Background.
In the era of catheter ablation there are no prospective data on AF progression according to AF guidelines classification and management.
Methods.
Of 402 screened patients with first-detected paroxysmal AF, 106 (mean age, 57.5 years) were enrolled for this prospective study. Of them, 54 (mean age, 53.3 years) had lone AF and 52 (mean age, 62.0 years) had comorbidities. Patients were treated according to recent guidelines management. Primary endpoint of the study was the cumulative probability of progression to permanent AF over a 5-year follow-up among patients who underwent catheter ablation or antiarrhythmic drug therapy alone (ADT). Predictors of progression to permanent AF were also analyzed by multivariate analysis.
Results.
At the end of the 5-year follow-up, 50 patients with lone AF had no further recurrences after the first episode in the absence of ADT. The remaining 56 patients at a median follow-up of 19 months after the first episode experienced recurrent episodes of paroxysmal AF requiring ADT (45 patients) or catheter ablation (11 patients) because of ADT failure. Patients who underwent ablation had similar clinical characteristics as patients on ADT. K-M curves demonstrated that patients on ADT were more likely to progress to permanent AF than those who underwent catheter ablation (p=0.029, by log-rank test, Figure 1
). Age (p<0.0001), diabetes (p=0.003) and heart failure (p=0.002) predicted progression to permanent AF.
Conclusions.
Over a 5-year follow-up, catheter ablation is of benefit in delaying arrhythmia progression. Age, diabetes and heart failure predict progression to permanent AF.
Antiarrhythmic drug therapy in 367 heart failure patients: Class I drugs but not amiodarone are associated with increased sudden death risk