Original-clinicalAtrial fibrillation progression and management: A 5-year prospective follow-up study
Introduction
At present, no prospective data on atrial fibrillation (AF) progression and management according to recent AF guideline recommendations are available.1, 2 Published data on AF progression mainly derive from retrospective analyses3, 4, 5, 6 or survey data registries.7 To date, no prospective information that includes a potential influence of catheter ablation is available. Accordingly, the purpose of this prospective study was to report additional data on AF progression and management, which includes catheter ablation as an alternative to conventional antiarrhythmic drug therapy.
Section snippets
Study population
All consecutive patients admitted to the emergency department with a first episode of paroxysmal AF were recruited for this 5-year prospective follow-up study. Final inclusion required ECG confirmation of the arrhythmia and verification of the episode as the first recognized AF event for the individual without previous antiarrhythmic drug therapy. Patients with arrhythmia due to potentially reversible causes, such as acute or recent (<6 months) myocardial infarction, recent cardiac surgery, New
Study population
Enrollment began between January 2002 and July 2002, and the study ended in July 2007. Among 402 screened patients, 244 had potentially reversible causes and were excluded from the study. Of the 158 eligible patients, 52 declined to enter the study, and the remaining 106 patients completed the study protocol (Figure 1). Baseline clinical characteristics of the 106 patients and of those who progressed are given in Table 1. Heart failure was present in 12.2% of subjects with preserved left
Discussion
According to current guidelines for classification and management, AF is characterized by different clinical forms depending on its clinical presentation and course, in all probability reflecting different stages with multiple mechanisms.1, 2 Frequently, a first episode is due to a reversible cause, and in most cases after treatment of the underlying disease AF will not recur and no therapy is required.1, 2 However, in other patients, the first episode may not be due to a reversible cause, and
Conclusion
This prospective study provides new insights into AF progression and shows that over 5-year follow-up, patients with lone AF are less likely to progress from the first detected episode to permanent AF. Age, diabetes mellitus, and heart failure predict final progression, which indicates a significant role of underlying heart disease in modulating such progression. Catheter ablation may be of benefit in preventing AF recurrences and delaying final AF progression, but larger randomized studies are
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