Characteristics and outcomes of atrial fibrillation in patients without traditional risk factors: an RE-LY AF registry analysis

Abstract

Aims Data on patient characteristics, prevalence, and outcomes of atrial fibrillation (AF) patients without traditional risk factors, often labelled ‘lone AF’, are sparse. Methods and results The RE-LY AF registry included 15 400 individuals who presented to emergency departments with AF in 47 countries. This analysis focused on patients without traditional risk factors, including age ≥60 years, hypertension, coronary artery disease, heart failure, left ventricular hypertrophy, congenital heart disease, pulmonary disease, valve heart disease, hyperthyroidism, and prior cardiac surgery. Patients without traditional risk factors were compared with age- and region-matched controls with traditional risk factors (1:3 fashion). In 796 (5%) patients, no traditional risk factors were present. However, 98% (779/796) had less-established or borderline risk factors, including borderline hypertension (130–140/80–90 mmHg; 47%), chronic kidney disease (eGFR < 60 mL/min; 57%), obesity (body mass index > 30; 19%), diabetes (5%), excessive alcohol intake (>14 units/week; 4%), and smoking (25%). Compared with patients with traditional risk factors (n = 2388), patients without traditional risk factors were more often men (74% vs. 59%, P < 0.001) had paroxysmal AF (55% vs. 37%, P < 0.001) and less AF persistence after 1 year (21% vs. 49%, P < 0.001). Furthermore, 1-year stroke occurrence rate (0.6% vs. 2.0%, P = 0.013) and heart failure hospitalizations (0.9% vs. 12.5%, P < 0.001) were lower. However, risk of AF-related re-hospitalization was similar (18% vs. 21%, P = 0.09). Conclusion Almost all patients without traditionally defined AF risk factors have less-established or borderline risk factors. These patients have a favourable 1-year prognosis, but risk of AF-related re-hospitalization remains high. Greater emphasis should be placed on recognition and management of less-established or borderline risk factors.

Feasibility of weight loss in obese atrial fibrillation patients attending a specialist arrhythmia clinic and its impact on ablation outcomes

“…[1][2][3][4] Obesity is recognized as an important risk factor for AF. 5,6 Obesity is associated with an increased left atrial size and decreased left ventricular diastolic function, 7 which contribute to higher left atrial pressure. 8,9 These changes promote the initiation and maintenance of AF.…”

“…Atrial fibrillation (AF) is a significant health condition that is associated with increased morbidity and mortality 1‐4 . Obesity is recognized as an important risk factor for AF 5,6 . Obesity is associated with an increased left atrial size and decreased left ventricular diastolic function, 7 which contribute to higher left atrial pressure 8,9 .…”

Comparison of risk profiles for new-onset atrial fibrillation between patients aged <60 and ≥60 years

“…This strategy may be a viable option when managing younger patients [ 30 ]. A recent study supported the management of borderline risk factors in relatively younger patients without traditional risk factors for AF [ 35 ]. Marcos et al investigated about sex-based differences in clinical profiles, especially in younger AF patients, but did not find significant differences in cardiovascular outcomes [ 36 ].…”

Atrial fibrillation: villain or bystander in vascular brain injury

“…Atrial stretch is a consequence of pressure and/or volume overload due to risk factors and comorbidities, eventually triggering atrial dilatation, dysfunction, and fibrosis, i.e., atrial cardiomyopathy ( Figure 3 ). 117–119 Once AF develops, the atrial cardiomyopathy further deteriorates. Due to underlying risk factors and comorbidities an overall cardiomyopathy develops, including ventricular involvement.…”

“… Risk factors, co-morbidities, and AF all involved in the development of an atrial cardiomyopathy (modified from Kloosterman et al 117 with permission). …”