From the Department of Cardiology (H.O., Y. An, S.I., Y. Aono, K.D., M. Ishii, M. Iguchi, N.M., M. Abe, M. Akao).
Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan (M.E.).
Stroke. 2018 Oct;49(10):2301-2308. doi: 10.1161/STROKEAHA.118.021396.
Background and Purpose- Atrial fibrillation (AF) is a common arrhythmic disorder among the elderly and sometimes progresses from paroxysmal to sustained (persistent or permanent) types. Clinical outcomes of patients with progression of AF were unknown. This study assessed the characteristics of patients with AF progression and the impact of AF progression on various clinical events. Methods- The Fushimi AF Registry is a community-based prospective survey of the patients with AF in Fushimi-ku, Kyoto. Analyses were performed on 4045 patients, which included 1974 paroxysmal AF (PAF; 48.8%) and 2071 sustained (persistent or permanent) AF (SAF; 51.2%) at baseline. Results- During the median follow-up period of 1105 days, progression of AF occurred in 252 patients with PAF (4.22 per 100 person-years). Multivariate Cox regression analysis demonstrated that progression of AF was significantly associated with an increased risk of ischemic stroke or systemic embolism (adjusted hazard ratio [HR], 4.10; 95% CI, 1.95-8.24; P<0.001 [versus PAF without progression]; adjusted HR, 2.20; 95% CI, 1.11-4.00; P=0.025 [versus SAF]) during progression period from paroxysmal to sustained forms. The risk after the progression was equivalent to SAF (adjusted HR, 1.54; 95% CI, 0.78-2.75; P=0.201 [versus SAF]). AF progression was significantly associated with a higher risk of hospitalization for heart failure (adjusted HR, 2.70; 95% CI, 1.55-4.52; P<0.001 [versus PAF without progression]; adjusted HR, 1.81; 95% CI, 1.08-2.88; P=0.026 [versus SAF]). Conclusions- Progression of AF was associated with increased risk of clinical adverse events during arrhythmia progression period from PAF to SAF among Japanese patients with AF. The risk of adverse events was transiently elevated during progression period from PAF to SAF and declined to the level equivalent to SAF after the progression. Clinical Trial Registration- URL: http://www.umin.ac.jp/ctr/ . Unique identifier: UMIN000005834.
背景与目的- 心房颤动（AF）是老年人常见的心律失常疾病，有时会从阵发性进展为持续性（持久或永久性）类型。AF 进展患者的临床结局尚不清楚。本研究评估了 AF 进展患者的特征以及 AF 进展对各种临床事件的影响。
方法- 伏见 AF 登记处是对京都府伏见区 AF 患者的一项基于社区的前瞻性调查。对 4045 名患者进行了分析，其中基线时有 1974 名阵发性 AF（PAF；48.8%）和 2071 名持续性（持久或永久性）AF（SAF；51.2%）。
结果- 在中位随访 1105 天期间，1974 名 PAF 患者中有 252 名（每 100 人年 4.22 例）发生 AF 进展。多变量 Cox 回归分析表明，AF 进展与缺血性卒中和全身性栓塞的风险增加显著相关（调整后的危险比[HR]，4.10；95%可信区间[CI]，1.95-8.24；P<0.001[与无进展性 PAF 相比]；调整后的 HR，2.20；95%CI，1.11-4.00；P=0.025[与 SAF 相比]）。在阵发性向持续性进展期间，进展后的风险与 SAF 相当（调整后的 HR，1.54；95%CI，0.78-2.75；P=0.201[与 SAF 相比]）。AF 进展与心力衰竭住院治疗的风险显著增加相关（调整后的 HR，2.70；95%CI，1.55-4.52；P<0.001[与无进展性 PAF 相比]；调整后的 HR，1.81；95%CI，1.08-2.88；P=0.026[与 SAF 相比]）。
结论- 在日本 AF 患者中，AF 从 PAF 向 SAF 进展期间，AF 进展与心律失常进展期间临床不良事件风险增加相关。在从 PAF 向 SAF 进展期间，不良事件的风险短暂升高，进展后降至与 SAF 相当的水平。
临床试验注册- URL：http://www.umin.ac.jp/ctr/ 。独特标识符：UMIN000005834。
