P1175Determinants of progression of persistent to permanent atrial fibrillation - data from the RACE 3 study

Abstract

Introduction: Atrial fibrillation (AF) is a progressive disease. AF progression is associated with increased cardiovascular morbidity and mortality. However, understanding of clinical determinants of AF progression is limited. Purpose: To assess determinants of AF progression from persistent to permanent AF in patients with early persistent AF and early mild to moderate heart failure (HF). Methods: AF progression was assessed in 245 patients with early-persistent AF and early mild to moderate HF included in the 1:1 randomized, open-label, multicenter, prospective Routine versus Aggressive Risk Factor Driven Upstream Rhythm Control for Prevention of Early Atrial Fibrillation in Heart Failure (RACE 3) study during 1-year follow-up (FU). The intervention group (upstream therapies) received 4 therapies on top of conventional rhythm control care: 1) mineralocorticoid receptor antagonists, 2) statins, 3) angiotensin converting enzyme inhibitors and/or receptor blockers, and 4) cardiac rehabilitation including physical activity, dietary restrictions, and counselling. AF progression was defined as permanent AF at 12-month. Determinants of progression were assessed by univariable and backward multivariable Cox proportional hazards regression. Results: Age was 6569 years, 193 (79%) were men, total AF history was 3 (2-6) months, persistent AF history 2 (1-4) months, heart failure duration 2 (1-4) months. Hypertension was present in 144 (59%) patients, diabetes in 26 (11%) and coronary artery disease in 33 (13%). At 1-year, 49 (20%) patients had AF progression. Multivariable determinants of AF progression were total cholesterol, glucose, left ventricular ejection fraction (LVEF) <45% and upstream therapies randomization group (Table 1). Conclusion: In patients with early persistent AF LVEF <45% and upstream therapies reduced the occurrence of AF progression. Higher glucose levels were associated with increased risk of AF progression. Total cholesterol was inversely related to AF progression.