Effect of Systemic Hypertension With Versus Without Left Ventricular Hypertrophy on the Progression of Atrial Fibrillation (From the Euro Heart Survey)

Hypertension is a risk factor for both progression of atrial fibrillation (AF) and development of AF-related complications, i.e. major adverse cardiac and cerebrovascular events (MACCE). It is unknown whether left ventricular hypertrophy (LVH) as a consequence of hypertension is also a risk factor for both these endpoints. We aimed to assess this in low-risk AF patients, also assessing sex related differences. We included 799 patients from the Euro Heart Survey with non-valvular AF and a baseline echocardiogram. Patients with and without hypertension were included. Endpoints after 1 year were occurrence of AF progression, i.e. paroxysmal AF becoming persistent/permanent AF, and MACCE. Echocardiographic LVH was present in 33% of 379 hypertensive patients. AF progression after 1 year occurred in 10.2% of 373 patients with rhythm follow-up. In hypertensive patients with LVH, AF progression occurred more frequently as compared to hypertensive patients without LVH (23.3% vs. 8.8%, p=0.011). Amongst hypertensive AF patients, LVH was the most important multi-variably adjusted determinant of AF progression on multivariable logistic regression (Odds Ratio 4.84, 95% Confidence Interval 1.70-13.78, p=0.003). This effect was only seen in male patients (27.5% vs. 5.8%, p=0.002), while in female hypertensive patients, no differences were found in AF progression rates regarding the presence or absence of LVH (15.2% vs. 15.0%, p=0.999). No differences were seen in MACCE for hypertensive patients with and without LVH. In conclusion, in men with hypertension, LVH is associated with AF progression. This association seems to be absent in hypertensive women.