The objective of this study is to assess the risk profile in patients with atrial fibrillation, which represents the degree of changes in the atrial tissue and which can help predict in which patients rhythm control will be successful. This risk profile will consist of a combination of underlying (heart) disease and risk factors, measurements obtained from echocardiograms, and circulating biomarkers. Ultimately this risk profile can be used to guide type of rhythm control therapy in individual patients with atrial fibrillation.
Atrial fibrillation is responsible for substantial morbidity and mortality.Identification of patients with atrial fibrillation that is difficult to treat may improve the outcome of rhythm control therapy. Left atrial size could be a useful tool to select patients that will benefit from rhythm control therapy.Beside echocardiographic parameters,atrial fibrillation has been also associated with circulating biomarkers in blood like collagen metabolism, inflammatory mediators,neurohumoral factors and proteins/proteomic profiles. Beside more accepted risk factors (myocardial ischemia, diabetes and pulmonary disease)other less well-known clinical factors (sleep apnea, alcohol or other intoxication abuse, excessive physical activity, esophageal problems and increased body mass index) may also predict the outcome of rhythm control.It likes also plausible that recurrent atrial fibrillation within one month after start of rhythm control are associated with a different risk profile than late atrial fibrillation recurrence.During this study we will try to identify patients with atrial fibrillation who are more or less likely to respond to rhythm control therapy.
Study Type
OBSERVATIONAL
Enrollment
500
University Medical Center Groningen
Groningen, Netherlands
Success of rhythm control
(1) \< 1 second AF on end-of-study ECG; (2) \< 30 seconds AF on end-of-study 48-hour Holter recording; (3) no AF on end-of-study 2 weeks Vitaphone ECG-card recording.
Time frame: 12 month
Time to recurrence of (a)symptomatic AF
by assessment Percentage AF-burden on 24-holter during follow up
Time frame: 1+3+6+9+12 month
Failure of rhythm control, i.e. permanent AF
failure of rhythm control medication or electric cardioversion.
Time frame: 1+3+6+9+12 month
Risk profiles associated with early versus late AF recurrence
These parameters include underlying (heart) disease and risk factors (including age, family history for AF, signs of ischemia, coronary risk factors, pulmonary disease, diabetes, obesity, sleep apnea, esophageal problems), lifestyle (including caffeine and alcohol intake, exercise), autonomic trigger patterns of AF (i.e. vagal or adrenergic induced AF, or combination
Time frame: 1month and 12 month
Progression of paroxysmal AF to persistent or permanent AF and of persistent AF to permanent AF
clinical commplaints and 3-lead Holter monitoring will be used for assessing the onset of AF episode
Time frame: 1+3+6+9+12 month
Changes in atrial and ventricular echocardiographic parameters
Echocardiographic measures of LA size (LA size parasternal long axis view, LA volume,LA ejection fraction measurement, electro-echocardiographic parameters (Tissue Doppler total atrial conduction time (during sinus rhythm), AF cycle length and velocity (during AF)), and parameters of diastolic dysfunction, including E (early mitral valve flow velocity), A (late mitral valve flow velocity), E/A ratio, deceleration time, E' (early tissue Doppler lengthening velocity), and E/E' ratio
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Time frame: 1month and 12 month
Cardiovascular morbidity and mortality
hospitalization for cardiovascular reasons, non-cardiovascular and cardiovascular death will be carefully monitored through-out the study.
Time frame: 1month and 12month
Pulmonary vein ablation
hospital admission for pulmonary vein ablation will be monitoring during the study.
Time frame: 1month, 3month, 6month, 9 month, 12month
Pathophysiological mechanisms associated with AF and success of rhythm control
To study pathophysiological mechanisms of AF, e.g. collagen mediated or inflammation mediated AF
Time frame: baseline-12 months