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A Population-Based Study of Unexplained/Lone Atrial Fibrillation: Temporal Trends, Management, and Outcomes

BACKGROUND: Previous studies on lone/unexplained atrial fibrillation and atrial flutter (AF) did not exclude patients with contemporary secondary AF triggers. We characterized unexplained AF using a strict definition, and compared it to secondary AF. METHODS: In this population-based study, unexplai...

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Autores principales: Roston, Thomas M., Islam, Sunjidatul, Hawkins, Nathaniel M., Laksman, Zachary W., Sanatani, Shubhayan, Krahn, Andrew D., Sandhu, Roopinder, Kaul, Padma
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767123/
https://www.ncbi.nlm.nih.gov/pubmed/35072029
http://dx.doi.org/10.1016/j.cjco.2021.09.006
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author Roston, Thomas M.
Islam, Sunjidatul
Hawkins, Nathaniel M.
Laksman, Zachary W.
Sanatani, Shubhayan
Krahn, Andrew D.
Sandhu, Roopinder
Kaul, Padma
author_facet Roston, Thomas M.
Islam, Sunjidatul
Hawkins, Nathaniel M.
Laksman, Zachary W.
Sanatani, Shubhayan
Krahn, Andrew D.
Sandhu, Roopinder
Kaul, Padma
author_sort Roston, Thomas M.
collection PubMed
description BACKGROUND: Previous studies on lone/unexplained atrial fibrillation and atrial flutter (AF) did not exclude patients with contemporary secondary AF triggers. We characterized unexplained AF using a strict definition, and compared it to secondary AF. METHODS: In this population-based study, unexplained AF was defined by the lack of any identifiable triggering medical/surgical diagnosis. Comparisons by AF type (unexplained vs secondary), age-of-onset (≤ / > 65 years), and sex were undertaken. Data were acquired by linking 6 population databases maintained by the Alberta Ministry of Health over a 9-year period (April 2006 to March 2015). The primary composite outcome of stroke, transient ischemic attack, thromboembolism, and/or death was assessed. RESULTS: There were 33,150 incident AF diagnoses identified, including 1145 patients (3.5%) with unexplained AF, 931 (81.2%) of whom were aged ≤ 65 years (2.8% of diagnoses, and 79% male). Patients with unexplained AF less often received rate/rhythm-control drugs (P < 0.0001), but they more often underwent electrical cardioversion (P < 0.0001) vs secondary AF patients. Men were younger at unexplained AF diagnosis (45 [interquartile range: 34-59] vs 58 [interquartile range: 40-69] years; P < 0.001). After adjusting for age at diagnosis, there were no sex-based differences in the primary outcome. Event-free survival in young unexplained AF (age ≤ 65 years) was 99.4% at 1 year and 98.3% at 3 years. At 3 years, hospitalization(s)/emergency visit(s) for noncardiovascular reasons and for AF occurred in 56.6% and 23.8% of these patients, respectively. CONCLUSIONS: Using a strict contemporary definition of unexplained AF, this study shows that the condition is rare, predominantly male, and has excellent event-free survival. However, the high rate of acute hospital utilization after diagnosis is concerning.
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spelling pubmed-87671232022-01-21 A Population-Based Study of Unexplained/Lone Atrial Fibrillation: Temporal Trends, Management, and Outcomes Roston, Thomas M. Islam, Sunjidatul Hawkins, Nathaniel M. Laksman, Zachary W. Sanatani, Shubhayan Krahn, Andrew D. Sandhu, Roopinder Kaul, Padma CJC Open Original Article BACKGROUND: Previous studies on lone/unexplained atrial fibrillation and atrial flutter (AF) did not exclude patients with contemporary secondary AF triggers. We characterized unexplained AF using a strict definition, and compared it to secondary AF. METHODS: In this population-based study, unexplained AF was defined by the lack of any identifiable triggering medical/surgical diagnosis. Comparisons by AF type (unexplained vs secondary), age-of-onset (≤ / > 65 years), and sex were undertaken. Data were acquired by linking 6 population databases maintained by the Alberta Ministry of Health over a 9-year period (April 2006 to March 2015). The primary composite outcome of stroke, transient ischemic attack, thromboembolism, and/or death was assessed. RESULTS: There were 33,150 incident AF diagnoses identified, including 1145 patients (3.5%) with unexplained AF, 931 (81.2%) of whom were aged ≤ 65 years (2.8% of diagnoses, and 79% male). Patients with unexplained AF less often received rate/rhythm-control drugs (P < 0.0001), but they more often underwent electrical cardioversion (P < 0.0001) vs secondary AF patients. Men were younger at unexplained AF diagnosis (45 [interquartile range: 34-59] vs 58 [interquartile range: 40-69] years; P < 0.001). After adjusting for age at diagnosis, there were no sex-based differences in the primary outcome. Event-free survival in young unexplained AF (age ≤ 65 years) was 99.4% at 1 year and 98.3% at 3 years. At 3 years, hospitalization(s)/emergency visit(s) for noncardiovascular reasons and for AF occurred in 56.6% and 23.8% of these patients, respectively. CONCLUSIONS: Using a strict contemporary definition of unexplained AF, this study shows that the condition is rare, predominantly male, and has excellent event-free survival. However, the high rate of acute hospital utilization after diagnosis is concerning. Elsevier 2021-09-14 /pmc/articles/PMC8767123/ /pubmed/35072029 http://dx.doi.org/10.1016/j.cjco.2021.09.006 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Roston, Thomas M.
Islam, Sunjidatul
Hawkins, Nathaniel M.
Laksman, Zachary W.
Sanatani, Shubhayan
Krahn, Andrew D.
Sandhu, Roopinder
Kaul, Padma
A Population-Based Study of Unexplained/Lone Atrial Fibrillation: Temporal Trends, Management, and Outcomes
title A Population-Based Study of Unexplained/Lone Atrial Fibrillation: Temporal Trends, Management, and Outcomes
title_full A Population-Based Study of Unexplained/Lone Atrial Fibrillation: Temporal Trends, Management, and Outcomes
title_fullStr A Population-Based Study of Unexplained/Lone Atrial Fibrillation: Temporal Trends, Management, and Outcomes
title_full_unstemmed A Population-Based Study of Unexplained/Lone Atrial Fibrillation: Temporal Trends, Management, and Outcomes
title_short A Population-Based Study of Unexplained/Lone Atrial Fibrillation: Temporal Trends, Management, and Outcomes
title_sort population-based study of unexplained/lone atrial fibrillation: temporal trends, management, and outcomes
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767123/
https://www.ncbi.nlm.nih.gov/pubmed/35072029
http://dx.doi.org/10.1016/j.cjco.2021.09.006
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