Over the past years, prevention and control of risk factors has begun to play an important role in the management of patients prone to develop atrial fibrillation (AF). A considerable number of risk factors that contribute to the creation of a predisposing substrate for AF has been identified over the years. Although certain AF risk factors such as age, gender, genetic predisposition, or race are unmodifiable, controlling modifiable risk factors may represent an invaluable tool in the management of AF patients. In the recent decades, numerous studies have evaluated the mechanisms linking different risk factors to AF, but the exact degree of atrial remodeling induced by each factor remains unknown. Elucidating these mechanisms is essential for initiating personalized therapies in patients prone to develop AF. The present review aims to provide an overview of the most relevant modifiable risk factors involved in AF occurrence, with a focus on the mechanisms by which these factors lead to AF initiation and perpetuation.
Tag Archives: atrial fibrillation
COPD – Risk Factor for Complex Chronic Comorbidities, a Retrospective Case-Control Study
Background: Increasing evidence indicates that chronic obstructive pulmonary disease (COPD) is a complex disease involving more than airflow obstruction. Systemic inflammation can initiate or worsen comorbid diseases, such as ischemic heart disease, heart failure, arrhythmia, diabetes, osteoporosis, lung cancer and depression.
Material and method: We explored the Medprax database, from an ambulatory care in order to obtain rates of comorbidities in COPD patients. Medprax electronic database is a locally developed system designed to fulfil the requirements of an integrated healthcare system. We identified a population of 9,659 patients (4472 men and 5187 women) aged ≥ 30 years registered between 01.01.2000 and 01.02.2010.
Results: The overall prevalence of COPD was 5.17% (384 men and 116 women). Compared to the non-COPD patients, COPD was found to be a significant risk factor in both sexes for cardiovascular events: ischemic heart disease (OR = 3.06, 95%CI 2.54–3.68), atrial fibrillation (OR = 2.70, 95%CI 2.12–3.43) and heart failure (OR = 4.49, 95%CI 3.74–5.40) regardless of age. Association with diabetes mellitus type 2 was extremely significant in COPD men (OR = 1.69, 95%CI 1.26–2.27), but not in COPD women. Significant correlation with osteoporosis (OR = 3.26, 95%CI 1.94–5.48) was found only in women over 60 years and men under 60. Pulmonary malignancy was found only in male COPD patient compared to non-COPD patients (OR = 5.04, 95%CI 2.02–12.44). The impact on
depressive disorders was noted only in younger COPD men (OR = 5.71, 95%CI 1.94–16.82).
Conclusions: Our results indicate that COPD is a risk factor for all these comorbid conditions and that in the management of COPD all these conditions need to be carefully evaluated.
Atrial Fibrillation, the First Manifestation of Atrial Myxoma
Introduction: Atrial myxomas are the most common primary heart tumors. Although quite rare, left atrial myxomas account for 80% of all cardiac tumors. Diagnosis is often difficult due to the wide array of presenting symptoms. This case report discusses an unusual presentation of left atrial myxoma in an elderly patient.
Case presentation: A 73-year old woman with a history of hypertension, dyslipidemia and hyperthyroidism treatment presented to the emergency department with a new onset episode of palpitations. The electrocardiogram revealed atrial fibrillation. Rate control was achieved with beta-blockers and sinus rhythm transition was achieved shortly after admission. Transthoracic echocardiography revealed a heterogeneous mass in the left atria with a villous surface, occupying more than 50% of the left atrial cavity. Surgery was recommended because of the embolic potential of such a mass and tumor excision was performed. Microscopic pathology showed typical histological features of cardiac myxoma with no atypia or malignancy, and the patient was discharged in sinus rhythm 7 days after surgery.
Discussion and conclusions: Left atrial myxoma presenting in the seventh decade of life is rare. Elderly patients often present with non- specific symptoms that are often overlooked in the absence of a supporting cardiac history, which makes an early diagnosis challenging. We conclude that the majority of myxomas mimic many cardiovascular diseases and were detected in symptomatic patients, so a high index of clinical suspicion is important for its early and correct diagnosis. Two-dimensional echocardiography provides substantial advantages in detecting intracardiac tumors.
Therapeutical Features of Permanent Atrial Fibrillation in Hypertensive Elderly Patients
Introduction: The atrial fibrillation is a form of arrhythmia, which occurs most frequently among the aged and which often influences the therapy prescribed to them.
