title: Long-term prognosis after cardioversion of the first episode of symptomatic atrial fibrillation: a condition believed to be benign revised.
abstract: OBJECTIVE
  We evaluated the prognostic impact of a first episode of symptomatic atrial fibrillation under real life conditions.
  
  
  BACKGROUND
  Most studies regarding the treatment and long-term outcome of patients with atrial fibrillation mainly refer to patients with recurrent episodes. In contrast, data on the prognostic implications of a first episode of atrial fibrillation are scarce.
  
  
  METHODS
  Over a follow-up period of 5 years, we analyzed 1053 patients, initially scheduled for cardioversion of symptomatic atrial fibrillation, who were included into the prospective registry ANTIK (Ludwigshafener ANTIKoagulationsstudie).
  
  
  RESULTS
  Of those, 618 patients (59%) were included with a first episode of symptomatic atrial fibrillation whereas 435 patients (41%) presented with recurrent episodes. As a consequence of referral for cardioversion of symptomatic atrial fibrillation, structural heart disease was newly diagnosed in a significantly higher proportion of patients with a first episode (27 vs 13%, OR 2.4, 95% CI 1.7-3.3) and patients with a first episode were more likely to have an EF</=40% (21 vs 15%, OR 1.5, 95% CI 1.1-2.2). After 5 years, the mortality rate for patients with a first episode was higher than for those with recurrent episodes (27 vs 16%, OR 2.0, 95% CI 1.4-2.7). In the multivariate analysis, a first episode also was independently associated with an increased longterm mortality (HR 1.4, 95% CI 1.02-1.98). In contrast to patients with recurrent episodes, a first episode was associated with a significantly higher mortality, when compared to an age-matched control group calculated from mortality tables.
  
  
  CONCLUSIONS
  The first episode of symptomatic atrial fibrillation intended for cardioversion serves as a marker for underlying cardiac diseases and is associated with impaired prognosis.
authors.affiliation: Klinikum der Stadt Ludwigshafen, Herzzentrum, Bremserstr. 79, 67063, Ludwigshafen, Germany. beckert@klilu.de
authors.forename: Torsten
authors.initials: T
authors.lastname: Becker
authors.forename: Thomas
authors.initials: T
authors.lastname: Kleemann
authors.forename: Margit
authors.initials: M
authors.lastname: Strauss
authors.forename: Klaus
authors.initials: K
authors.lastname: Doenges
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Seidl
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D016001:Confidence Intervals; D042241:Early Diagnosis; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome