Prevalence and determinants of atrial fibrillation progression in paroxysmal atrial fibrillation

B.O. Nguyen; V. Weberndorfer; H.J.G.M. Crijns; B. Geelhoed; H. Ten Cate; H. Spronk; A. Kroon; R. De With; M. Al-Jazairi; A.H. Maass; Y. Blaauw; R.G. Tieleman; M.E.W. Hemels; J. Luermans; J. de Groot; C.P. Allaart; A. Elvan; M. De Melis; C. Scheerder; A.J. van Zonneveld; U. Schotten; D. Linz; I. Van Gelder; M. Rienstra

doi:10.1136/heartjnl-2022-321027

Prevalence and determinants of atrial fibrillation progression in paroxysmal atrial fibrillation

B.O. Nguyen, V. Weberndorfer, H.J.G.M. Crijns, B. Geelhoed, H. Ten Cate, H. Spronk, A. Kroon, R. De With, M. Al-Jazairi, A.H. Maass, Y. Blaauw, R.G. Tieleman, M.E.W. Hemels, J. Luermans, J. de Groot, C.P. Allaart, A. Elvan, M. De Melis, C. Scheerder, A.J. van ZonneveldU. Schotten, D. Linz, I. Van Gelder^*, M. Rienstra

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objective Atrial fibrillation (AF) often progresses from paroxysmal AF (PAF) to more permanent forms. To improve personalised medicine, we aim to develop a new AF progression risk prediction model in patients with PAF.Methods In this interim-analysis of the Reappraisal of AF: Interaction Between HyperCoagulability, Electrical Remodelling, and Vascular Destabilisation in the Progression of AF study, patients with PAF undergoing extensive phenotyping at baseline and continuous rhythm monitoring during follow-up of >= 1 year were analysed. AF progression was defined as (1) progression to persistent or permanent AF or (2) progression of PAF with >3% burden increase. Multivariable analysis was done to identify predictors of AF progression.Results Mean age was 65 (58-71) years, 179 (43%) were female. Follow-up was 2.2 (1.6-2.8) years, 51 of 417 patients (5.5%/year) showed AF progression. Multivariable analysis identified, PR interval, impaired left atrial function, mitral valve regurgitation and waist circumference to be associated with AF progression. Adding blood biomarkers improved the model (C-statistic from 0.709 to 0.830) and showed male sex, lower levels of factor XIIa:C1-esterase inhibitor and tissue factor pathway inhibitor, and higher levels of N-terminal pro-brain natriuretic peptide, proprotein convertase subtilisin/kexin type 9 and peptidoglycan recognition protein 1 were associated with AF progression.Conclusion In patients with PAF, AF progression occurred in 5.5%/year. Predictors for progression included markers for atrial remodelling, sex, mitral valve regurgitation, waist circumference and biomarkers associated with coagulation, inflammation, cardiomyocyte stretch and atherosclerosis. These prediction models may help to determine risk of AF progression and treatment targets, but validation is needed.

Original language	English
Pages (from-to)	186-194
Number of pages	9
Journal	Heart
Volume	109
Issue number	3
Early online date	20 Jul 2022
DOIs	https://doi.org/10.1136/heartjnl-2022-321027
Publication status	Published - Feb 2023

Keywords

CORONARY
OUTCOMES

Access to Document

10.1136/heartjnl-2022-321027Licence: CC BY

Cite this

Nguyen, B. O., Weberndorfer, V., Crijns, H. J. G. M., Geelhoed, B., Ten Cate, H., Spronk, H., Kroon, A., De With, R., Al-Jazairi, M., Maass, A. H., Blaauw, Y., Tieleman, R. G., Hemels, M. E. W., Luermans, J., de Groot, J., Allaart, C. P., Elvan, A., De Melis, M., Scheerder, C., ... Rienstra, M. (2023). Prevalence and determinants of atrial fibrillation progression in paroxysmal atrial fibrillation. Heart, 109(3), 186-194. https://doi.org/10.1136/heartjnl-2022-321027

@article{08ca632ba5ad4735b60d05272ac65cda,

title = "Prevalence and determinants of atrial fibrillation progression in paroxysmal atrial fibrillation",

