Wada Hideki, Miyauchi Katsumi, Suwa Satoru, Miyazaki Sakiko, Hayashi Hidemori, Yamashiro Kazuo, Tanaka Ryota, Nishizaki Yuji, Nojiri Shuko, Sumiyoshi Masataka, Nakazato Yuji, Urabe Takao, Hattori Nobutaka, Minamino Tohru, Daida Hiroyuki
Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan.
Department of Cardiovascular Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan.
J Cardiol. 2023 May;81(5):450-455. doi: 10.1016/j.jjcc.2022.12.010. Epub 2023 Jan 12.
The type of atrial fibrillation (AF) (paroxysmal or non-paroxysmal) is important in determining its therapeutic management. However, the prognostic impact of AF type on the incidence of cardiovascular events remains uncertain.
We investigated patients with AF who were selected from an observational, multicenter, prospective registry (RAFFINE) comprising 4 university hospitals and 50 general hospitals/clinics in Japan between 2013 and 2015. In this subanalysis study, patients were divided into two groups according to their AF pattern at the time of enrollment. The primary outcome was the composite of death, ischemic stroke, and heart-failure-related hospitalization.
Among 3845 patients, 1472 (38.3 %) and 2373 (61.7 %) had paroxysmal and non-paroxysmal type AF, respectively. Patients with non-paroxysmal AF were older and had higher CHADS score and prevalence of comorbidities. During median follow-up of 3.7 years, 681 (17.7 %) primary endpoints were identified. Cumulative incidences of the primary endpoint were significantly higher in the non-paroxysmal AF group; however, rates of bleeding events were not significantly different between the groups. Multivariate Cox hazard analysis showed that non-paroxysmal AF had significantly higher risk of cardiovascular events compared with paroxysmal AF (hazard ratio, 1.38; 95 % confidence interval, 1.17-1.64; p = 0.0002).
Non-paroxysmal AF was significantly associated with cardiovascular events. Long-term clinical outcomes might be improved if transition from paroxysmal to non-paroxysmal AF can be prevented.
心房颤动（AF）的类型（阵发性或非阵发性）对于确定其治疗管理很重要。然而，AF类型对心血管事件发生率的预后影响仍不确定。
我们调查了从2013年至2015年在日本的4所大学医院和50所综合医院/诊所组成的观察性、多中心、前瞻性登记处（RAFFINE）中选取的AF患者。在这项亚分析研究中，患者根据入组时的AF模式分为两组。主要结局是死亡、缺血性卒中和心力衰竭相关住院的复合终点。
在3845例患者中，分别有1472例（38.3%）和2373例（61.7%）患有阵发性和非阵发性AF。非阵发性AF患者年龄更大，CHADS评分更高，合并症患病率更高。在3.7年的中位随访期间，确定了681例（17.7%）主要终点事件。非阵发性AF组主要终点的累积发生率显著更高；然而，两组之间的出血事件发生率没有显著差异。多变量Cox风险分析显示，与阵发性AF相比，非阵发性AF发生心血管事件的风险显著更高（风险比，1.38；95%置信区间，1.17 - 1.64；p = 0.0002）。
非阵发性AF与心血管事件显著相关。如果能够预防从阵发性AF转变为非阵发性AF，可能会改善长期临床结局。
