• Cees B De Vos, Günter Breithardt, A John Camm, Paul Dorian, Peter R Kowey, Jean-Yves Le Heuzey, Lisa Naditch-Brûlé, Eric N Prystowsky, Peter J Schwartz, Christian Torp-Pedersen, William S Weintraub, and Harry J Crijns.
• Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands. cees.devos@yahoo.com
• Am. Heart J. 2012 May 1;163(5):887-93.

IntroductionParoxysmal atrial fibrillation (AF) may progress to persistent AF. We studied the clinical correlates and the effect of rhythm-control strategy on AF progression.MethodsRecordAF was a worldwide prospective survey of AF management. Consecutive eligible patients with recent-onset AF were included and allocated to rate or rhythm control according to patient/physician choice. A total of 2,137 patients were followed up for 12 months. Atrial fibrillation progression was defined as a change from paroxysmal to persistent/permanent AF.ResultsProgression of AF occurred in 318 patients (15%) after 1 year. Patients with AF progression were older; had a higher diastolic blood pressure; and more often had a history of coronary artery disease, stroke or transient ischemic attack, hypertension, or heart failure. Patients treated with rhythm control were less likely to show progression than those treated only with rate control (164/1542 [11%] vs 154/595 [26%], P < .001). Multivariable analysis showed that history of heart failure (odds ratio [OR] 2.2, 95% CI 1.7-2.9, P < .0001), history of hypertension (OR 1.5, 95% CI 1.1-2.0, P = .01), and rate control rather than rhythm control (OR 3.2, 95% CI 2.5-4.1, P < .0001) were independent predictors of AF progression. The propensity score-adjusted OR of AF progression in patients with rate rather than rhythm control was 3.3 (95% CI 2.4-4.6, P < .0001).ConclusionsAlthough heart failure and hypertension are associated with AF progression, rhythm control is associated with lower risk of AF progression.Copyright © 2012 Mosby, Inc. All rights reserved.

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