Atrial Fibrillation Beyond the Electrocardiogram: Towards Understanding and Preventing Progression

Atrial fibrillation (AF) is a common cardiac arrhythmia that usually starts in a paroxysmal nature and often progresses to permanent AF. This transition is often referred to as AF progression. AF progression is associated with a higher rate of complications, including stroke. In part 1 of the thesis, we focused on identifying factors associated with AF progression.
First, we describe that even patients with young-onset AF often have underlying heart and vascular disease. Secondly, the risk profile between men and women differs significantly, but this does not result in a difference in AF progression rate between sexes.
In several cohorts, we aimed to identify risk factors for AF progression and found left atrial size, left ventricular hypertrophy, elevated blood pressure and 2 blood biomarkers (PAI-1, involved in coagulation and NT-proBNP, a marker of ventricular stretch) to be associated with AF progression. Furthermore, patients with a higher number of heart and vascular disease, had longer episodes of AF.
In part 2, we focused on potential manners to prevent AF progression. In RACE 3, targeted therapy of underlying diseases was associated with a higher proportion of patients in sinus rhythm at 1 year. Similarly, quality of life was better in these patients, compared to usual care.
Future studies will have to determine which combination of interventions is effective in preventing AF progression and thereby improving the prognosis of AF patients.