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; I² = 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 (β = 5.4; 95% CI 1.4-9.4; P = .01; R² = 14.3%) and the prevalence of hypertension (β = 5.2; 95% CI 1.0-9.4; P = .02; R² = 18.0%) were associated with a higher AF progression rate. Follow-up duration (β = -4.5; 95% CI -5.8 to -3.3; P < .0001; R² = 68.0%) and the prevalence of paroxysmal AF (β = -9.5; 95% CI -18.7 to -0.3; P = .04; R² = 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.