Progression of atrial fibrillation in the REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation cohort: clinical correlates and the effect of rhythm-control therapy

Am Heart J. 2012 May;163(5):887-93. doi: 10.1016/j.ahj.2012.02.015.


Introduction: Paroxysmal atrial fibrillation (AF) may progress to persistent AF. We studied the clinical correlates and the effect of rhythm-control strategy on AF progression.

Methods: RecordAF was a worldwide prospective survey of AF management. Consecutive eligible patients with recent-onset AF were included and allocated to rate or rhythm control according to patient/physician choice. A total of 2,137 patients were followed up for 12 months. Atrial fibrillation progression was defined as a change from paroxysmal to persistent/permanent AF.

Results: Progression of AF occurred in 318 patients (15%) after 1 year. Patients with AF progression were older; had a higher diastolic blood pressure; and more often had a history of coronary artery disease, stroke or transient ischemic attack, hypertension, or heart failure. Patients treated with rhythm control were less likely to show progression than those treated only with rate control (164/1542 [11%] vs 154/595 [26%], P < .001). Multivariable analysis showed that history of heart failure (odds ratio [OR] 2.2, 95% CI 1.7-2.9, P < .0001), history of hypertension (OR 1.5, 95% CI 1.1-2.0, P = .01), and rate control rather than rhythm control (OR 3.2, 95% CI 2.5-4.1, P < .0001) were independent predictors of AF progression. The propensity score-adjusted OR of AF progression in patients with rate rather than rhythm control was 3.3 (95% CI 2.4-4.6, P < .0001).

Conclusions: Although heart failure and hypertension are associated with AF progression, rhythm control is associated with lower risk of AF progression.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Age Factors
  • Aged
  • Anti-Arrhythmia Agents / therapeutic use*
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / drug therapy*
  • Atrial Fibrillation / mortality*
  • Cause of Death*
  • Cohort Studies
  • Confidence Intervals
  • Disease Progression*
  • Electrocardiography / methods*
  • Female
  • Follow-Up Studies
  • Heart Conduction System / physiopathology
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Registries
  • Risk Assessment
  • Severity of Illness Index
  • Sex Factors
  • Survival Analysis
  • Tachycardia, Paroxysmal / diagnosis
  • Tachycardia, Paroxysmal / drug therapy
  • Tachycardia, Paroxysmal / mortality
  • Treatment Outcome


  • Anti-Arrhythmia Agents