Abstract: AIM The aim of this study was to explore follow-up events in patients with paroxymal atrial fibrillation (AF) and to analyze risk factors which influence AF progression. METHODS A total of 216 patients with paroxysmal AF were retrospective analyzed. In the present investigation, there was observation of the main endpoint (AF progression) and clinical events, including stroke, cardiac dysfunction, rehospitalization, and bleeding. Patients were divided into paroxysmal AF group (n=87) and AF progression group (n=129). Nested case-control study was used for univariate and multivariate analysis (logistic regression model) to explore risk factors which influnence AF progression. RESULTS 87 patients with paroxysmal AF progressed to persistent AF or permanent AF during follow-up period (3.45 years, median). The totle rate of AF progression was 40.2% and the annual rate was 11.7%. AF progression group had higher rate of stroke, cardiac dysfunction, and rehospitalization (17% vs. 6%, 18% vs. 5%, 37% vs. 17%, P<0.05, P<0.01, P<0.01). There were no statistical differences of death and bleeding (P>0.05). Multivariate analysis showed that age (OR 1.082, 95%CI 1.016-1.392, P<0.05), LAD>45 mm (OR 2.339, 95%CI 1.445-3.785, P<0.05). CHADS2 score>3 (OR 1.382, 95%CI 1.081-1.987, P<0.05) and hs-CRP (OR 1.124, 95%CI 1.005-2.345, P<0.05) were independent risk factors to predict AF progression. CONCLUSION Age, LAD>45 mm, CHADS2 score>3 and level of hs-CRP are independent risk factors to predict AF progression.