Evaluation of Time Course and Predicting Factors of Progression of Paroxysmal or Persistent Atrial Fibrillation to Permanent Atrial Fibrillation

Abstract

To evaluate time course and predictors of progression of paroxysmal or persistent atrial fibrillation (AF) to permanent AF. We included 460 patients referred for paroxysmal (n= 337) or persistent (n= 123) AF between 1994 and 2012. Mean follow-up was 13.2± 6.5years. AF progression rate was 3.7% per year, 19.7% at 5years, and 38.1% at 10years. Lone AF was diagnosed in 217 patients (47%). Predictors of permanent AF were: age, persistent AF, left atrial (LA) size, left ventricular-fractional shortening (LV-FS), lack of antiarrhythmic (AA) drugs, VVI pacing (P< 0.001 for all), and valvular disease (P< 0.02). Independent predictors were age (P< 0.001), persistent AF (P< 0.001), LA diameter (P< 0.005), lack of AA drugs (P< 0.005), and VVI pacing (P< 0.01). When adjusted at means of covariates, persistent AF and age >75years remained highly significant (P< 0.01). LA dimension >50 mm was highly significant at univariate model (P< 0.001) but to a lesser extent when adjusted (P< 0.05). In patients with paroxysmal AF-with age<75years-on AA drugs, progression rate to permanent AF was 6.5% at 5years and 23.7% at 10years. Among four predictors (age, LA size, LV-FS, and VVI pacing), only age (P< 0.01) and LA size (P< 0.005) remained independently significant, but LA size was not significant when adjusted. Progression to permanent AF is a slow process. Aging, LA size, VVI pacing, lack of AA therapy, and a persistent form of AF independently increased the progression to permanent AF.