abstract = "Objective Atrial fibrillation (AF) often progresses from paroxysmal AF (PAF) to more permanent forms. To improve personalised medicine, we aim to develop a new AF progression risk prediction model in patients with PAF.Methods In this interim-analysis of the Reappraisal of AF: Interaction Between HyperCoagulability, Electrical Remodelling, and Vascular Destabilisation in the Progression of AF study, patients with PAF undergoing extensive phenotyping at baseline and continuous rhythm monitoring during follow-up of >= 1 year were analysed. AF progression was defined as (1) progression to persistent or permanent AF or (2) progression of PAF with >3% burden increase. Multivariable analysis was done to identify predictors of AF progression.Results Mean age was 65 (58-71) years, 179 (43%) were female. Follow-up was 2.2 (1.6-2.8) years, 51 of 417 patients (5.5%/year) showed AF progression. Multivariable analysis identified, PR interval, impaired left atrial function, mitral valve regurgitation and waist circumference to be associated with AF progression. Adding blood biomarkers improved the model (C-statistic from 0.709 to 0.830) and showed male sex, lower levels of factor XIIa:C1-esterase inhibitor and tissue factor pathway inhibitor, and higher levels of N-terminal pro-brain natriuretic peptide, proprotein convertase subtilisin/kexin type 9 and peptidoglycan recognition protein 1 were associated with AF progression.Conclusion In patients with PAF, AF progression occurred in 5.5%/year. Predictors for progression included markers for atrial remodelling, sex, mitral valve regurgitation, waist circumference and biomarkers associated with coagulation, inflammation, cardiomyocyte stretch and atherosclerosis. These prediction models may help to determine risk of AF progression and treatment targets, but validation is needed.",

keywords = "CORONARY, OUTCOMES",

author = "B.O. Nguyen and V. Weberndorfer and H.J.G.M. Crijns and B. Geelhoed and {Ten Cate}, H. and H. Spronk and A. Kroon and {De With}, R. and M. Al-Jazairi and A.H. Maass and Y. Blaauw and R.G. Tieleman and M.E.W. Hemels and J. Luermans and {de Groot}, J. and C.P. Allaart and A. Elvan and {De Melis}, M. and C. Scheerder and {van Zonneveld}, A.J. and U. Schotten and D. Linz and {Van Gelder}, I. and M. Rienstra",

note = "Funding Information: This study was funded from the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation, CVON 2014-9: Reappraisal of Atrial Fibrillation: interaction between hyperCoagulability, Electrical remodelling and Vascular destabilisation in the progression of AF (RACE V). Unrestricted grant support from Medtronic Trading. Funding Information: US reports grants from Roche Diagnostics, EP Solutions, Dutch Heart Foundation, European Union, personal fees from Roche Diagnostics, EP Solutions, other from YourRhythmics BV, outside the submitted work. In addition, US has a patent Noninvasive classification of AF licensed to YourRhythmics. JDeG reports grants and personal fees from Atricure, Bayer, Daiichi Sankyo, Johnson&Johnson, grants from Boston Scientific, personal fees from Novartis and Servier, outside the submitted work. JL reports consultancy agreement Medtronic. HTC reports grants from Bayer and Pfizer and consultancy agreements for Pfizer, Alveron, STAGO, Leo Pharma, Daiichi Sankyo, Gilead/Galapagos, Portola/Aexia and Coagulation Profile. All other authors have nothing to disclose. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.",

year = "2023",

month = feb,

doi = "10.1136/heartjnl-2022-321027",

language = "English",

volume = "109",

pages = "186--194",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

number = "3",

}

Nguyen, BO, Weberndorfer, V , Crijns, HJGM, Geelhoed, B, Ten Cate, H , Spronk, H , Kroon, A, De With, R, Al-Jazairi, M, Maass, AH, Blaauw, Y, Tieleman, RG, Hemels, MEW, Luermans, J, de Groot, J, Allaart, CP, Elvan, A, De Melis, M, Scheerder, C, van Zonneveld, AJ, Schotten, U , Linz, D, Van Gelder, I & Rienstra, M 2023, 'Prevalence and determinants of atrial fibrillation progression in paroxysmal atrial fibrillation', Heart, vol. 109, no. 3, pp. 186-194. https://doi.org/10.1136/heartjnl-2022-321027

TY - JOUR

T1 - Prevalence and determinants of atrial fibrillation progression in paroxysmal atrial fibrillation

AU - Nguyen, B.O.

AU - Weberndorfer, V.

AU - Crijns, H.J.G.M.

AU - Geelhoed, B.

AU - Ten Cate, H.

AU - Spronk, H.

AU - Kroon, A.

AU - De With, R.

AU - Al-Jazairi, M.

AU - Maass, A.H.

AU - Blaauw, Y.

AU - Tieleman, R.G.

AU - Hemels, M.E.W.

AU - Luermans, J.

AU - de Groot, J.

AU - Allaart, C.P.

AU - Elvan, A.

AU - De Melis, M.

AU - Scheerder, C.

AU - van Zonneveld, A.J.

AU - Schotten, U.

AU - Linz, D.

AU - Van Gelder, I.

AU - Rienstra, M.

N1 - Funding Information: This study was funded from the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation, CVON 2014-9: Reappraisal of Atrial Fibrillation: interaction between hyperCoagulability, Electrical remodelling and Vascular destabilisation in the progression of AF (RACE V). Unrestricted grant support from Medtronic Trading. Funding Information: US reports grants from Roche Diagnostics, EP Solutions, Dutch Heart Foundation, European Union, personal fees from Roche Diagnostics, EP Solutions, other from YourRhythmics BV, outside the submitted work. In addition, US has a patent Noninvasive classification of AF licensed to YourRhythmics. JDeG reports grants and personal fees from Atricure, Bayer, Daiichi Sankyo, Johnson&Johnson, grants from Boston Scientific, personal fees from Novartis and Servier, outside the submitted work. JL reports consultancy agreement Medtronic. HTC reports grants from Bayer and Pfizer and consultancy agreements for Pfizer, Alveron, STAGO, Leo Pharma, Daiichi Sankyo, Gilead/Galapagos, Portola/Aexia and Coagulation Profile. All other authors have nothing to disclose. Publisher Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

PY - 2023/2

Y1 - 2023/2

N2 - Objective Atrial fibrillation (AF) often progresses from paroxysmal AF (PAF) to more permanent forms. To improve personalised medicine, we aim to develop a new AF progression risk prediction model in patients with PAF.Methods In this interim-analysis of the Reappraisal of AF: Interaction Between HyperCoagulability, Electrical Remodelling, and Vascular Destabilisation in the Progression of AF study, patients with PAF undergoing extensive phenotyping at baseline and continuous rhythm monitoring during follow-up of >= 1 year were analysed. AF progression was defined as (1) progression to persistent or permanent AF or (2) progression of PAF with >3% burden increase. Multivariable analysis was done to identify predictors of AF progression.Results Mean age was 65 (58-71) years, 179 (43%) were female. Follow-up was 2.2 (1.6-2.8) years, 51 of 417 patients (5.5%/year) showed AF progression. Multivariable analysis identified, PR interval, impaired left atrial function, mitral valve regurgitation and waist circumference to be associated with AF progression. Adding blood biomarkers improved the model (C-statistic from 0.709 to 0.830) and showed male sex, lower levels of factor XIIa:C1-esterase inhibitor and tissue factor pathway inhibitor, and higher levels of N-terminal pro-brain natriuretic peptide, proprotein convertase subtilisin/kexin type 9 and peptidoglycan recognition protein 1 were associated with AF progression.Conclusion In patients with PAF, AF progression occurred in 5.5%/year. Predictors for progression included markers for atrial remodelling, sex, mitral valve regurgitation, waist circumference and biomarkers associated with coagulation, inflammation, cardiomyocyte stretch and atherosclerosis. These prediction models may help to determine risk of AF progression and treatment targets, but validation is needed.

AB - Objective Atrial fibrillation (AF) often progresses from paroxysmal AF (PAF) to more permanent forms. To improve personalised medicine, we aim to develop a new AF progression risk prediction model in patients with PAF.Methods In this interim-analysis of the Reappraisal of AF: Interaction Between HyperCoagulability, Electrical Remodelling, and Vascular Destabilisation in the Progression of AF study, patients with PAF undergoing extensive phenotyping at baseline and continuous rhythm monitoring during follow-up of >= 1 year were analysed. AF progression was defined as (1) progression to persistent or permanent AF or (2) progression of PAF with >3% burden increase. Multivariable analysis was done to identify predictors of AF progression.Results Mean age was 65 (58-71) years, 179 (43%) were female. Follow-up was 2.2 (1.6-2.8) years, 51 of 417 patients (5.5%/year) showed AF progression. Multivariable analysis identified, PR interval, impaired left atrial function, mitral valve regurgitation and waist circumference to be associated with AF progression. Adding blood biomarkers improved the model (C-statistic from 0.709 to 0.830) and showed male sex, lower levels of factor XIIa:C1-esterase inhibitor and tissue factor pathway inhibitor, and higher levels of N-terminal pro-brain natriuretic peptide, proprotein convertase subtilisin/kexin type 9 and peptidoglycan recognition protein 1 were associated with AF progression.Conclusion In patients with PAF, AF progression occurred in 5.5%/year. Predictors for progression included markers for atrial remodelling, sex, mitral valve regurgitation, waist circumference and biomarkers associated with coagulation, inflammation, cardiomyocyte stretch and atherosclerosis. These prediction models may help to determine risk of AF progression and treatment targets, but validation is needed.

KW - CORONARY

KW - OUTCOMES

U2 - 10.1136/heartjnl-2022-321027

DO - 10.1136/heartjnl-2022-321027

M3 - Article

C2 - 35858774

SN - 1355-6037

VL - 109

SP - 186

EP - 194

JO - Heart

JF - Heart

IS - 3

ER -