|
Study |
Year |
Lone AF definition |
Number of patients |
Age >60 years (%) |
Follow-up |
Main findings |
Main conclusions |
'Lone' AF is a benign condition |
1 |
Evans et al. [2] |
1954 |
Non-paroxysmal AF without heart disease or thyroid toxaemia |
20 (all males) |
50 |
10 years (4 pts), 20 years (2 pts) |
No adverse events (i.e., HF, TE or death) |
A benign disorder with normal life expectancy; rate control with digitalis if needed |
Yes |
2 |
Brand et al. [52] |
1985 |
AF in patients free of CAD, CHF, rheumatic and hypertensive heart disease* |
43 (32 males) |
56 |
30 years |
A fivefold greater risk of stroke vs. age- and sex-matched controls; a similar CAD and CHF rates |
'Lone' AF patients have significantly greater stroke rates and a distinct preponderance of preexisting ECG abnormalities (e.g., interventricular block and ST-T changes) |
No |
3 |
Kopecky et al. [53] |
1987 |
AF in the absence of overt cardiovascular disease or precipitating illness |
97 (gender not reported) |
0 |
14.8 years per patient |
94% probability of survival at 15 years; 1.3% of patients experienced a stroke (stroke rate of 0.55 per 100 person-years), no deaths |
'Lone' AF in patients under 60 years is associated with a very low risk of stroke, suggesting that routine anticoagulation may not be warranted |
Yes |
4 |
Davidson et al. [54] |
1989 |
AF in patients free of CAD, CHF, rheumatic and hypertensive heart disease |
32 (19 males) |
0 |
Mean 4.9 years (2–16) |
No progression to permanent AF, CHF or CAD development; one patient experienced a stroke (stroke rate of 0.64 per 100 person-years) |
Most 'lone' AF patients have symptomatic paroxysmal AF, normal left atrial size and a low rate of stroke |
Yes |
5 |
Rostagno et al. [55] |
1995 |
No clinical evidence of any organic cardiac disease† |
106 (43 males) |
? (43 pts older than 70) |
Mean 6 years (1–138 months) |
Progression to permanent AF in five patients (4.7%); five patients had stroke (stroke rate of 1% per year); mortality similar to age-matched controls |
Low rates of progression to permanent AF, stroke and mortality; the cumulative survival rate of 78% at 8 years; mortality higher in elderly, but not greater than age-matched mortality derived from life-insurance data |
Yes |
6 |
Scardi et al. [56] |
1999 |
No evidence of organic heart disease |
145 (118 males) |
0% All younger than 50 |
Mean 10 years (1–35) |
Progression to chronic AF in 23% patients; the rate of TE was 3.1% vs. 16.3% (0.36 vs. 1.3 per 100 person-years) in patients with paroxysmal vs. chronic AF; CHF (one patient) and death (three patients) occurred only in chronic AF |
The prognosis of 'lone' AF is not homogenous – it appears to be excellent in young individuals with the paroxysmal form, whilst chronic 'lone' AF confers an increased risk of embolic complications and increased mortality rates |
Yes/No Yes, if paroxysmal No, if chronic AF |
7 |
Jouven et al. [57] |
1999 |
No clinical evidence of any heart disease‡ |
25 (gender not reported) |
0 |
Average 23 years |
Individuals with 'lone' AF had a fourfold cardiovascular death rate (32% vs. 8%), the same non-cardiovascular death rate (20% vs. 21%) and higher total death rate (52% vs. 29%) vs. controls |
'Lone' AF is associated with an increased mortality and clearly requires clinical attention; could be the first sign of an underlying cardiovascular disorder |
No |
8 |
Rienstra et al. [63] |
2004 |
AF without any underlying disease (i.e. CAD, valvular disease, HF, cardiomyopathy, congenital heart disease, hypertension, previous TE events, diabetes mellitus or previous thyrotoxicosis)§ |
89 (75 males) |
? Mean age 65 ± 10 |
Mean 2.3 years |
As compared to AF patients with a concomitant cardiac disease, 'lone' AF patients scored higher on 7 of 8 SF-36 scales; 3 'lone' AF patients died (3%) vs. 33 (8%) controls (all three 'lone' AF patients died from bleeding during the OAC use); TE complications occurred in 2% of 'lone' AF patients vs. 8% of those with a comorbidity; no CHF occurred in the 'lone' AF group |
QoL was almost comparable to healthy controls; cardiovascular morbidity and mortality uncommon (and predominantly caused by bleeding); elderly 'lone' AF patients have a favourable outcome and higher QoL as compared to AF patients with comorbiditiesThe rate vs. rhythm analyses: the number of end-points was low in both strategies but twice as low in patients randomised to rhythm control |
Yes |
9 |
Jahangir et al. [58] |
