Epidemiologic Features of Chronic Atrial Fibrillation

Abstract

In the Framingham Study 2325 men and 2866 women 30 to 62 years old at entry were followed biennially over 22 years for the development of chronic atrial fibrillation in relation to antecedent cardiovascular disease and risk factors. During surveillance, atrial fibrillation developed in 49 men and 49 women. The incidence rose sharply with age but did not differ significantly between the sexes. Overall, there was a 2.0 per cent chance that the disorder would develop in two decades. Atrial fibrillation usually followed the development of overt cardiovascular disease. Only 18 men and 12 women (31 per cent) had chronic atrial fibrillation in the absence of cardiovascular disease. Cardiac failure and rheumatic heart disease were the most powerful predictive precursors, with relative risks in excess of sixfold. Hypertensive cardiovascular disease was the most common antecedent disease, largely because of its frequency in the general population. Among the risk factors for cardiovascular disease, diabetes and electrocardiographic evidence of left ventricular hypertrophy were related to the occurrence of atrial fibrillation. The development of chronic atrial fibrillation was associated with a doubling of overall mortality and of mortality from cardiovascular disease.

Investigation of the predictors of transition to persistent atrial fibrillation in patients with paroxysmal atrial fibrillation

“…8,10,11 The ability to predict progression from paroxysmal to persistent AF is therefore also important clinically. Previous studies have identified disease duration, 4 left ventricular dysfunction, 12 enlarged left atrial dimension, 13 advanced age, 14 prolongation of FPD, 13 and a low root mean square voltage for the last 30 ms of the filtered P wave 13 as indicators of transition from paroxysmal to persistent AF. How-72 Abbreviations: ECG = electrocardiogram, P-SAECG = P-wavetriggered signal-averaged electrocardiogram, FPD = filtered P-wave duration, RMS30 = root mean square voltage for the last 30 ms of filtered P-wave, Echo = echocardiogram, LAD = left atrial dimension, LVDd = left ventricular end-diastolic dimension, LVEF = left ventricular ejection fraction.…”

“…Studies have previously been conducted to identify factors predictive of progression from paroxysmal to persistent AF. 4,[12][13][14] However, further investigation is required, since most of these studies did not investigate predictive accuracy for transition to persistent AF and some used the results of only short-term follow-up. The present prospective study was conducted for identifying indicators capable of predicting progression from paroxysmal to persistent AF based on longterm follow-up, and to examine the predictive accuracy of those indicators.…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…Hypertension is a well-established, independent risk factor for AF, 9,279,321,322 and this risk increases in patients with uncontrolled systolic BP, 323 particularly in those with EF less than 40%. 324 Even BPs that are near the upper limit of normal (systolic 130–139 mm Hg, diastolic 85–89 mm Hg) predict risk for AF in healthy middle-aged men 325 and women.…”

Selecting antithrombotic therapy for patients with atrial fibrillation

“…It affects more than 10% of people over age 80 and is often associated with cardiovascular disease. 2 Based on Framingham Heart Study data, a person’s lifetime risk of developing it is about 25%. 3 …”