Predictors of young-onset atrial fibrillation

Atrial fibrillation (AF) in the young is uncommon and not well studied. A recent retrospective study in a large cohort evaluated the presence of predictors for new-onset AF in individuals ≤45 years and identified a profile of comorbidities and ECG abnormalities associated with early-onset AF [1].

Dr Amitai Segev (Sheba Medical Centre, Israel) presented a study that retrospectively evaluated 16,432 patients aged ≤45 years who were admitted to the internal and cardiology wards at a large tertiary centre between January 2009 and December 2019 [1]. The purpose of the study was to identify the determinants of AF in this population to facilitate timely diagnosis, follow-up, and management.

Clinical, electrocardiographic (ECG), and echocardiographic data were collected and compared between participants with AF (n=366) and without AF (n=16,066) at baseline. A subgroup of participants without AF at baseline and a subsequent hospital visit were followed for the development of new-onset AF. Baseline characteristics of patients with AF were statistically significantly different from those without AF in a variety of parameters strongly and independently associated with young-onset AF, including age, male gender, obesity, and heart failure (see Table).

Table: Idependent predictors of new-onset AF. Adapted from [1]

AF, atrial fibrillation; CHF, congestive heart failure; CI, confidence interval; LBBB, left bundle branch block; RBBB, right bundle branch block       
Cox proportional hazards regression on determinants associated with new-onset AF.

A total of 10,691 participants were followed for a median of 41.5 (16.6-78.6) months, during which 85 patients developed new-onset AF (equivalent to 0.5%/year). Independent predictors of new-onset AF were increased age, hypertension, heart failure, and right and left bundle branch block (P≤0.045).

The analysis also compared 2 clinical scores in their ability to predict new-onset AF. The CHARGE-AF score is a validated clinical score incorporating readily available variables, such as age, ethnicity, lifestyle parameters, and cardiovascular comorbidities. The CHA₂DS₂-VASc score has originally been developed to predict the risk of stroke in AF. In this study, the CHARGE-AF score outperformed the CHA₂DS₂-VASc score in new-onset AF prediction (area under the ROC curve 0.75 [0.7-0.8] vs 0.56 [0.48-0.65], respectively).

In summary, young-onset AF is characterised by a specific clinical profile of comorbidities and ECG abnormalities. The incidence of new-onset AF in individuals admitted to hospital was 0.5%/year. Outcomes of this retrospective cohort study suggest that patients at high risk for the development of new-onset AF can be identified by clinical parameters and that more intense follow-up of selected individuals may result in early diagnosis, followed by early intervention.

1. 
   
   1. Segev A. Atrial fibrillation in the young: clinical characteristics, predictors of new onset and outcomes. EHRA 2021 Congress, 23-25 April.

 

Copyright ©2021 Medicom Medical Publishers



Posted on 16 June 202122 June 2021