P1175Determinants of progression of persistent to permanent atrial fibrillation - data from the RACE 3 study

On behalf of: RACE 3 study group Funding Acknowledgements: Netherlands Heart Foundation, AstraZeneca, Bayer, Biotronik, Boehringer-Ingelheim, Boston Scientific, Medtronic, Sanofi-Aventis, St-Jude Medical Introduction: Atrial fibrillation (AF) is a progressive disease. AF progression is associated with increased cardiovascular morbidity and mortality. However, understanding of clinical determinants of AF progression is limited. Purpose: To assess determinants of AF progression from persistent to permanent AF in patients with early persistent AF and early mild to moderate heart failure (HF). Methods: AF progression was assessed in 245 patients with early-persistent AF and early mild to moderate HF included in the 1:1 randomized, open-label, multicenter, prospective Routine versus Aggressive Risk Factor Driven Upstream Rhythm Control for Prevention of Early Atrial Fibrillation in Heart Failure (RACE 3) study during 1-year follow-up (FU). The intervention group (upstream therapies) received 4 therapies on top of conventional rhythm control care: 1) mineralocorticoid receptor antagonists, 2) statins, 3) angiotensin converting enzyme inhibitors and/or receptor blockers, and 4) cardiac rehabilitation including physical activity, dietary restrictions, and counselling. AF progression was defined as permanent AF at 12-month. Determinants of progression were assessed by univariable and backward multivariable Cox proportional hazards regression. Results: Age was 65±9 years, 193 (79%) were men, total AF history was 3 (2-6) months, persistent AF history 2 (1-4) months, heart failure duration 2 (1-4) months. Hypertension was present in 144 (59%) patients, diabetes in 26 (11%) and coronary artery disease in 33 (13%). At 1-year, 49 (20%) patients had AF progression. Multivariable determinants of AF progression were total cholesterol, glucose, left ventricular ejection fraction (LVEF) <45% and upstream therapies randomization group (Table 1). Conclusion: In patients with early persistent AF LVEF <45% and upstream therapies reduced the occurrence of AF progression. Higher glucose levels were associated with increased risk of AF progression. Total cholesterol was inversely related to AF progression. Multivariable model for AF progression Table 1 – Multivariable factors associated with AF progression (Abbreviations: HR= hazard ratio; CI= confidence interval).