Young-onset atrial fibrillation: Sex differences in clinical profile, progression rate and cardiovascular outcome

Abstract

BackgroundWomen are underrepresented in major atrial fibrillation (AF) trials. In addition, data regarding clinical profile and outcome in young AF patients is limited. Therefore we aimed to investigate the clinical profile, AF progression rate and cardiovascular outcome between sexes in patients with young-onset AF.MethodsA total of 497 patients with AF-onset <60 years of age were included. Data on clinical profile and cardiovascular outcome were prospectively collected.ResultsOf 497 patients, 125 (25%) patients were women. Women had more often familial AF (34% versus 22%, P = 0.012) and obesity (26% versus 18%, P = 0.03). Men had more often coronary artery disease (11% versus 5%, P = 0.04), a longer PR interval [163 (148–180) versus 150 (138–167) ms, P < 0.001] and higher left ventricular mass index [82 (71–96) versus 72 (61–83) g/m2, P < 0.001]. During a median follow-up of 7.0 (2.7–10.0) years AF progression rate was comparable (HR 2.03 for men versus women, 95%CI 0.92–4.48; P = 0.08), and no difference in cardiovascular events was observed between women and men (Log rank P-value = 0.07).ConclusionsIn young patients with AF, clinical patient profile is different between the sexes but did not result in differences in cardiovascular outcome.

Sleep apnea and atrial fibrillation: Update 2020

“…The diagnosis and treatment of sleep apnea in AF patients requires a close interdisciplinary collaboration between the electrophysiologist/cardiologist and sleep-specialists, possibly within an integrated care model [22] , [23] , [24] . In clinical practice, questionnaires are often used to decide whether a formal SDB screening should be performed [25] , [26] , [27] , [28] . Although questionnaires, like the Epworth sleepiness scale, can help to quantify subjective daytime sleepiness, the absence of subjective sleepiness is not a reliable means of ruling out OSA in AF patients.…”

Gender differences and daily variation in atrial fibrillation risk factor profiles: Considerations for risk factor management

“…According to current clinical practice, Marcos et al assessed established risk factors in a structured way at the timepoint, when AF patients present the first time in the AF Clinic [10]. However, in addition to the established risk factors, emerging risk factors such as sleep apnea [17], chronic obstructive pulmonary disease or gastrointestinal reflux [18] were not assessed in this study.…”

“…In this Issue of the IJC Heart & Vasculature, Marcos et al [10] investigated gender-differences in clinical AF risk factor profiles, AF progression rates and cardiovascular outcomes between sexes in a prospective cohort study including 497 patients with young-onset AF <60 years of age, a quarter of whom were women. Most conventional risk factors, including age, hypertension, heart failure and diabetes mellitus, were not different between sexes at baseline.…”

“…It is important to note that, as with many AF studies, the current study also had an under-representation of women with only 25% of the cohort being female. A further limitation of the study by Marcos et al [10] is that a time-to-event analysis was performed for AF progression to permanent AF only. Without structured rhythm monitoring during follow-up, the authors were unable to report on progression from paroxysmal to persistent AF.…”

Atrial Fibrillation Beyond the Electrocardiogram: Towards Understanding and Preventing Progression

“…In the late '90s, Gallagher and Camm described the generally accepted temporal AF patterns paroxysmal, persistent and permanent AF, often referred to as 'the 3 Ps' . (27) This classi cation is still incorporated in the European Society of Cardiology AF guidelines. (27,28) In paroxysmal AF, episodes come and go and last <7 consecutive days and are terminated spontaneously or by an intervention.…”