Does the presence of a secondary precipitant at the time of first-detected atrial fibrillation affect long-term AF recurrence and morbidity compared to AF without a secondary precipitant?
Atrial fibrillation diagnosed during a secondary precipitant has a high rate of long-term recurrence and similar risks of stroke and mortality compared to unprecipitated AF, challenging the notion that secondary AF is a benign, isolated event.
BACKGROUND: Guidelines have proposed that atrial fibrillation (AF) can occur as an isolated event, particularly when precipitated by a secondary, or reversible, condition. However, knowledge of long-term AF outcomes after diagnosis during a secondary precipitant is limited. METHODS AND RESULTS: In 1409 Framingham Heart Study participants with new-onset AF, we examined associations between first-detected AF episodes occurring with and without a secondary precipitant and both long-term AF recurrence and morbidity. We selected secondary precipitants based on guidelines (surgery, infection, acute myocardial infarction, thyrotoxicosis, acute alcohol consumption, acute pericardial disease, pulmonary embolism, or other acute pulmonary disease). Among 439 patients (31%) with AF diagnosed during a secondary precipitant, cardiothoracic surgery (n=131 30%), infection (n=102 23%), noncardiothoracic surgery (n=87 20%), and acute myocardial infarction (n=78 18%) were most common. AF recurred in 544 of 846 eligible individuals without permanent AF (5-, 10-, and 15-year recurrences of 42%, 56%, and 62% with versus 59%, 69%, and 71% without secondary precipitants; multivariable-adjusted hazard ratio, 0.65 95% confidence interval, 0.54-0.78). Stroke risk (n=209/1262 at risk; hazard ratio, 1.13 95% confidence interval, 0.82-1.57) and mortality (n=1098/1409 at risk; hazard ratio, 1.00 95% confidence interval, 0.87-1.15) were similar between those with and without secondary precipitants, although heart failure risk was reduced (n=294/1107 at risk; hazard ratio, 0.74 95% confidence interval, 0.56-0.97). CONCLUSIONS: AF recurs in most individuals, including those diagnosed with secondary precipitants. Long-term AF-related stroke and mortality risks were similar between individuals with and without secondary AF precipitants. Future studies may determine whether increased arrhythmia surveillance or adherence to general AF management principles in patients with reversible AF precipitants will reduce morbidity.
Lubitz et al. (Fri,) studied this question.