What Percentage of Paroxysmal go to Persistent?

Does anyone have any stats or studies that show what percentage of paroxysmal afibbers go to persistent? And are there any markers that indicate when it is likely to happen? For example, if you are paroxysmal for ten years then you are even less likely to go to persistent...markers like that is what I'm wondering about.

I ask this because I've had a few people email me asking this question. They always want to know if it's "inevitable" that they'll go persistent. I'd like to reply with some stats.

Travis

Not exactly the answer to your question, however an endpoint:

Distribution and Risk Profile of Paroxysmal, Persistent, and
Permanent Atrial Fibrillation in Routine Clinical Practice
Insight From the Real-Life Global Survey Evaluating Patients With
Atrial Fibrillation International Registry

<[circep.ahajournals.org]

Methods and Results—Real-life global survey evaluating patients with atrial fibrillation (RealiseAF) was a contemporary,
large-scale, cross-sectional international survey of patients with AF who had ≥1 episode in the past 12 months.
Investigators were randomly selected to avoid bias. Among 9816 eligible patients from 831 sites in 26 countries, 2606
(26.5%) had paroxysmal, 2341 (23.8%) had persistent, and 4869 (49.6%) had permanent AF. As AF progressed from
paroxysmal to persistent and permanent forms, the prevalence of comorbidities, such as heart failure (32.9%, 44.3%, and
55.6%), coronary artery disease (30.0%, 32.9%, and 34.3%), cerebrovascular disease (11.7%, 10.8%, and 17.6%), and
valvular disease (16.7%, 21.2%, and 35.8%), increased, and the prevalence of lone AF decreased. Similarly, there was an
increase in mean CHADS2 [cardiac failure, hypertension, age, diabetes, stroke (doubled)] score (1.7, 1.8, and 2.2), and
more than half of patients (51.0%, 56.7%, and 67.3%) qualified for oral anticoagulants. Almost 90% of patients received
≥1 antiarrhythmic drug, but >60% had European Heart Rhythm Association symptom scores from II to IV. Furthermore,
40.7% of persistent and 49.8% of permanent AF patients were still in AF with a heart rate >80 beats per minute

In broad strokes, I’d say it depends on mediation. Vagally mediated AF is unlikely to become persistent or permanent. Adrenergically mediated AF, on the other hand, tends to be progressive.

I don't know what will happen tomorrow, but for the last 19 years I have had episodes of AF and am still paroxysmal. I do take one tab (150mg.) of Propafenone at night before bed (I am vagal). , my episodes range from 3 hours to about 12., sometimes I can go for longer periods like 2 months then it seems in the wintertime my episodes are a little more frequent.

The funny thing is the months of August, Sept., and half of Oct. I did not get any episodes of AF and I worked very hard in my garden, canning about 150 qts of tomatoes. During that time I ate a lot of fresh corn, just about every day, from my garden. Maybe there is something in corn that helped me, it does have a lot of nutrients. Perhaps we should check the countries, like Mexico, that do eat a lot of corn and see if the people have a lot of AF.

Liz

Quote
wolfpack
In broad strokes, I’d say it depends on mediation. Vagally mediated AF is unlikely to become persistent or permanent. Adrenergically mediated AF, on the other hand, tends to be progressive.

I read that when I first had afib. I was very vagal. Then I had a 2 1/2 month episode when had to be cardioverted chemically with flecainide.

Statistics don't really mean a lot as an individual.

Liz, speculating out aloud - perhaps it's the longer daylight/sun exposure/vit. D3?

Quote
wolfpack
In broad strokes, I’d say it depends on mediation. Vagally mediated AF is unlikely to become persistent or permanent. Adrenergically mediated AF, on the other hand, tends to be progressive.

What do you base that on?

Carey,

I can't provide hard evidence and/or references, but having been hanging around here as a vagally mediated PAFr this last 18 years (still paroxysmal myself - touch wood), Elizabeth's stated views tally with pretty much everything I've ever read here and elsewhere over the years. Maybe someone else will be along with some references.

Cheers,

Mike

Joe:

I am sure the longer daylight has something to do with AF---however, in June and July I had 1 AF episode in each month, I did go longer in AUG., SEPT AND 1/2 OF OCT., so I had a longer run without AF in the last 3 months, I was trying to figure out why. We sometimes tend to grasp at straws and why not, the medical field doesn't really know what causes our AF, they don't know why it starts and stops.

Liz

Quote
Carey

In broad strokes, I’d say it depends on mediation. Vagally mediated AF is unlikely to become persistent or permanent. Adrenergically mediated AF, on the other hand, tends to be progressive.

What do you base that on?

An article I read years ago and can’t find anymore!

Vagal tone isn’t generally associated with any sort of structural heart abnormalities, whereas adrenergic can be. Interestingly enough, the effect of increased vagal (parasympathetic) tone OR increased adrenergic (sympathetic) tone is the same on the atria - the refractory period shortens. The effect on the ventricles, however, differs. Parasympathetic tones increases refractoriness (slows them), and sympathetic tones decreases refractoriness (speeds them up). In general, hypertonicity in either branch of the central nervous system lays the groundwork for AF. If it’s vagal, maybe it boils down to just some errant inputs to the heart (PVI sources) that drive it nuts, but beyond that nothing’s really going to change over time. If it’s adrenergic, maybe there’s some small bit of muscle damage or sub-clinical cardiomyopathy that sets things off but will grow over time if left unaddressed.

Again, BROAD STROKES. We are all experiments of one, and for each individual who identifies with one category or another there will undoubtedly be someone who identifies with both.

