Long-Term Progression and Outcomes With Aging in Patients With Lone Atrial Fibrillation: A 30-Year Follow-Up Study
Open accessAbstract
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 > or = 1 risk factor for thromboembolism. CONCLUSIONS: Comorbidities significantly modulate progression and complications of atrial fibrillation. Age or development of hypertension increases thromboembolic risk.
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In a small proportion of patients, AF will remain paroxysmal over several decades (2-3% of AF patients).
“In a small proportion of patients, AF will remain paroxysmal over several decades (2-3% of AF patients).161”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [161]
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- Authors
- Jahangir, A., Lee, V., Friedman, P. A., Trusty, J. M., Hodge, D. O., Kopecky, S. L., Packer, D. L., Hammill, S. C., Shen, W.-K., & Gersh, B. J.
- Affiliations
- Mayo Clinic (US)
- ORCID
- Venue
- Circulation
- Published
- 2007-06-19
- Volume
- 115
- Issue
- 24
- Pages
- 3050-3056
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1967792178
- Cited by
- 392
- References
- 38
- Citations by year
- 2026: 6 · 2025: 16 · 2024: 19 · 2023: 4 · 2022: 14 · 2021: 15 · 2020: 13 · 2019: 8 · 2018: 14 · 2017: 16 · 2016: 30 · 2015: 23 · 2014: 25 · 2013: 39 · 2012: 29
- FWCI
- 19.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (R01AG021201, R01 AG21201)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- lone atrial fibrillation, paroxysmal atrial fibrillation, persistent atrial fibrillation, heart failure, thromboembolism, stroke, transient ischemic attack, overall survival, comorbidities, hypertension, aging
- MeSH terms
- Adolescent, Adult, Aging, Anticoagulants, Atrial Fibrillation, Ischemic Attack, Transient, Electrocardiography, Female, Follow-Up Studies, Heart Failure, Humans, Male, Middle Aged, Predictive Value of Tests, Risk Factors, Cohort Studies, Comorbidity, Survival Analysis, Treatment Outcome, Disease Progression, Stroke
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