Non-paroxysmal atrial fibrillation is associated with a highly significant increase in thromboembolism and death .
AIMS Thromboembolic risk stratification schemes and clinical guidelines for atrial fibrillation ( AF ) regard risk as independent of classification into paroxysmal ( PAF ) and non-paroxysmal atrial fibrillation ( NPAF ) .
The aim of the current study was to conduct a systematic review evaluating the impact of AF type on thromboembolism , bleeding , and mortality .
Thromboembolic event rate in paroxysmal and persistent atrial fibrillation: Data from the GISSI-AF trial
Background Few data on the thromboembolic ( TE ) risk of paroxysmal and persistent atrial fibrillation ( AF ) are available . This study aim ed to assess the incidence of TE events in paroxysmal and persistent AF . Methods We performed a subset post hoc analysis of 771 patients with paroxysmal and 463 with persistent AF enrolled in the multicenter , prospect i ve , r and omized , double-blind , placebo-controlled GISSI-AF trial - comparing the efficacy of valsartan versus placebo in preventing AF recurrences – where the choice of antithrombotic treatment was left to the judgment of the referring physician . TE and major outcome events were central ly vali date d. AF recurrences were detected by frequent clinic visits and a transtelephonic monitoring device with weekly and symptomatic transmissions . Results Eighty-five percent of patients had a history of hypertension , and the 7.7 % had heart failure , left ventricular dysfunction , or both .  The mean CHADS2 score was 1.41±0.84 . TE and major bleeding events were observed at a low incidence among the overall population at 1-year follow-up ( 0.97 % and 0.81 % , respectively ) . The univariate and multivariable analyses revealed no statistically significant differences in the incidence of TE , major bleeding events or mortality in paroxysmal and persistent AF patients . TE events were more common among women than men ( p=0.02 ) . The follow-up examination showed under- or overtreatment with warfarin in many patients , according to guideline suggestions . Warfarin was more frequently prescribed to patients with persistent AF ( p<0.0001 ) and patients with AF recurrences ( p<0.0001 ) . AF recurrences were noninvasively detected in 632 ( 51.2 % ) patients . In patients without AF recurrences , the TE event rate was 0.5 % versus 1.74 % , 1.28 % , and 1.18 % for those with only symptomatic , only asymptomatic or both symptomatic and asymptomatic AF recurrences , respectively , but the difference was not statistically significant , even after adjusting for warfarin treatment and the CHADS2 score ( HR 2.93 ; CI 95 % ; 0.8 - 10.9 ; p=0.11 ) . Conclusions TE and major bleeding events showed a very low incidence in the GISSI-AF trial population , despite under- or overtreatment with warfarin in many patients . TE events had a similar rate in paroxysmal and persistent AF.Trial registration Trial registration number :
Non-paroxysmal atrial fibrillation is associated with a highly significant increase in thromboembolism and death .
AIMS Thromboembolic risk stratification schemes and clinical guidelines for atrial fibrillation ( AF ) regard risk as independent of classification into paroxysmal ( PAF ) and non-paroxysmal atrial fibrillation ( NPAF ) .
The aim of the current study was to conduct a systematic review evaluating the impact of AF type on thromboembolism , bleeding , and mortality .