Heart Rhythm 2018: (Journal)
Blum S., Meyre P., Aeschbacher S., Berger S., Auberson C., Briel M., Osswald S., Conen D.
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: 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 or 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 (py). The pooled incidence of AF-progression was 8.1 per 100 py of follow-up (95% confidence interval [CI], 7.1;9.1; I2=98%, p<0.0001). The incidence was 7.1 ([95%CI 6.2;8.0], 42 studies) for progression from paroxysmal to non-paroxysmal AF, compared to 18.6 ([95%CI 8.9;28.3], 5 studies) for progression from persistent to permanent AF. Higher age (β=5.4, [95%CI 1.4;9.4], p=0.01, R214.3%) and prevalence of hypertension (β=5.2, [95%CI 1.0;9.4], p=0.02, R218.0%) were associated with a higher AF-progression rate. Follow-up duration (β=-4.5, [95%CI -5.8;-3.3], p<0.0001, R268.0%) and prevalence of paroxysmal AF (β=-9.5, [95%CI -18.7;-0.3], p=0.04, R24.4%) 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 go down with longer follow-up. Age, hypertension, baseline AF type and follow-up duration explained a high proportion of the observed between-study heterogeneity.