Heart rhythm · 2026
Identification, multimodal characterization, and clinical outcomes of pre-atrial fibrillation subclasses.
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Wahab Ali, Nadarajah Ramesh, Kazi Khalid, Bennett Sheena, Camm A John, Lip Gregory Y H, Svennberg Emma, Freedman Ben, Wu Jianhua, Gale Chris P
Аннотация
BACKGROUND: A pre-atrial fibrillation (Pre-AF) status has been postulated to exist when there are structural or electrical findings predisposing to AF, but it is not well-described in relation to prognosis.
OBJECTIVES: This prospective cohort study aims to subclassify Pre-AF by structural, electrical, and biomarker parameters and quantify associations with major adverse events.
METHODS: Prospective cohort study of individuals with high risk of developing AF (according to the Future Innovation in Novel Detection of Atrial Fibrillation [FIND-AF] risk score), who underwent echocardiographic, electrocardiogram (ECG), and biomarker assessment. Pre-AF subclasses were specified as follows: Pre-AF 1 (1 of echocardiographic, ECG, or biomarker parameters); Pre-AF 2 (2 parameters); and Pre-AF 3 (3 parameters). Individuals were followed up for a composite primary outcome of major adverse cardiovascular, cerebrovascular, and cognitive events (incident AF, heart failure, ischemic stroke/transient ischemic attack, myocardial infarction, dementia, or cardiovascular death).
RESULTS: Of 254 participants (mean age 74.9 [±5.8] years, 50% women), 82 (32.3%) were classified as Pre-AF 1, 90 (35.4%) as Pre-AF 2, and 82 (32.3%) as Pre-AF 3. Higher Pre-AF subclass was associated with higher N-terminal pro-B-type natriuretic peptide (84.0 ng/L vs 186.1 ng/L vs 558.2 ng/L, P < .001) and larger left atrial volume (29.0 mL/m2 vs 39.8 mL/m2 vs 46.1 mL/m2, P < .001). Over a median follow-up of 24.4 months (interquartile range 19.6-26.3 months), the primary outcome was 23.2% (19/82) for Pre-AF 3, 11.1% (10/90) for Pre-AF 2, and 4.9% (4/82) for Pre-AF 1 (log-rank P = .002).
CONCLUSION: Subclassification of Pre-AF using ECG, echocardiography, and N-terminal pro-B-type natriuretic peptide has prognostic implications but is not specifically associated with diagnosis of incident AF in routine care.
OBJECTIVES: This prospective cohort study aims to subclassify Pre-AF by structural, electrical, and biomarker parameters and quantify associations with major adverse events.
METHODS: Prospective cohort study of individuals with high risk of developing AF (according to the Future Innovation in Novel Detection of Atrial Fibrillation [FIND-AF] risk score), who underwent echocardiographic, electrocardiogram (ECG), and biomarker assessment. Pre-AF subclasses were specified as follows: Pre-AF 1 (1 of echocardiographic, ECG, or biomarker parameters); Pre-AF 2 (2 parameters); and Pre-AF 3 (3 parameters). Individuals were followed up for a composite primary outcome of major adverse cardiovascular, cerebrovascular, and cognitive events (incident AF, heart failure, ischemic stroke/transient ischemic attack, myocardial infarction, dementia, or cardiovascular death).
RESULTS: Of 254 participants (mean age 74.9 [±5.8] years, 50% women), 82 (32.3%) were classified as Pre-AF 1, 90 (35.4%) as Pre-AF 2, and 82 (32.3%) as Pre-AF 3. Higher Pre-AF subclass was associated with higher N-terminal pro-B-type natriuretic peptide (84.0 ng/L vs 186.1 ng/L vs 558.2 ng/L, P < .001) and larger left atrial volume (29.0 mL/m2 vs 39.8 mL/m2 vs 46.1 mL/m2, P < .001). Over a median follow-up of 24.4 months (interquartile range 19.6-26.3 months), the primary outcome was 23.2% (19/82) for Pre-AF 3, 11.1% (10/90) for Pre-AF 2, and 4.9% (4/82) for Pre-AF 1 (log-rank P = .002).
CONCLUSION: Subclassification of Pre-AF using ECG, echocardiography, and N-terminal pro-B-type natriuretic peptide has prognostic implications but is not specifically associated with diagnosis of incident AF in routine care.