Risk Profile for Atrial Fibrillation

Primary Outcome Measures:

• assess the risk profile associated with success of rhythm control therapy at follow-up. [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  1) < 1 second AF on end-of-study ECG; (2) < 30 seconds AF on end-of-study 48-hour Holter recording
  
  

Secondary Outcome Measures:

• Time to recurrence of (a)symptomatic AF; [ Time Frame: 1+12+60 months ] [ Designated as safety issue: Yes ]
  by assessment Percentage AF-burden on 24-Holter during follow up
  
  
• Failure of rhythm control, i.e. permanent AF; [ Time Frame: 1+12+60 months ] [ Designated as safety issue: Yes ]
  <1 second AF on ECG during rhythm control medication or after electric cardioversion.
  
  
• Risk profiles associated with early versus late AF recurrence; [ Time Frame: 1+12+60 months ] [ Designated as safety issue: Yes ]
  Parameters including underlying (heart) disease and risk factors (age, family history for AF, signs of ischemia, coronary risk factors, pulmonary disease, diabetes, obesity, sleep apnea, esophageal problems), lifestyle (caffeine and alcohol intake, exercise), autonomic trigger patterns of AF (i.e. vagal or adrenergic induced AF, or combination)
  
  
• Progression of paroxysmal AF to persistent or permanent AF and of persistent AF to permanent AF [ Time Frame: 1+12+60 months ] [ Designated as safety issue: Yes ]
  3-lead Holter monitoring will be used
  
  
• Changes in atrial and ventricular echocardiographic parameters [ Time Frame: 1+12+60 month ] [ Designated as safety issue: Yes ]
  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
  
  
• Cardiovascular morbidity and mortality [ Time Frame: 1+12+60 months ] [ Designated as safety issue: Yes ]
  hospitalization for cardiovascular reasons, non-cardiovascular and cardiovascular death will be carefully monitored through-out the study.
  
  
• Pulmonary vein ablation [ Time Frame: 1+12+60 months ] [ Designated as safety issue: Yes ]
  hospital admission for pulmonary vein ablation will be monitoring during the study.
  
  
• Differences in clinical profile and outcome between patients presenting at the emergency room and the outpatient department [ Time Frame: Baseline,12+60 months ] [ Designated as safety issue: Yes ]
  collected parameters will be compared between these two groups.
  
  
• relate risk profiles to quality of life [ Time Frame: 1+12+60 months ] [ Designated as safety issue: Yes ]
  a quality of life questionnaire will be handed
  
  
• biomarkers associated with success of rhythm control [ Time Frame: baseline, 12 months, 60 months ] [ Designated as safety issue: No ]
  biomarker profiles (collagen mediated, inflammation, neurohumoral) associated with underlying mechanism of AF
  
  

Atrial fibrillation is responsible for substantial morbidity and mortality.Identification of patients with AF that is difficult to treat may improve the outcome of rhythm control therapy. Left atrial size or volume 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 seems also plausible that recurrent atrial fibrillation within one month after start of rhythm control is associated with a different risk profile than late atrial fibrillation recurrences.During this study we will try to identify patients with atrial fibrillation who are more or less likely to respond to rhythm control therapy.