Even if we found some Stats, how accurate would they be? Someone would have to organize a compilation of data from many Heart patients over a long period of time. Such a study would not really have direct benefit to sell some product or treatment, so funding would probably not be available. We could all ask our Doctors what their personnel experience has been as part of our own Survey.

In my own experience, I went the other way, from Persistent back to Paroxysmal for about a year when I was on Flec. Problem was I got more Episodes, and Flutter that I did not have before, so I stopped the Flec. Now I am back at Persistent, but in smooth NSR for 8 months now.



Edited 1 time(s). Last edit at 11/24/2017 06:18AM by The Anti-Fib.

Evolution of Paroxysmal Atrial Fibrillation to Persistent or Permanent Atrial Fibrillation: Predictors of Progression <[www.jafib.com]

Conclusions
Moderate to severe valvular heart disease, larger
left atrial size and cardiomyopathy predict progression
of PAF to persistent/permanent AF.
While higher BMI and cardiomyopathy predict
progression to persistent AF, larger LA size and
significant VHD predict progression to permanent
AF directly. Prospective randomized studies that
evaluate modifiable risk factors are needed and
studies should be geared towards understanding
the mechanism of LA enlargement.


Progression to chronic atrial fibrillation after the initial diagnosis of paroxysmal atrial fibrillation: results from the Canadian Registry of Atrial Fibrillation.
<[www.ncbi.nlm.nih.gov]

CONCLUSIONS:
After the initial diagnosis of paroxysmal AF, there is a slow but steady progression to CAF. Baseline echocardiographic variables, age, cardiomyopathy, and heart rate were independently associated with progression to CAF.

Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study.
<[www.ncbi.nlm.nih.gov]

CONCLUSIONS:
Comorbidities significantly modulate progression and complications of atrial fibrillation. Age or development of hypertension increases thromboembolic risk.

Progression of paroxysmal AF
FLORENCE, ITALY. Paroxysmal (intermittent, self-terminating) atrial
fibrillation may over time progress to persistent or permanent afib
(episodes lasting 7 days or longer). It is not clear why some paroxysmal
afibbers progress to the persistent variety, while other remain paroxysmal
for decades. A group of American and Italian researchers now provide at
least a partial answer to this question.
Their study involved 330 patients with a history of paroxysmal AF (mean
age of 70 years, 61% male) who had had a pacemaker implanted to deal
with bradycardia (slow heart beat). Most study participants had
underlying heart disease, but 21% were lone afibbers. The pacemaker
(Medtronic AT501) automatically recorded the daily burden (duration) of
afib and tachycardia for an average of 400 days. After a mean interval of
147 days, 24% of the patients progressed to persistent afib. The
researchers made the following interesting observations.
• The prevalence of lone atrial fibrillation (LAF) did not differ
between the group that remained in paroxysmal afib and the
one that progressed to persistent afib.
• Patients with congestive heart failure were significantly more
likely to progress to persistent AF.
• Patients destined to progress to persistent AF experienced a
higher daily afib burden and a higher probability of
experiencing afib on any given day than those in the
paroxysmal group.
• The mean daily afib burden in the group destined for
progression to persistent AF increased by about 14
seconds/day, while it stayed relatively constant in the group
that remained paroxysmal.
• Lone afibbers experienced significantly more PACs
(premature atrial beats, ectopics) than did patients with CVD.
However, the incidence of these ectopics decreased over
time.
• The conversion to persistent afib occurred suddenly and was
often preceded by a period of normal sinus rhythm.
• It is possible that treatment with ACE inhibitors or
angiotensin receptor blockers (ARBs) may slow down the
remodeling that underlies progression to persistent AF.
The researchers conclude that, “Our results suggest that functional
electrical remodeling may not impact all patients or inevitably lead to
increasing AT/AF burden and persistent AF. In fact, a large proportion of
patients may not increase their AT/AF burden, particularly in the absence
of CVD.”
Saksena, S, et al. Progression of paroxysmal atrial fibrillation to persistent atrial
fibrillation in patients with bradyarrhythmias. American Heart Journal, Vol. 154,
November 2007, pp. 884-92
Editor’s comment: This study indicates that a steady progression of afib
burden (longer and more frequent episodes) may lead to persistent afib.
Thus, if such a trend is noted, it may be worth trying an ACE inhibitor or an
ARB. <[www.yourhealthbase.com] p14

Left atrial volume predicts cardiovascular events in patients originally diagnosed with lone atrial fibrillation: three-decade follow-up
<[pdfs.semanticscholar.org]

Conclusion
In this historical cohort study, we demonstrated that patients
originally diagnosed with lone AF may follow divergent
courses based on LAV. Those patients who retained small
atria throughout the three decade follow-up consistently
experienced a benign clinical course. Patients originally diagnosed
with benign lone AF, who had unrecognized LAV
enlargement at diagnosis or later during the long-term
follow-up, experienced adverse events. LAV measurement is
a promising tool for risk stratification and monitoring of
patients presenting with AF.

Also reported starting p104 <[www.yourhealthbase.com]

I think many people assign way too much importance to the concept of vagal vs. adrenergic afib.

How do you know if you are vagal or adrenergic? My afib follows no pattern. It is random.

Sounds like your "mixed", being both Adrenergic and Vagal.

Quote
amyorca
How do you know if you are vagal or adrenergic? My afib follows no pattern. It is random.

Here is an explanation: <[www.afibbers.org]

Thanks for the link. After reading it, I think that I am mixed. Though more vagal than adrenergic.