Padfield Gareth J, Steinberg Christian, Swampillai Janice, Qian Hong, Connolly Stuart J, Dorian Paul, Green Martin S, Humphries Karin H, Klein George J, Sheldon Robert, Talajic Mario, Kerr Charles R
University of British Columbia, Vancouver, British Columbia, Canada.
Centre for Health Evaluation & Outcome Sciences, UBC, Vancouver, British Columbia, Canada.
Heart Rhythm. 2017 Jun;14(6):801-807. doi: 10.1016/j.hrthm.2017.01.038. Epub 2017 Feb 21.
Progression from paroxysmal to persistent atrial fibrillation (AF) has important clinical implications and is relevant to the management of patients with AF.
The purpose of this study was to define the long-term rate of progression from paroxysmal to persistent AF and the relevant clinical variables.
The Canadian Registry of Atrial Fibrillation enrolled patients after a first electrocardiographic diagnosis of paroxysmal AF. Associations between baseline characteristics and clinical outcomes were evaluated using a multivariable Cox proportional hazard model and a competing risk model accounting for death as a competing risk, where appropriate.
We enrolled 755 patients (61.7% men) aged between 14 and 91 years (mean age 61.2 ± 14.2 years). The median follow-up was 6.35 years (interquartile range 2.93-10.04 years), with a rate of progression to persistent AF at 1, 5, and 10 years was 8.6%, 24.3%, and 36.3%, respectively. All-cause mortality was 30.3% at 10 years. Factors associated with AF progression were increasing age (hazard ratio [HR] 1.40; 95% confidence interval [CI] 1.23-1.60, for each 10-year increment), mitral regurgitation (HR 1.87; 95% CI 1.28-2.73), left atrial dilatation (HR 3.01; 95% CI 2.03-4.47), aortic stenosis (HR 2.40; 95% CI 1.05-5.48), and left ventricular hypertrophy (HR .47; 95% CI 1.04-2.08). Factors associated with a lower rate of progression were a faster heart rate during AF (HR 0.94; 95% CI 0.92-0.96 per 5-beat/min increment) and angina (HR 0.54; 95% CI 0.38-0.77). After accounting for death as a competing risk, left ventricular hypertrophy and aortic stenosis were no longer significant.
Within 10 years of presenting with paroxysmal AF, >50% of patients will progress to persistent AF or be dead. Increasing age, mitral regurgitation, aortic stenosis, left ventricular hypertrophy, and left atrial dilatation were associated with progression to persistent AF.
从阵发性心房颤动（房颤）进展为持续性房颤具有重要的临床意义，且与房颤患者的管理相关。
本研究的目的是确定阵发性房颤进展为持续性房颤的长期发生率以及相关临床变量。
加拿大房颤注册研究纳入首次经心电图诊断为阵发性房颤的患者。使用多变量Cox比例风险模型和竞争风险模型评估基线特征与临床结局之间的关联，在适当情况下将死亡作为竞争风险考虑在内。
我们纳入了755例患者（男性占61.7%），年龄在14至91岁之间（平均年龄61.2±14.2岁）。中位随访时间为6.35年（四分位间距2.93 - 10.04年），1年、5年和10年进展为持续性房颤的发生率分别为8.6%、24.3%和36.3%。10年全因死亡率为30.3%。与房颤进展相关的因素包括年龄增长（风险比[HR]1.40；95%置信区间[CI]1.23 - 1.60，每增加10岁）、二尖瓣反流（HR 1.87；95% CI 1.28 - 2.73）、左心房扩大（HR 3.01；95% CI 2.03 - 4.47）、主动脉瓣狭窄（HR 2.40；95% CI 1.05 - 5.48）和左心室肥厚（HR 1.47；95% CI 1.04 - 2.08）。与较低进展率相关的因素包括房颤期间较快的心率（HR 0.94；95% CI 0.92 - 0.96，每增加5次/分钟）和心绞痛（HR 0.54；95% CI 0.38 - 0.77）。将死亡作为竞争风险考虑在内后，左心室肥厚和主动脉瓣狭窄不再具有统计学意义。
在出现阵发性房颤后的10年内，超过50%的患者将进展为持续性房颤或死亡。年龄增长、二尖瓣反流、主动脉瓣狭窄、左心室肥厚和左心房扩大与进展为持续性房颤相关。
