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December 27, 1985, Vol 254, No. 24 >
ARTICLE | December 27, 1985

Characteristics and Prognosis of Lone Atrial Fibrillation: Title and subTitle Break30-Year Follow-up in the Framingham Study FREE

Frederick N. Brand, MD; Robert D. Abbott, PhD; William B. Kannel, MD; Philip A. Wolf, MD
[+] Author Affiliations

Reprint requests to Framingham Heart Study, 118 Lincoln St, Framingham, MA 01701 (Dr Brand).


JAMA. 1985;254(24):3449-3453. doi:10.1001/jama.1985.03360240061035
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References

In 30 years of follow-up of 5,209 participants in the Framingham Study, 193 men and 183 women developed atrial fibrillation (AF). Among this group, "lone" AF occurred in 32 men and 11 women free of coronary heart disease, congestive heart failure, rheumatic heart disease, and hypertensive cardiovascular disease. To determine the characteristics and prognosis of lone AF, each case was matched to controls in the remaining Framingham sample. Comparisons indicated that levels of several risk factors associated with coronary heart disease were similar between the two groups. Atrial fibrillation cases, however, had significantly higher rates of preexisting nonspecific T- or ST-wave abnormalities and intraventricular block as determined by electrocardiograms. Follow-up for new cardiovascular events indicated similar rates of coronary heart disease and congestive heart failure, but the rate of strokes was significantly greater in the lone AF group. Findings suggest that subjects with lone AF, despite similar cardiovascular risk profiles to normal controls, have a distinct preponderance of preexisting electrocardiographic abnormalities. Furthermore, contrary to general belief, lone AF is not a benign condition; it has a serious prognosis, indicating a greater need for detection and treatment.

(JAMA 1985;254:3449-3453)

