Abstract
Background: Several clinical factors such as age, hypertension, and heart failure are known to be associated with progression from paroxysmal to persistent atrial fibrillation (AF). On the other hand, which echocardiographic variables are associated with the progression remains unknown. Method: We used 286 patients in the J-RHYTHM II study, a randomized clinical trial examining effect of calcium channel blocker (amlodipine) and angiotensin receptor blocker (candesartan) in Japanese patients with paroxysmal AF and hypertension. Echocardiographic evaluation was performed at baseline. Left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), left ventricular ejection fraction (LVEF), interventricular septum (IVS), left ventricular posterior wall (LVPW), and left atrial dimension (LAD) were measured in a standard manner. The end point was development of persistent AF, defined as incidence of AF lasting for longer than 7 days and/or need of electrical cardioveresion. Cox proportional hazards models were used to examine the associations between echocardiographic variables and development of persistent AF. Results: Among echocardiographic variables, LVDd, LVDs, and LAD were associated with development of persistent AF (Table). Only LAD was significantly associated with progression from paroxysmal into persistent AF after adjustment by after adjustment by age, sex, and other potential confounding factors. One millimeter increase in LAD was associated with 7% increased risk of developing persistent AF (HR 1.07, 95% CI 1.01-1.14). This means that a 10 mm increase in LAD was associated with twice the risk of developing persistent AF (HR 1.97, 95% CI 1.09-3.58). Conclusion: LAD is associated with progression from paroxysmal to persistent AF in patients with paroxysmal AF and hypertension. LAD may be a good echocardiographic predictor of AF progression.
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