from self-terminating episodes to a more sustained or permanent form [1, 2]. The Canadian Registry of Atrial Fibrillation (CARAF) registry found that the probability of progression to permanent AF was up to 25% at 5 years after the initial diagnosis [3]. Subsequently, several observational registries confirmed this finding [4–6]. Of note, clinical outcomes of patients who progress to permanent AF are gen
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