Jahangir Arshad, Lee Victor, Friedman Paul A, Trusty Jane M, Hodge David O, Kopecky Stephen L, Packer Douglas L, Hammill Stephen C, Shen Win-Kuang, Gersh Bernard J
Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Circulation. 2007 Jun 19;115(24):3050-6. doi: 10.1161/CIRCULATIONAHA.106.644484. Epub 2007 Jun 4.
The long-term natural history of lone atrial fibrillation is unknown. Our objective was to determine the rate and predictors of progression from paroxysmal to permanent atrial fibrillation over 30 years and the long-term risk of heart failure, thromboembolism, and death compared with a control population.
A previously characterized Olmsted County, Minnesota, population with first episode of documented atrial fibrillation between 1950 and 1980 and no concomitant heart disease or hypertension was followed up long term. Of this unique cohort, 76 patients with paroxysmal (n=34), persistent (n=37), or permanent (n=5) lone atrial fibrillation at initial diagnosis met inclusion criteria (mean age at diagnosis, 44.2+/-11.7 years; male, 78%). Mean duration of follow-up was 25.2+/-9.5 years. Of 71 patients with paroxysmal or persistent atrial fibrillation, 22 had progression to permanent atrial fibrillation. Overall survival of the 76 patients with lone atrial fibrillation was 92% and 68% at 15 and 30 years, respectively, similar to 86% and 57% survival for the age- and sex-matched Minnesota population. Observed survival free of heart failure was slightly worse than expected (P=0.051). Risk for stroke or transient ischemic attack was similar to the expected population risk during the initial 25 years of follow-up but increased thereafter (P=0.004), although CIs were wide. All patients who had a cerebrovascular event had developed > or = 1 risk factor for thromboembolism.
Comorbidities significantly modulate progression and complications of atrial fibrillation. Age or development of hypertension increases thromboembolic risk.
孤立性心房颤动的长期自然病史尚不清楚。我们的目的是确定30年间阵发性心房颤动进展为永久性心房颤动的发生率及预测因素，以及与对照组相比，心力衰竭、血栓栓塞和死亡的长期风险。
对明尼苏达州奥姆斯特德县一组先前已作特征描述的人群进行长期随访，该人群在1950年至1980年间首次出现有记录的心房颤动，且无合并心脏病或高血压。在这一独特队列中，76例初始诊断为阵发性（n = 34）、持续性（n = 37）或永久性（n = 5）孤立性心房颤动的患者符合纳入标准（诊断时平均年龄44.2±11.7岁；男性占78%）。平均随访时间为25.2±9.5年。在71例阵发性或持续性心房颤动患者中，22例进展为永久性心房颤动。76例孤立性心房颤动患者在15年和30年时的总生存率分别为92%和68%，与年龄和性别匹配的明尼苏达人群的86%和57%生存率相似。观察到的无心力衰竭生存率略低于预期（P = 0.051）。在随访的最初25年中，中风或短暂性脑缺血发作的风险与预期人群风险相似，但此后有所增加（P = 0.004），尽管置信区间较宽。所有发生脑血管事件的患者均已出现≥1个血栓栓塞危险因素。
合并症显著影响心房颤动的进展和并发症。年龄增长或高血压的发生会增加血栓栓塞风险。
