Author + information
- Received June 27, 2017
- Revision received August 24, 2017
- Accepted September 7, 2017
- Published online February 19, 2018.
- Melissa Leung, MBBS, BSc(med), MBiostat, PhDa,b,
- Philippe J. van Rosendael, MDa,
- Rachid Abou, MDa,
- Nina Ajmone Marsan, MD, PhDa,
- Dominic Y. Leung, MBBS, PhDb,
- Victoria Delgado, MD, PhDa and
- Jeroen J. Bax, MD, PhDa,∗ ()
- aDepartment of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
- bDepartment of Cardiology, Ingham Institute at Liverpool Hospital, University of New South Wales, Sydney, Australia
- ↵∗Address for correspondence:
Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
Objectives This study sought to investigate the prognostic implications of the clinical subtype of atrial fibrillation (AF): paroxysmal or persistent.
Background Underlying structural abnormalities of the left atrium may be responsible for the initial clinical presentation of AF in either paroxysmal or persistent form, yet the prognostic implications of the clinical subtype on presentation are unknown.
Methods Over a median of 7 years, 1,773 patients (age 64 ± 12 years, 74% males) with nonvalvular AF with index presentations for paroxysmal or persistent AF were followed for the occurrence of all-cause mortality. Clinical information including cardiovascular risk factors, comorbid diseases associated with AF, and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 [double weight], diabetes, stroke [double weight], vascular disease, age 65–74, and sex category [female]) score was collected and analyzed.
Results In this study, 1,005 patients (57%) had persistent AF. Eighty patients (10%) with paroxysmal AF and 174 patients (17%) with persistent AF died during the follow-up period. Persistent AF compared with paroxysmal AF upon initial AF diagnosis was independently associated with worse survival independent of the CHA2DS2-VASc score and other high-risk cardiovascular risk factors (hazard ratio: 1.24; 95% confidence interval: 1.11 to 1.38).
Conclusions In patients with nonvalvular AF, persistent AF compared with paroxysmal AF upon first diagnosis is independently associated with increased mortality.
The Department of Cardiology at Leiden University Medical Center has received unrestricted research grants from Biotronik, Boston Scientific, Medtronic, and Edwards Lifesciences. Dr. M. Leung has received a Pfizer Investigator Initiated Research Grant. Dr. Delgado has received speaker fees from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 27, 2017.
- Revision received August 24, 2017.
- Accepted September 7, 2017.
- 2018 American College of Cardiology Foundation
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