REFERENCES

1 +
Neufeld HN, Wagenvoort CA, Burchell HB, et al:  Idiopathic atrial fibrillation . Am J Cardiol 1961;;8:193-197.
2 +
Levine SA:  Benign atrial fibrillation of 40 years duration with sudden death from emotion . Ann Intern Med 1963;;58:681-684.
3 +
Godtfredsen J: Atrial Fibrillation, Etiology, Course, and Prognosis: A Follow-up Study of 1,212 Cases . Copenhagen, Munksgaard International Publishers, 1975;.
4 +
Godtfredsen J, Egeblad H, Berning J:  Echocardiography in lone atrial fibrillation . Acta Med Scand 1983;;213:111-113.
5 +
Kannel WB, Abbott RD, Savage DD, et al:  Epidemiologic features of chronic atrial fibrillation . N Engl J Med 1982;;306:1018-1022.
6 +
Dawber TR, Kannel WB, Lyell LP:  An approach to longitudinal studies in a community: The Framingham Study . Ann NY Acad Sci 1963;;107:539-556.
7 +
Gordon T, Moore FE, Shurtleff D, et al:  Some methodologic problems in the long term study of cardiovascular diseases: Observations from the Framingham Study . J Chronic Dis 1959;;10:186-206.
8 +
Marriot HJL, Myerburg RJ:  Atrial fibrillation , in Hurst JW (ed): The Heart: Arteries and Veins , ed 4. New York, McGraw-Hill International Book Co, 1978;, pp 663-665.
9 +
Sorlie P: Cardiovascular Disease and Death Following Myocardial Infarction and Angina Pectoris: Framingham Study: 20 Year Follow-up , Dept of Health, Education, and Welfare publication 77-1247. National Institutes of Health, 1977;,  section 32 .
10 +
Shurtleff D: Some Characteristics Related to the Incidence of Cardiovascular Disease and Death: Framingham Study: 18 Year Follow-up , Dept of Health, Education, and Welfare publication 74-599. National Institutes of Health, 1977;,  section 30 .
11 +
Breslow NE, Day NE: Statistical Methods in Cancer Research , scientific publication No. 32. Lyon, France, International Agency for Research on Cancer, 1980;, vol 1, pp 169-176.
12 +
Neter J, Wasserman W: Applied Linear Statistical Models . Homewood, II, Richard D Irwin Inc, 1974;, pp 214-268.
13 +
Cox DR:  Regression models and life-tables . J R Stat Soc 1972;;34:187-220.
14 +
Phillips E, Levine SA:  Auricular fibrillation without other evidence of heart disease . Am J Med 1949;;7:478-489.
15 +
Willios FA, Dry TJ:  The prognosis of auricular fibrillation of undetermined origin . JAMA 1941;;117:330-332.
16 +
Evans W, Swann P:  Lone auricular fibrillation . Br Heart J 1954;;16:189-194.
17 +
Singer K, Lundberg WB:  Ventricular arrhythmias associated with ingestion of alcohol . Ann Intern Med 1972;;77:247-248.
18 +
Greenspan AJ, Stang JM, Lewis RP, et al:  Provocation of ventricular tachycardia after consumption of alcohol . N Engl J Med 1979;; 301:1049-1050.
19 +
Ettinger PO, Wu CF, DeLaCruz C, et al.  Arrhythmias and the 'holiday heart': Alcohol associated cardiac rhythm disorders . Am Heart J 1976;;555:562.
20 +
Demakis JG, Proskey A, Rahimtoola SH, et al:  The natural course of alcoholic cardiomyopathy . Ann Intern Med 1974;;80:293-297.
21 +
Wolf PA, Dawber TR, Thomas HE Jr, et al:  Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: The Framingham Study . Neurology 1978;;28:973-977.
22 +
Wolf PA, Kannel WB, McGee DL, et al:  Duration of atrial fibrillation and imminence of stroke: The Framingham Study . Stroke 1983;; 14:664-667.
23 +
Close JB, Evans DW, Bailey SM:  Persistent lone atrial fibrillation: Its prognosis after clinical diagnosis . J R Coll Gen Pract 1979;; 29:547-549.
24 +
Thornton JR:  Atrial fibrillation in healthy non-alcoholic people after an alcoholic binge . Lancet 1984;;2:1013-1014.
25 +
Hinton RC, Kistler JP, Fallon JT, et al:  Influence of etiology of atrial fibrillation on incidence of systemic embolism . Am J Cardiol 1977;;40:509-513.
26 +
 Cerebral embolism . Lancet 1985;;1:29.
27 +
Cerebral Embolism Study Group:  Immediate anticoagulation of embolic stroke: A randomized trial . Stroke 1983;;14:668-776.
28 +
Colgan T, Wenger N:  Atrial fibrillation and cerebrovascular events in patients with nonrheumatic heart disease , in Hurst JW (ed): Clinical Essays on the Heart . New York, McGraw-Hill International Book Co, 1984;, pp 141-157.
29 +
Lamb LE, Pollard LW:  Atrial fibrillation in flying personnel . Circulation 1964;;29:694-701.

