The Impact of Atrial Fibrillation Clinical Subtype on Mortality.

OBJECTIVES

This study sought to investigate the prognostic implications of the clinical subtype of atrial fibrillation (AF): paroxysmal or persistent.

BACKGROUND

Underlying structural abnormalities of the left atrium may be responsible for the initial clinical presentation of AF in either paroxysmal or persistent form, yet the prognostic implications of the clinical subtype on presentation are unknown.

METHODS

Over a median of 7 years, 1,773 patients (age 64 ± 12 years, 74% males) with nonvalvular AF with index presentations for paroxysmal or persistent AF were followed for the occurrence of all-cause mortality. Clinical information including cardiovascular risk factors, comorbid diseases associated with AF, and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 [double weight], diabetes, stroke [double weight], vascular disease, age 65-74, and sex category [female]) score was collected and analyzed.

RESULTS

In this study, 1,005 patients (57%) had persistent AF. Eighty patients (10%) with paroxysmal AF and 174 patients (17%) with persistent AF died during the follow-up period. Persistent AF compared with paroxysmal AF upon initial AF diagnosis was independently associated with worse survival independent of the CHA2DS2-VASc score and other high-risk cardiovascular risk factors (hazard ratio: 1.24; 95% confidence interval: 1.11 to 1.38).

CONCLUSIONS

In patients with nonvalvular AF, persistent AF compared with paroxysmal AF upon first diagnosis is independently associated with increased mortality.