title: Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis.
abstract: OBJECTIVE
  We investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population.
  
  
  BACKGROUND
  Progression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF.
  
  
  METHODS
  We included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified.
  
  
  RESULTS
  Progression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score >5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events.
  
  
  CONCLUSIONS
  A substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future.
authors.affiliation: Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands. cees.de.vos@mumc.nl
authors.forename: Cees B
authors.initials: CB
authors.lastname: de Vos
authors.forename: Ron
authors.initials: R
authors.lastname: Pisters
authors.forename: Robby
authors.initials: R
authors.lastname: Nieuwlaat
authors.forename: Martin H
authors.initials: MH
authors.lastname: Prins
authors.forename: Robert G
authors.initials: RG
authors.lastname: Tieleman
authors.forename: Robert-Jan S
authors.initials: RJ
authors.lastname: Coelen
authors.forename: Antonius C
authors.initials: AC
authors.lastname: van den Heijkant
authors.forename: Maurits A
authors.initials: MA
authors.lastname: Allessie
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors