Age, diabetes and heart failure are independent predictors of atrial fibrillation (AF) progression, according to a study in the November edition of the Heart Rhythm Journal. The study also found that early catheter ablation rather than antiarrhythmic drug therapy reduces AF recurrences, delaying arrhythmia progression in almost all patients.
The study is the first to prospectively assess the progression of AF according to recent guideline classifications and management. In addition, while prior studies were based on retrospective data using older guidelines and did not include the potential influence of catheter ablation, this five-year prospective study is also the first to include catheter ablation as an alternative to conventional antiarrhythmic drug therapy, according to the study.
The long-term, prospective follow-up study, led by Carlo Pappone, MD, from San Raffaele University Hospital, Milan, Italy, showed that over a five-year follow-up, patients with lone AF, defined as AF occurring in the absence of structural heart disease, were at a very low risk to progress from the first detected episode to permanent AF. However, patients with AF and comorbidities, the presence of two or more disease processes, required treatment to avoid AF recurrences and arrhythmia progression.
Among 402 screened patients with a first episode of AF, 106 patients were selected and followed for five years. Of the 106 patients, 54 had lone AF and 52 had comorbidities.
A total of 50 patients (61 percent with lone AF), had no further recurrence after five years.
The remaining 56 patients within 19 months after the first episode developed recurrent paroxysmal AF requiring long-term antiarrhythmic drug therapy, which was continued in 45 patients and was stopped because of intolerance/failure in 11 patients who underwent catheter ablation.
AF became persistent in 24 of the 45 patients on antiarrhythmic drug therapy and then permanent in 16, of whom six had refused catheter ablation at the time of persistence. No AF recurrences or AF progression occurred after ablation.
Kaplan-Meier curves demonstrated that patients with comorbidities were significantly more likely to progress than were those with lone AF and that patients who underwent catheter ablation were at lower risk for progression to permanent AF than were those on antiarrhythmic drug therapy.
This has an important clinical impact in the growing AF population, considering the difficulty to maintain long-term sinus rhythm with antiarrhythmic drugs and the association of poor safety implications, the authors concluded.
Researchers concluded that age, diabetes and heart failure significantly predict final progression to permanent AF.
“Many prior studies reported predictors of AF development, but did not report predictors of arrhythmia progression,” Pappone said. “By identifying key arrhythmia progression predictors, patients at risk of AF progression will be better managed from an early ablation stage.”