Incidence and predictors of atrial fibrillation progression: A systematic review and meta-analysis

BACKGROUND More sustained forms of atrial fibrillation (AF) are less amenable to treatment and associated with worse outcomes, but the incidence and predictors of AF progression are not well defined. OBJECTIVE The purpose of this study was to perform a systematic review and meta-analysis assessing the incidence and predictors of AF progression. METHODS PubMed, EMBASE, and the Cochrane Library were searched from inception to August 2017. AF progression was defined as progression from paroxysmal to persistent/permanent AF or as progression from persistent to permanent AF. Random effect models were used to calculate pooled cumulative incidence rates. Predictors related to between-study variability were assessed using meta-regression analyses. RESULTS We identified 47 studies with 27,266 patients who were followed for 105,912 patient-years. The pooled incidence of AF progression was 8.1 per 100 patient-years of follow-up (95% confidence interval [CI] 7.1-9.1 per 100 patient-years of follow-up; I-2 = 98%; P<.0001). The incidence was 7.1 per 100 patient-years of follow-up (95% CI 6.2-8.0 per 100 patient-years of follow-up; across 42 studies) for progression from paroxysmal to non-paroxysmal AF as compared with 18.6 per 100 patient-years of follow-up (95% CI 8.9-28.3 per 100 patient-years of follow-up; across 5 studies) for progression from persistent to permanent AF. Higher age (beta=5.4; 95% CI 1.4-9.4; P=.01; R-2=14.3%) and the prevalence of hypertension (beta = 5.2; 95% CI 1.0-9.4; P =.02; R-2 = 18.0%) were associated with a higher AF progression rate. Follow-up duration (beta = -4.5; 95% CI -5.8 to -3.3; P< .0001; R-2 = 68.0%) and the prevalence of paroxysmal AF (beta=-9.5; 95% CI -18.7 to -0.3; P =.04; R-2 = 4.4%) were inversely associated with AF progression. Together these variables explained 73.8% of the observed between-study heterogeneity. CONCLUSION The incidence of AF progression appears to be relatively low, and the incidence seems to decrease with longer follow-up duration. Age, hypertension, baseline AF type, and follow-up duration explained a high percentage of the observed between-study heterogeneity.