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Heartbeat: prevention of atrial fibrillation progression
  1. Catherine M Otto
  1. Division of Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA; cmotto{at}uw.edu

http://dx.doi.org/10.1136/heartjnl-2022-322294

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    Prevention of persistent and permanent atrial fibrillation (AF) might reduce the incidence of adverse cardiovascular outcomes. Many patients initially present with paroxysmal AF and then progress to more permanent AF, yet there are few robust predictors of progressive AF. In an interim-analysis of the prospective Reappraisal of AF: Interaction Between HyperCoagulability, Electrical Remodelling, and Vascular Destabilisation in the Progression of AF (RACE V) study, the rate of AF progression was 5.5% per year.1 Multivariable predictors of progression from paroxysmal to more permanent AF were impaired left atrial function, more severe mitral regurgitation and a larger waist circumference in addition to biomarkers associated with coagulation, inflammation, cardiomyocyte stretch and atherosclerosis (figure 1). These findings suggest that risk stratification and targeted intervention to prevent progression from paroxysmal to more permanent AF may be possible.

    Figure 1

    Predictors of atrial fibrillation (AF) progression in the Reappraisal of AF: Interaction Between HyperCoagulability, Electrical Remodelling, and Vascular Destabilisation in the Progression of AF study. Clinical markers and blood biomarkers as predictors for atrial fibrillation progression and their physiological and pathophysiological mechanisms. The blue boxes represent the multivariable predictors of atrial fibrillation progression. The green boxes represent the physiological mechanisms, the yellow boxes represent the pathophysiological mechanisms. NTproBNP, N-terminal pro-brain natriuretic peptide; PCSK9, proprotein convertase subtilisin/kexin type 9; PGLYRP1, peptidoglycan recognition protein 1; TFPI, tissue factor pathway inhibitor.

    In the accompanying editorial, Hendriks and colleagues2 remind us that AF is a chronic condition associated with lifestyle factors and cardiovascular morbidities. As elegantly demonstrated in the research article by …

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    Footnotes

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    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.