• Aditya Bhat, Henry H L Chen, Shaun Khanna, GanGary C HGCHDepartment of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia., Walter P Abhayaratna, Maria Carmo P Nunes, Chandini Raina MacIntyre, and Timothy C Tan.
• Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.
• Eur. J. Clin. Invest. 2021 Mar 1; 51 (3): e13395.

AimsThe persistence of atrial fibrillation (AF) has been associated with differential clinical outcomes, with studies showing that persistent and permanent AF results in increased morbidity and mortality when compared to the paroxysmal subtype. Given the established prognostic implications of AF subtype, we sought to discern the clinical and structural cardiac parameters associated with persistent/ permanent AF.Materials And MethodsConsecutive patients admitted to our institution between January 2013 and January 2018 with a primary diagnosis of non-valvular AF who underwent comprehensive transthoracic echocardiography were retrospectively appraised. Assessment of clinical and echocardiographic parameters was undertaken and compared according to AF subtype.ResultsOf 1010 patients, 665 (mean age 66.8 ± 13.5 years, 53% men) had comprehensive transthoracic echocardiography on index admission and were included in the primary analysis. The majority of patients (n = 468; 70%) had paroxysmal AF while 197 (30%) had persistent/ permanent AF. Multivariable logistic regression analysis showed that heart failure (adjusted OR 3.135; 95% CI 2.099 to 4.682, P < .001), right atrial (RA) area ≥18 cm2 (adjusted OR 2.147; 95% CI 1.413 to 3.261, P < .001) and left atrial emptying fraction (LAEF) ≤34% (adjusted OR 2.959; 95% CI 1.991 to 4.398, P < .001) were independent predictors of persistent /permanent AF.ConclusionsThe presence of heart failure, increased RA size and impaired LA function were associated with persistent/ permanent AF. These clinical and cardiac structural risk markers of AF persistence may identify a target population for early intervention to prevent adverse cardiovascular outcomes.© 2020 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

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