Incidence and predictors of atrial fibrillation progression: A systematic review and meta-analysis

Steffen Blum; Pascal Meyre; Stefanie Aeschbacher; Sebastian Berger; Chloé Auberson; Matthias Briel; Stefan Osswald; David Conen

doi:10.1016/j.hrthm.2018.10.022

Incidence and predictors of atrial fibrillation progression: A systematic review and meta-analysis

Heart Rhythm. 2019 Apr;16(4):502-510. doi: 10.1016/j.hrthm.2018.10.022. Epub 2018 Oct 24.

Authors

Steffen Blum¹, Pascal Meyre², Stefanie Aeschbacher², Sebastian Berger², Chloé Auberson³, Matthias Briel⁴, Stefan Osswald², David Conen⁵

Affiliations

¹ Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland; Division of Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland.
² Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
³ Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
⁴ Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁵ Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. Electronic address: conend@mcmaster.ca.

PMID: 30366160
DOI: 10.1016/j.hrthm.2018.10.022

Abstract

Background: More sustained forms of atrial fibrillation (AF) are less amenable to treatment and associated with worse outcomes, but the incidence and predictors of AF progression are not well defined.

Objective: The purpose of this study was to perform a systematic review and meta-analysis assessing the incidence and predictors of AF progression.

Methods: PubMed, EMBASE, and the Cochrane Library were searched from inception to August 2017. AF progression was defined as progression from paroxysmal to persistent/permanent AF or as progression from persistent to permanent AF. Random effect models were used to calculate pooled cumulative incidence rates. Predictors related to between-study variability were assessed using meta-regression analyses.

Results: We identified 47 studies with 27,266 patients who were followed for 105,912 patient-years. The pooled incidence of AF progression was 8.1 per 100 patient-years of follow-up (95% confidence interval [CI] 7.1-9.1 per 100 patient-years of follow-up; I² = 98%; P < .0001). The incidence was 7.1 per 100 patient-years of follow-up (95% CI 6.2-8.0 per 100 patient-years of follow-up; across 42 studies) for progression from paroxysmal to non-paroxysmal AF as compared with 18.6 per 100 patient-years of follow-up (95% CI 8.9-28.3 per 100 patient-years of follow-up; across 5 studies) for progression from persistent to permanent AF. Higher age (β = 5.4; 95% CI 1.4-9.4; P = .01; R² = 14.3%) and the prevalence of hypertension (β = 5.2; 95% CI 1.0-9.4; P = .02; R² = 18.0%) were associated with a higher AF progression rate. Follow-up duration (β = -4.5; 95% CI -5.8 to -3.3; P < .0001; R² = 68.0%) and the prevalence of paroxysmal AF (β = -9.5; 95% CI -18.7 to -0.3; P = .04; R² = 4.4%) were inversely associated with AF progression. Together these variables explained 73.8% of the observed between-study heterogeneity.

Conclusion: The incidence of AF progression appears to be relatively low, and the incidence seems to decrease with longer follow-up duration. Age, hypertension, baseline AF type, and follow-up duration explained a high percentage of the observed between-study heterogeneity.

Keywords: Atrial fibrillation; Meta-analysis; Paroxysmal atrial fibrillation; Persistent atrial fibrillation; Progression.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Atrial Fibrillation / epidemiology*
Atrial Fibrillation / physiopathology*
Disease Progression
Humans
Incidence
Risk Factors
Time Factors