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1 +
Neufeld HN, Wagenvoort CA, Burchell HB, et al:  Idiopathic atrial fibrillation . Am J Cardiol 1961;;8:193-197.
2 +
Levine SA:  Benign atrial fibrillation of 40 years duration with sudden death from emotion . Ann Intern Med 1963;;58:681-684.
3 +
Godtfredsen J: Atrial Fibrillation, Etiology, Course, and Prognosis: A Follow-up Study of 1,212 Cases . Copenhagen, Munksgaard International Publishers, 1975;.
4 +
Godtfredsen J, Egeblad H, Berning J:  Echocardiography in lone atrial fibrillation . Acta Med Scand 1983;;213:111-113.
5 +
Kannel WB, Abbott RD, Savage DD, et al:  Epidemiologic features of chronic atrial fibrillation . N Engl J Med 1982;;306:1018-1022.
6 +
Dawber TR, Kannel WB, Lyell LP:  An approach to longitudinal studies in a community: The Framingham Study . Ann NY Acad Sci 1963;;107:539-556.
7 +
Gordon T, Moore FE, Shurtleff D, et al:  Some methodologic problems in the long term study of cardiovascular diseases: Observations from the Framingham Study . J Chronic Dis 1959;;10:186-206.
8 +
Marriot HJL, Myerburg RJ:  Atrial fibrillation , in Hurst JW (ed): The Heart: Arteries and Veins , ed 4. New York, McGraw-Hill International Book Co, 1978;, pp 663-665.
9 +
Sorlie P: Cardiovascular Disease and Death Following Myocardial Infarction and Angina Pectoris: Framingham Study: 20 Year Follow-up , Dept of Health, Education, and Welfare publication 77-1247. National Institutes of Health, 1977;,  section 32 .
10 +
Shurtleff D: Some Characteristics Related to the Incidence of Cardiovascular Disease and Death: Framingham Study: 18 Year Follow-up , Dept of Health, Education, and Welfare publication 74-599. National Institutes of Health, 1977;,  section 30 .
11 +
Breslow NE, Day NE: Statistical Methods in Cancer Research , scientific publication No. 32. Lyon, France, International Agency for Research on Cancer, 1980;, vol 1, pp 169-176.
12 +
Neter J, Wasserman W: Applied Linear Statistical Models . Homewood, II, Richard D Irwin Inc, 1974;, pp 214-268.
13 +
Cox DR:  Regression models and life-tables . J R Stat Soc 1972;;34:187-220.
14 +
Phillips E, Levine SA:  Auricular fibrillation without other evidence of heart disease . Am J Med 1949;;7:478-489.
15 +
Willios FA, Dry TJ:  The prognosis of auricular fibrillation of undetermined origin . JAMA 1941;;117:330-332.
16 +
Evans W, Swann P:  Lone auricular fibrillation . Br Heart J 1954;;16:189-194.
17 +
Singer K, Lundberg WB:  Ventricular arrhythmias associated with ingestion of alcohol . Ann Intern Med 1972;;77:247-248.
18 +
Greenspan AJ, Stang JM, Lewis RP, et al:  Provocation of ventricular tachycardia after consumption of alcohol . N Engl J Med 1979;; 301:1049-1050.
19 +
Ettinger PO, Wu CF, DeLaCruz C, et al.  Arrhythmias and the 'holiday heart': Alcohol associated cardiac rhythm disorders . Am Heart J 1976;;555:562.
20 +
Demakis JG, Proskey A, Rahimtoola SH, et al:  The natural course of alcoholic cardiomyopathy . Ann Intern Med 1974;;80:293-297.
21 +
Wolf PA, Dawber TR, Thomas HE Jr, et al:  Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: The Framingham Study . Neurology 1978;;28:973-977.
22 +
Wolf PA, Kannel WB, McGee DL, et al:  Duration of atrial fibrillation and imminence of stroke: The Framingham Study . Stroke 1983;; 14:664-667.
23 +
Close JB, Evans DW, Bailey SM:  Persistent lone atrial fibrillation: Its prognosis after clinical diagnosis . J R Coll Gen Pract 1979;; 29:547-549.
24 +
Thornton JR:  Atrial fibrillation in healthy non-alcoholic people after an alcoholic binge . Lancet 1984;;2:1013-1014.
25 +
Hinton RC, Kistler JP, Fallon JT, et al:  Influence of etiology of atrial fibrillation on incidence of systemic embolism . Am J Cardiol 1977;;40:509-513.
26 +
 Cerebral embolism . Lancet 1985;;1:29.
27 +
Cerebral Embolism Study Group:  Immediate anticoagulation of embolic stroke: A randomized trial . Stroke 1983;;14:668-776.
28 +
Colgan T, Wenger N:  Atrial fibrillation and cerebrovascular events in patients with nonrheumatic heart disease , in Hurst JW (ed): Clinical Essays on the Heart . New York, McGraw-Hill International Book Co, 1984;, pp 141-157.
29 +
Lamb LE, Pollard LW:  Atrial fibrillation in flying personnel . Circulation 1964;;29:694-701.

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