2007 |
AF with no concomitant heart disease or hypertension |
76 (59 males) |
0 |
Mean 25 years |
A 30-year progression to permanent AF was 29%; the overall survival was similar to age- and sex-matched Minnesota population; the probability of survival free of CHF was 97% and 85% at 15 and 30 years, respectively, and the probability of survival free of stroke was 94% and 88% at 15 and 25 years, respectively (similar to the expected rates) |
Age at diagnosis was the sole multivariable risk factor for stroke, total mortality and cardiac mortality All patients who experienced stroke had developed ≥ 1 stroke risk factor Aging and/or developing other cardiovascular risk factors strongly influences 'lone' AF progression and complications; therefore, screening for comorbidities is essential in 'lone' AF |
Yes, with caution if aged > 45 years at diagnosis or develop cardiovascular risk factors during follow-up |
10 |
Potpara et al. [59] |
2010 |
AF with no evidence of any cardiopulmonary or other disease including hypertension and no obvious cause of a transient 'acute' AF |
442 (gender not reported) |
14.7 |
Mean 11.5 years |
12 deaths (seven non-cardiac and five cardiovascular deaths); low annual rates of any TE, stroke or transitory ischemic episodes (0.44%, 0.21% and 0.18%, respectively), as well as the annual rates of all-cause mortality (0.25%) and cardiovascular mortality (0.10%) |
All-cause and cardiovascular mortality of 'lone' or idiopathic AF patients are similar to mortality rates of the general population in Serbia Close monitoring for prevention (or early detection) of newly developed cardiovascular risk factors is necessary |
Yes, with regular follow-up |
11 |
Potpara et al. [60] |
2012 |
AF in individuals ≤ 60 years old with no evidence of any cardiopulmonary or other disease including hypertension and no obvious precipitating factors for AF |
346 (263 males) |
0 |
Mean 12 years |
Approximately a third of patients developed cardiovascular disorders during follow-up; a 10-year progression to permanent AF was 26.1%; TE events occurred in 14 patients (4.0%); a 10-year survival free of TE was 97.3%, and multivariable risk factors for TE were the development of hypertension or CAD; a 10-year survival free from CHF was 95.9%, and multivariable risk factor for CHF was the progression to permanent AF; only five patients died – the 10-year survival was 99.6% |
A generally favourable prognosis of 'lone' AF; the long-term outcome is strongly influenced by aging and development of underlying heart disease; a thorough screening, prevention and treatment of associated comorbidities is mandatory Progression to permanent AF despite active treatment in young, otherwise apparently healthy AF patients may serve as an additional risk stratification clinical tool to identify those with subclinical cardiac structural alterations and an increased risk for adverse cardiovascular events |
Yes, in young and otherwise healthy individuals |
12 |
Weijs et al. [64] |
2012 |
AF in the absence of any cardiovascular disease or comorbidities |
119 (57 males) |
48 |
1 year |
No significant difference in LA size between older and younger patients; progression to permanent AF in only two patients; no cardiovascular events during 1-year follow-up |
Idiopathic AF may present at advanced age and even then it is not associated with significant atrial enlargement, AF progression or an adverse short-term outcome |
Yes, even in elderly |
13 |
Weijs et al. [65] |
2013 |
AF in the absence of any cardiovascular disease or comorbidities |
45 (27 males) |
? Upper age limit was at 64 years |
Mean 5 years |
CVD occurred significantly more often in idiopathic AF compared with SR controls (49% vs. 20%), most frequently hypertension and CAD; 3 AF (7%) and no SR patients died; there were two strokes (in AF patients); AF patients were significantly younger at the time of CV event (59 ± 9 vs. 64 ± 5 years), and LA diameter increased in 15 AF (75%) vs. eight SR patients |
Idiopathic AF patients develop CVD more often, earlier in time and at younger age compared with healthy SR controls; age, history of AF, and posterior wall width were significant predictors of CVD Detection and treatment of CVD in an early stage could improve the prognosis, and it seems prudent to regularly check idiopathic AF patients for the development of CV disease |
No |
|
|
|
|
Σ 1075¶ |
|
|
7 Yes, 3 No, 3 Yes, with some caution(s) |