• atrial fibrillation
• biomarkers
• obesity

It has now been established that atrial fibrillation (AF) is a chronic condition, associated with significant cardiovascular comorbidities and lifestyle factors. This underlying substrate contributes to the fact that it is considered a progressive condition. International guidelines have recommended a holistic and comprehensive treatment approach that goes beyond the treatment of symptoms and thus the arrhythmia alone but also includes prevention of thromboembolic complications and identification and management of risk and lifestyle factors, contributing to the progression of AF.1

Nguyen and colleagues2 outline the development of a prediction model for AF progression and further explore the associated contribution of underlying pathophysiological mechanisms. They performed an interim analysis of the Reappraisal of AF: Interaction between Hypercoagulability, Electrical Remodelling, and Vascular Destabilisation in the Progression of AF (RACE V Study), which aims to investigate the association of clinical factors and biomarkers related to the progression of AF in patients diagnosed with self-terminating (paroxysmal) AF. These patients underwent extensive clinical assessment and phenotyping at baseline and ongoing rhythm monitoring by means of a Medtronic Reveal LINQ implantable loop recorder or Medtronic pacemaker during at least 1-year follow-up. The phenotyping included diagnostic tests such as ECG, echocardiography, vascular assessment and a CT scan, as well as extensive blood biomarker assessment. Progression of AF was defined as development of persistent or permanent AF during follow-up, or an increase in AF burden of >3% over the first 6 months or total follow-up. In total, 417 patients were included in the analysis, median age 65 (58–71) years and 43% were …