Lone atrial fibrillation: Prognostic differences between paroxysmal and chronic forms after 10 years of follow-up,☆☆

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Abstract

Background Lone atrial fibrillation (LAF) is defined by the presence of atrial fibrillation unassociated with other evidence of organic heart disease. There are conflicting data concerning the prognostic importance, rate of embolic complications, and survival in subjects affected by this arrhythmia. Methods and Results One hundred forty-five patients younger than 50 years at the time of the first diagnosis were identified; 96 had paroxysmal and 49 had chronic LAF. They were followed up with clinical and echocardiographic controls, and we recorded every thromboembolic complication and death. During the follow-up (10 ± 8 years) among patients with paroxysmal LAF, 1 (1%) had an ischemic stroke, 2 a transient ischemic attack, and 1 a myocardial infarction. In the group with chronic LAF, 1 patient had moderate heart failure, 2 myocardial infarction, and 1 transient ischemic attack. In this group, 8 embolic complications in 7 (16.3%) patients were observed. One patient with intestinal embolism died during surgery; 2 (6.1%) patients died suddenly. Conclusions The prognosis of young patients with paroxysmal LAF appears to be excellent, whereas patients with chronic LAF are at increased risk of embolic complications and higher mortality rates. Our results suggest that LAF is not always a benign disorder, as suggested by previous studies. Subgroups with substantially increased risk for thromboembolic events caused by LAF should be better identified. (Am Heart J 1999;137:686-91.)

Section snippets

Methods

Between 1966 and 1995, we examined 7523 patients with atrial fibrillation referred by their family physicians in the outpatient clinic of the Department of Cardiology of Ospedale Maggiore, Trieste, Italy. The study base consisted of 157 patients identified as having idiopathic or lone atrial fibrillation. On the basis of the clinical history and serial electrocardiographic patterns, the arrhythmia was categorized as chronic (when it appeared on more than 1 routine periodic examination and/or

Results

During the study period, 145 patients (118 male, 81.4%) were identified as having had LAF. At the time of first diagnosis, the isolated or recurrent form was present in 125 (86.2%) patients and the chronic form in 20 (15.8%). At the conclusion of the study, the paroxysmal form had become chronic in 29 (23%) patients, after a mean period of 85.9 ± 87.2 months (range 1 to 312 months) after the first paroxysmal episode.

At the end of the follow-up period, 96 (66.3%) had the paroxysmal form and 49

Discussion

Although our study was not population based, there is no other facility in the Trieste area for outpatients except our cardiovascular clinic; thus the results may be considered representative of the whole population. We have found that LAF represents a significant proportion (1.9%) of atrial fibrillation in our outpatient clinic.

As mentioned in the introduction, the estimation of the prevalence and incidence of LAF as well as direct comparison of various studies is difficult because of the

Acknowledgements

We thank Marie Luise Artero, MD, for valuable assistance in the preparation of the manuscript.

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    Reprint requests: Sabino Scardi, MD, Cardiovascular Center, Ospedale Maggiore, via Pietà 19, 34100 Trieste, Italy.

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