Atrial fibrillation progression occurred at 5.5%/year, with patients showing higher comorbidities and 66% experiencing adverse events versus 43% without progression.
In patients with paroxysmal atrial fibrillation, progression to more sustained forms occurs at a rate of 5.5% per year and is associated with a higher burden of comorbidities and adverse events.
Absolute Event Rate: 0% vs 0%
Abstract Background Atrial fibrillation (AF) frequently progresses from paroxysmal AF (PAF) to more sustained forms, contributing to increased disease burden. Understanding the factors that drive AF progression and healthcare burden in this specific population may help refine patient risk assessment and inform treatment strategies. Purpose The Reappraisal of AF: Interaction Between HyperCoagulability, Electrical Remodelling, and Vascular Destabilisation in the Progression of AF (RACE V) study aims to characterize phenotypical differences between patients with and without AF progression, and to examine whether progression is associated with a higher incidence of adverse events. We now report the incidence of AF progression, differences in baseline characteristics between those with and without AF progression, and adverse events in the total RACE V cohort during long-term follow-up. Methods The RACE V study is a prospective, multicenter, observational study involving 612 patients with PAF. All patients were continuously monitored using implantable loop recorders, allowing precise tracking of AF recurrences and progression. AF progression was defined as (1) progression to persistent or permanent AF, or (2) AF burden increase 3%, during follow-up. The occurrence of adverse events was prospectively assessed. Results Patients had a median age of 64 (57 – 70) years, 42% were female, 180 (29%) had heart failure, 521 (85%) had hypertension, and 61 (10%) had coronary artery disease (CAD). The median CHA2DS2-VASc score was 3 (2 – 4). A total of 108 (5.5%/year) patients had AF progression during a median follow-up of 3.2 (2.2 – 3.7) years. Sixty-seven (11%) patients had no recurrent AF after inclusion. Patients with AF progression were older (67 62 – 73 vs. 64 57 – 70 years, p = 0.001), had a higher left atrial volume index (LAVI; 36 29 – 41 vs. 31 26 – 39 mL/m2, p = 0.031), a lower eGFR (78 66 – 87 vs. 83 72 – 90 mL/min/1.73 m2, p = 0.003), a higher Agatston calcium score (99 5 – 473 vs. 28 0 – 244, p = 0.004), and a higher prevalence of comorbidities, including diabetes (14% vs 7%, p = 0.029) and CAD (18% vs 8%, p = 0.006), compared to patients without progression. Those with progression had a higher median number of comorbidities (3 2 – 4 vs 3 2 -3, p = 0.046). Adverse events were more likely in patients with AF progression (66% vs. 43% of patients, p 0.001). The distribution by event type is shown in Table 1. Of all adverse events, 60% were AF-associated. Conclusions In patients with PAF, progression occurred at a rate of 5.5% patients per year. Those with progression exhibited a higher burden of comorbidities and a greater incidence of adverse events. These findings underscore the critical role of comprehensive management of comorbidities in mitigating the risk of AF progression and potentially alleviating burden on the healthcare system.
Baron et al. (Sat,) reported a other. Atrial fibrillation progression occurred at 5.5%/year, with patients showing higher comorbidities and 66% experiencing adverse events versus 43% without progression.