Atrial fibrillation pattern and factors affecting the progression to permanent atrial fibrillation

Atrial fibrillation (AF) may progress from a non-permanent to a permanent form, and improvement in prediction may help in decision-making. In- and outpatients with non-permanent AF were enrolled in a prospective study and followed every 6 months. At baseline, 314 out of 523 patients (60%) had non-permanent AF (25.5% paroxysmal AF, 52.5% persistent, 2% first diagnosed AF). They were mostly males (188, 59.9%), median age 71 years [interquartile range (IQ) 62–77], median CHA₂DS₂VASc 3 (IQ 1–4), median HATCH score 1 (IQ 1–2). During a follow-up of 701 (IQ 437–902) days, 66 patients (21%) developed permanent AF. CHA₂DS₂VASc and HATCH scores were incrementally associated with AF progression (p for trend CHA₂DS₂VASc < 0.001, HATCH p = 0.001). Cox multivariable proportional hazard regression analysis showed that age [hazard ratio (HR) 1.042; 95%CI 1.005–1.080; p = 0.025], moderate–severe left atrial (LA) enlargement at echo (HR 2.072, 95%CI, 1.121–3.831; p = 0.020), antiarrhythmics drugs (HR 0.087, 95%CI 0.011–0.659, p = 0.018), EHRA score > 2 (HR 0.358, 95%CI 0.162–0.791, p = 0.011) and valvular disease (HR 2.196, 95%CI 1.072–4.499, p = 0.032) were significantly associated with AF progression. Adding “moderate–severe LA dilation” to clinical scores, eg. HATCH score (HATCH-LA) with 2 points (Cox multivariable regression analysis) improved prediction of AF progression vs. HATCH score (p = 0.0225). In patients without permanent AF, progression of AF was independently associated with age, LA dilation, AF symptoms severity, antiarrhythmic drugs and valvular disease. Adding LA dilation (moderate–severe volume increase) to clinical scores improved prediction of progression to permanent AF.