Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation?
OBJECTIVE
To assess the relation between the atrial fibrillation (AF) subtype and thrombo-embolic events.


RESULTS
The observational Euro Heart Survey on AF (2003-04) enrolled 1509 paroxysmal, 1109 persistent, and 1515 permanent AF patients, according to the 2001 American College of Cardiology, American Heart Association, and the European Society of Cardiology guidelines definitions. A 1 year follow-up was performed. Permanent AF patients had at baseline a worse stroke risk profile than paroxysmal and persistent AF patients. In paroxysmal AF, the risk for stroke, any thrombo-embolism, major bleeding and the combined endpoint of cardiovascular mortality, any thrombo-embolism, and major bleeding was comparable with persistent and permanent AF, in both univariable and multivariable analyses. Compared with AF patients without stroke, patients suffering from a stroke had a comparable frequency and duration of AF attacks, but tended to have a worse stroke risk profile at baseline. During 1 year following cardioversion, paroxysmal AF patients had a higher risk for stroke (P = 0.029) and any thrombo-embolism (P = 0.001) than persistent AF patients.


CONCLUSIONS
In the Euro Heart Survey, paroxysmal AF had a comparable risk for thrombo-embolic events as persistent and permanent AF. This observation strengthens the guideline recommendation not to consider the clinical AF subtype when deciding on anticoagulation.
Nieuwlaat
Robby
R
Department of Cardiology, University Hospital Maastricht, P. Debyelaan 25, PO Box 5800, Maastricht 6221AZ, The Netherlands. nieuwlaatrobby@live.com.au
Dinh
Trang
T
Olsson
S Bertil
SB
Camm
A John
AJ
Capucci
Alessandro
A
Tieleman
Robert G
RG
Lip
Gregory Y H
GY
Crijns
Harry J G M
HJ
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy; D004554:Electric Countershock / Q000009:adverse effects; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D028761:Withholding Treatment
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D001241:Aspirin