European Heart Journal Advance Access originally published online on March 10, 2008
European Heart Journal 2008 29(7):915-922; doi:10.1093/eurheartj/ehn101
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Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation?
1 Department of Cardiology, University Hospital Maastricht, P. Debyelaan 25, PO Box 5800, Maastricht 6221AZ, The Netherlands
2 Department of Cardiology, University Hospital Lund, Lund, Sweden
3 Department of Cardiology, St George’s Hospital, London, UK
4 Department of Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy
5 Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
Received 31 July 2007; revised 15 January 2008; accepted 16 January 2008; online publish-ahead-of-print 10 March 2008.
* Corresponding author. Tel: +31 433875350, Fax: +31 433875104, Email: nieuwlaatrobby{at}live.com.au
See page 840 for the editorial comment on this article (doi:10.1093/eurheartj/ehm594)
Aims: To assess the relation between the atrial fibrillation (AF) subtype and thrombo-embolic events.
Methods and results: The observational Euro Heart Survey on AF (2003–04) enrolled 1509 paroxysmal, 1109 persistent, and 1515 permanent AF patients, according to the 2001 American College of Cardiology, American Heart Association, and the European Society of Cardiology guidelines definitions. A 1 year follow-up was performed. Permanent AF patients had at baseline a worse stroke risk profile than paroxysmal and persistent AF patients. In paroxysmal AF, the risk for stroke, any thrombo-embolism, major bleeding and the combined endpoint of cardiovascular mortality, any thrombo-embolism, and major bleeding was comparable with persistent and permanent AF, in both univariable and multivariable analyses. Compared with AF patients without stroke, patients suffering from a stroke had a comparable frequency and duration of AF attacks, but tended to have a worse stroke risk profile at baseline. During 1 year following cardioversion, paroxysmal AF patients had a higher risk for stroke (P = 0.029) and any thrombo-embolism (P = 0.001) than persistent AF patients.
Conclusion: In the Euro Heart Survey, paroxysmal AF had a comparable risk for thrombo-embolic events as persistent and permanent AF. This observation strengthens the guideline recommendation not to consider the clinical AF subtype when deciding on anticoagulation.
Key Words: Atrial fibrillation • Subtype • Paroxysmal atrial fibrillation • Stroke • Thrombo-embolism • Anticoagulation
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