Key result
First-detected paroxysmal atrial fibrillation was associated with a higher rate of freedom from conversion to chronic AF at 120 months compared to non-first-detected AF, though cardiovascular event rates did not differ.
Why the study?
Does the clinical profile and prognosis differ between first detected and non-first detected paroxysmal atrial fibrillation in Japanese patients?
Cohort (n=459)
No
Does the clinical profile and prognosis differ between first detected and non-first detected paroxysmal atrial fibrillation in Japanese patients?
Patients with first detected paroxysmal atrial fibrillation have fewer recurrences and lower rates of conversion to chronic AF compared to those with non-first detected AF, and respond better to antiarrhythmic drug therapy.
Answers are grounded in this paper and cite their sources.
First-detected paroxysmal AF may indicate slower progression; extends observational data on AF subtypes but leaves open distinct management strategies.
Little information is available concerning clinical profiles and outcomes of treatment in Japanese patients with first detected atrial fibrillation (AF). In the present study, 459 patients with paroxysmal AF (309 males, mean age, 66 ± 12 years) were divided into a first detected AF group (group A, n = 143) and a non-first detected AF group (group B, n = 316). Clinical profiles, prophylactic efficacy of antiarrhythmic drug therapy (AAD), and cardiovascular prognosis during a mean follow-up period of 50 ± 35 months were compared between the two groups. The number of AF recurrences in the individual patients regardless of AAD were significantly lower in group A than in group B (0.8 ± 1.4 versus 1.7 ± 1.9)(P < 0.05). The percentages of patients free from conversion to chronic AF at 12, 36, 60, and 120 months were significantly higher in group A (98%, 96%, 93%, and 91%, respectively) than in group B (95%, 86%, 83%, and 79%, respectively)(P < 0.01). The annual rates of hospitalization for thromboembolism, heart failure, and cardiovascular death did not differ between group A (2.2%, 1.1% and 1.0%, respectively) and group B (2.2%, 1.9% and 1.1%, respectively). In multivariate logistic regression analysis, a CHADS₂ score ≥ 2 points (odds ratio 13.1, 95% confidence interval 3.36-51.0, P = 0.001), nocturnal AF onset (OR 0.201, 95% CI 0.050-0.815, P = 0.025), left ventricular diastolic dimension (LVDd) ≥ 50 mm (OR 3.845, 95% CI 1.078-13.71, P = 0.038), and conversion to chronic AF (OR 3.547, 95% CI 1.002-13.64, P = 0.048) were associated with cardiovascular events in group A. Rhythm control therapy with antiarrhythmic drugs was shown to be more effective for patients in group A than in group B. It is particularly important to prevent cardiovascular events in first detected AF patients with a CHADS₂ score ≥ 2 points, LVDd ≥ 50 mm, and conversion to chronic AF.
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Komatsu et al. (2011) conducted a cohort in Paroxysmal Atrial Fibrillation (n=459). First detected paroxysmal atrial fibrillation vs. Non-first detected paroxysmal atrial fibrillation was evaluated on Freedom from conversion to chronic AF at 120 months (p=<0.01). First-detected paroxysmal atrial fibrillation was associated with a higher rate of freedom from conversion to chronic AF at 120 months compared to non-first-detected AF, though cardiovascular event rates did not differ.
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