Abstract 13420: Risk Factors Associated with Development of Paroxysmal versus Persistent Atrial Fibrillation

Abstract

Introduction: Several lifestyle and cardiovascular risk factors are associated with incident atrial fibrillation (AF). However, few studies have examined whether these risk factors differ with regard to early development of persistent rather than paroxysmal AF.

Methods: A total of 34,720 women enrolled in the Women’s Health Study who were >45 years and free of cardiovascular disease and AF at baseline in 1993 were prospectively followed for incident AF. AF was classified into subtypes: paroxysmal (self-terminating within 7 days), persistent (requiring cardioversion or lasting > 7 days), and permanent (> 1 year and/or attempts to convert rhythm abandoned) within 2 years of initial AF diagnosis. Women with persistent and permanent AF were grouped together. All AF events were confirmed by medical record review. A competing risk analysis using Cox proportional hazard models was performed and likelihood ratio tests were utilized to test the equality of risk factor associations with AF subtypes.

Results: During a median follow-up of 16.4 years (IQR 15.6:16.8),1039 women developed incident AF. Of these, 349 (33%) developed persistent AF within 2 years of AF diagnosis whereas 690 (67%) remained paroxysmal. The multivariable associations between risk factors and AF subtypes are displayed in Table 1. Age and body mass index (BMI) were more strongly associated with the development of persistent AF (Model 1A); whereas associations for other risk factors did not differ. When height and weight were substituted for BMI in the multivariable model (Model 1B), only weight was more strongly associated with the development of persistent AF (p=0.006). The relationship for BMI and weight persisted in updated time-varying models and was not significantly attenuated when controlling for inflammatory markers.

Conclusions: In this large prospective cohort of women, adiposity was strongly associated with development of persistent AF rather than paroxysmal AF within two years of diagnosis.