Clinical Profiles, Efficacy of Antiarrhythmic Drug Therapy, and Cardiovascular Prognosis in Patients With First Detected Paroxysmal Atrial Fibrillation

Abstract

SummaryLittle information is available concerning clinical profiles and outcomes of treatment in Japanese patients with first detected atrial fibrillation (AF). In the present study, 459 patients with paroxysmal AF (309 males, mean age, 66 ± 12 years) were divided into a first detected AF group (group A, n = 143) and a non-first detected AF group (group B, n = 316). Clinical profiles, prophylactic efficacy of antiarrhythmic drug therapy (AAD), and cardiovascular prognosis during a mean follow-up period of 50 ± 35 months were compared between the two groups. The number of AF recurrences in the individual patients regardless of AAD were significantly lower in group A than in group B (0.8 ± 1.4 versus 1.7 ± 1.9) (P < 0.05). The percentages of patients free from conversion to chronic AF at 12, 36, 60, and 120 months were significantly higher in group A (98%, 96%, 93%, and 91%, respectively) than in group B (95%, 86%, 83%, and 79%, respectively)(P < 0.01). The annual rates of hospitalization for thromboembolism, heart failure, and cardiovascular death did not differ between group A (2.2%, 1.1% and 1.0%, respectively) and group B (2.2%, 1.9% and 1.1%, respectively). In multivariate logistic regression analysis, a CHADS 2 score ≥ 2 points (odds ratio 13.1, 95% confidence interval 3.36-51.0, P = 0.001), nocturnal AF onset (OR 0.201, 95% CI 0.050-0.815, P = 0.025), left ventricular diastolic dimension (LVDd) ≥ 50 mm (OR 3.845, 95% CI 1.078-13.71, P = 0.038), and conversion to chronic AF (OR 3.547, 95% CI 1.002-13.64, P = 0.048) were associated with cardiovascular events in group A. Rhythm control therapy with antiarrhythmic drugs was shown to be more effective for patients in group A than in group B. It is particularly important to prevent cardiovascular events in first detected AF patients with a CHADS 2 score ≥ 2 points, LVDd ≥ 50 mm, and conversion to chronic AF. (Int Heart J 2011; 52: 32-38)

Relationship between CHA2DS2-VASc scores and ischemic stroke/cardiovascular events in Japanese patients with paroxysmal atrial fibrillation without receiving anticoagulant therapy

“…A meta-analysis of a large-scale multicenter comparative study (AFFIRM) in a Western country showed that AF type (paroxysmal or persistent) did not significantly affect cardiovascular prognosis for each AF patient, while independent predictors were factors including age, diabetes, underlying heart disease, complications involving heart failure or ischemic stroke, sinus rhythm maintenance, and warfarinbased anticoagulation therapy [29]. We reported that in a follow-up of patients for about 50 months, left ventricular ejection fraction, conversion to permanent AF, and anticoagulation therapy are independent predictors of cardiovascular prognosis following antiarrhythmic drug therapy in patients with AF [30]. However, research remains inadequate on the indicators that may be used to assess prognosis more conveniently.…”

Current strategies of antiarrhythmic drug therapy for paroxysmal atrial fibrillation

“…The mortality rate among AF patients with congestive heart failure 1 year after initial diagnosis is relatively high, between 13% and 20% in Western and countries including the United States [51,52] and 7.3% in Japan [53]. In data from our institute [54], the incidence of new-onset CHF at 1 year in Japanese patients with paroxysmal AF receiving rhythm control therapy was nearly 1.0-2.0%, and the independent predictors of hospitalization for CHF were CHADS 2 score, left ventricular ejection fraction, and underlying heart disease ( Table 5). When cardiovascular events included the composite of hospitalization for thromboembolism, heart failure, and cardiovascular death, the independent predictors of cardiovascular events in Japanese patients with paroxysmal AF receiving rhythm control therapy were also CHADS 2 score, underlying heart disease, left ventricular ejection fraction, conversion to persistent AF, and anticoagulant therapy.…”

Comparison Between CHADS₂ and CHA₂DS₂-VASc Score for Risk Stratification of Ischemic Stroke in Japanese Patients With Non-Valvular Paroxysmal Atrial Fibrillation Not Receiving Anticoagulant Therapy

“…Based on the results of a largescale controlled study in Japan, Europe, and the United States, 17,22) antiplatelet therapy recommended in the previous JCS guidelines was deleted. Furthermore, warfarin therapy for prevention of ischemic stroke/systemic thromboembolism in patients with non-valvular AF is expected to be about more than 60% in Europe and the United States, 23) and Japan, 24) although its effi cacy is infl uenced by the quality of anticoagulant control that it provides (management of PT-INR). 25,26) According to a report from the J-RHYTHM registry, anticoagulant therapy is administered in more than 80% of patients with nonvalvular AF.…”