Long-term progression and outcomes with aging in patients with lone atrial fibrillation - A 30-year follow-up study
Long-term progression and outcomes with aging in patients with lone atrial fibrillation - A 30-year follow-up study
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DOI：
10.1161/circulationaha.106.644484
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发表时间：
2007-06-19
期刊：
影响因子：
37.8
通讯作者：
Gersh, Bernard J.
中科院分区：
文献类型：
--
作者：
Jahangir, Arshad;Lee, Victor;Gersh, Bernard J.
孤立性心房颤动的长期自然史尚不清楚.我们的目的是确定30年内阵发性房颤进展为永久性房颤的发生率和预测因素，以及与对照人群相比心力衰竭、血栓栓塞和死亡的长期风险。对1950年至1980年间首次记录房颤发作且无伴随心脏病或高血压的人群进行长期随访。在这个独特的队列中，76例首次诊断时阵发性（n = 34）、持续性（n = 37）或永久性（n = 5）孤立性房颤患者符合入选标准（诊断时平均年龄，44.2 = 11.7岁;男性，78%）。平均随访时间为25.2 ± 9.5年。在71例阵发性或持续性房颤患者中，22例进展为永久性房颤。76例孤立性房颤患者的15年和30年总生存率分别为92%和68%，与明尼苏达州年龄和性别匹配人群的86%和57%生存率相似。观察到的无心力衰竭生存率比预期略差（P = 0.051）。在最初的25年随访中，卒中或短暂性脑缺血发作的风险与预期的人群风险相似，但此后增加（P = 0.004），尽管CI较宽。所有发生脑血管事件的患者都有>= 1个血栓栓塞的危险因素。结论：合并症显著调节房颤的进展和并发症。年龄或高血压的发展增加血栓栓塞风险。
Background - The long- term natural history of lone atrial fibrillation is unknown. Our objective was to determine the rate and predictors of progression from paroxysmal to permanent atrial fibrillation over 30 years and the long- term risk of heart failure, thromboembolism, and death compared with a control population.Methods and Results - A previously characterized Olmsted County, Minnesota, population with first episode of documented atrial fibrillation between 1950 and 1980 and no concomitant heart disease or hypertension was followed up long term. Of this unique cohort, 76 patients with paroxysmal ( n = 34), persistent ( n = 37), or permanent ( n = 5) lone atrial fibrillation at initial diagnosis met inclusion criteria ( mean age at diagnosis, 44.2 = 11.7 years; male, 78%). Mean duration of follow- up was 25.2 +/- 9.5 years. Of 71 patients with paroxysmal or persistent atrial fibrillation, 22 had progression to permanent atrial fibrillation. Overall survival of the 76 patients with lone atrial fibrillation was 92% and 68% at 15 and 30 years, respectively, similar to 86% and 57% survival for the age- and sex- matched Minnesota population. Observed survival free of heart failure was slightly worse than expected ( P = 0.051). Risk for stroke or transient ischemic attack was similar to the expected population risk during the initial 25 years of follow- up but increased thereafter ( P = 0.004), although CIs were wide. All patients who had a cerebrovascular event had developed >= 1 risk factor for thromboembolism.Conclusions - Comorbidities significantly modulate progression and complications of atrial fibrillation. Age or development of hypertension increases thromboembolic risk.