Time of onset of atrial fibrillation and atrial fibrillation progression data from the RACE V study

Abstract

AimsAtrial fibrillation (AF) progression is associated with adverse outcome, but the role of the circadian or diurnal pattern of AF onset remains unclear. We aim to assess the association between the time of onset of AF episodes with the clinical phenotype and AF progression in patients with self-terminating AF.Methods and resultsThe Reappraisal of AF: Interaction Between Hypercoagulability, Electrical Remodelling, and Vascular Destabilization in the Progression of AF study included patients with self-terminating AF who underwent extensive phenotyping at baseline and continuous rhythm monitoring with an implantable loop recorder (ILR). In this subanalysis, ILR data were used to assess the development of AF progression and the diurnal pattern of AF onset: predominant (>80%) nocturnal AF, predominant daytime AF, or mixed AF without a predominant diurnal AF pattern. The median follow-up was 2.2 (1.6–2.8) years. The median age was 66 (59–71) years, and 117 (42%) were women. Predominant nocturnal (n = 40) and daytime (n = 43) AF onset patients had less comorbidities compared to that of mixed (n = 195) AF patients (median 2 vs. 2 vs. 3, respectively, P = 0.012). Diabetes was more common in the mixed group (12% vs. 5% vs. 0%, respectively, P = 0.031), whilst obesity was more frequent in the nocturnal group (38% vs. 12% vs. 27%, respectively, P = 0.028). Progression rates in the nocturnal vs. daytime vs. mixed groups were 5% vs. 5% vs. 24%, respectively (P = 0.013 nocturnal vs. mixed and P = 0.008 daytime vs. mixed group, respectively).ConclusionIn self-terminating AF, patients with either predominant nocturnal or daytime onset of AF episodes had less associated comorbidities and less AF progression compared to that of patients with mixed onset of AF.Clinical trial registrationNCT02726698

Comprehensive atrial fibrillation burden and symptom reduction post-ablation: insights from DECAAF II

“…Results from the RACE V trial demonstrated that patients with a predominant pattern of AF occurrence (daytime or nocturnal) have a better comorbidity profile compared with those with a mixed pattern of AF. 16 …”

Women have less progression of paroxysmal atrial fibrillation: data from the RACE V study

“…This subanalysis includes 417 patients, all having a follow-up duration of ≥1 year. 20 No patients were lost to follow-up in this first year or died before AF progression. Patients or the public were not involved in the design, or conduct, or reporting or dissemination plans of our research.…”

“…As described previously, AF progression was defined as (1) the development of persistent or permanent AF during follow-up or (2) an increase of >3% AF burden over the first 6 months or total follow-up. 18 The 3% cutoff has been published previously, and details concerning the 3% cut-off for AF burden can be found in the paper by Nguyen et al [19][20][21] The duration of monitoring for the current analysis lasted until 1 May 2020, until the last available rhythm monitoring for patients who died after >1 year of continuous rhythm monitoring or until the date of PVI in case of a successful PVI.…”

Longer and better lives for patients with atrial fibrillation: the 9th AFNET/EHRA consensus conference

“…Recent data from the RACE V registry suggest that paroxysmal AF has a higher burden that can be further differentiated into subgroups. 76 , 77 While continuous rhythm monitoring is the preferred method to evaluate AF burden, serial longer-term monitor 10 , 78 or even long-term intermittent monitoring by recording one to three short-term handheld ECGs per day provides effective, albeit less precise alternative methods. 79 So far, these rhythm monitoring methods have mainly been used in research settings.…”