Material and methods: The present study addresses to a focus group of 79 hypertensive elderly patients, hospitalized at the Internal Medicine Clinic of Targu Mures during the year 2007. The parameters taken into consideration were distribution by age groups, gender, the existence of atrial fibrillation or other comorbidities and the administrated therapy.
Results: The distribution by age groups and gender reveals a higher number of hypertensive patients between 70 and 75 years and a more frequent affection of male patients. The associated comorbidities to our group of 28 patients with atrial fibrillation were cardiac ischemic disease (13 patients), heart failure (2 patients), both of these (6 patients) and chronic obstructive lung disease (7 patients). The medication administrated for the rate control consists of: beta-blocker in almost 50% of cases (13 out of 28 patients), digitalis (2 patients), and beta-blocker+digitalis for 6 patients. In 7 cases the rate control medication was not required.
Conclusions: The atrial fibrillation is a common condition among the hypertensive elders, and not infrequently associated with other cardiac comorbidities which contribute to the choice of appropriate medication.
Atrial Fibrillation In Acute Myocardial Infarction
Background: Although atrial fibrillation (AF) is a common complication of acute myocardial infarction (MI), patients characteristics and association with outcomes remain poorly defined.
Material and method: A prospective study of 341 consecutive patients admitted to the conducted in the Clinic of Cardiology – Institute of Cardiovascular Diseases Tg Mures – from 31 Jan 08 to 31 Dec 10 with ST-segment elevation myocardial infarction. Patients underwent routine clinical exam, lab tests, echocardiogram.
Results: The incidence of atrial fibrillation complicating myocardial infarction was 11.6%. Statistically significant correlations were found between atrial fibrillation and age (p <0.001), smoking (p <0.01), and mitral regurgitation (p <0.05).
Conclusions: Post-MI AF is more common in older patients, in patients with heart failure, and after more extensive infarction. AF is a common complication of acute MI in smoking patients and in patients with significant mitral regurgitation.
Incidence of Stroke and CHADS2 Score in Patients with Paroxysmal, Persistent or Permanent Atrial Fibrillation: Prognosis at 1 Year of Follow-Up
Objectives: our main endpoints were to determine the incidence of fatal or nonfatal stroke either ischemic or hemorrhagic or transient ischaemic attack, associated with paroxysmal versus persistent and permanent atrial fibrillation (AF), in patients receiving oral anticoagulation therapy (OAC) compared to antiplatelet group, and to test the accuracy of CHADS2 score for the prediction of tromboembolic and hemorrhagic complications, at one year follow up. Secondary endpoints were the hospitalization rate, case fatality at one year and rate of progression of paroxysmal to persistent/permanent AF.
Material and methods: we performed a retrospective (2007–2008) observational study on 468 patients admitted to our department with paroxysmal, persistent and permanent nonvalvular AF, on oral anticoagulation or antiplatelet therapy. We compared the incidence of thromboembolic and hemorrhagic events in patients with paroxysmal AF, persistent and permanent AF, and in patients undergoing anticoagulation versus antiplatelet therapy.
Results: we found a statistically difference between the group of patients treated with OAC and the one treated with antiplatelet therapy in favor for the OAC group of AF in what concerns one year rate of stroke. We also found a statistical difference between the CHADS2 score values and the rate of stroke after during one year.
Conclusions: permanent form of atrial fibrillation carries a higher risk of tromboembolic events than persistent and paroxysmal AF. OAC therapy is superior to platelet therapy in all forms of cardiac arrhythmia in preventing the tromboembolic events. CHADS2 score is a good predictor for stroke.
The Risk/Benefit Analysis of Oral Anticoagulant Treatment in Atrial Fibrillation Using HAS-BLED and CHA2DS2-VASc Score
Introduction. The purpose of this study is to evaluate the risk and the benefit of oral anticoagulant treatment in nonvalvular atrial fibrillation (AF) patients, using the two scores recommended by the guidelines: the CHA2DS2-VASc score and HAS-BLED score.
Material and method. We conducted a retrospective observational study on 144 patients with nonvalvular atrial fibrillation, admitted between 1st of July 2013 and 30th September 2013 in the 3rd Medical Clinic of Tîrgu Mureș with a prospective follow-up at 6 months. Based on the data collected from the patient charts, the thromboembolic risk was assessed using the CHA2DS2-VASc score and the hemorrhage risk was assessed using the HAS-BLED score. At 6 months, the patients were contacted via telephone and were questioned regarding their state of health, the existence of hospitalizations in the last 6 months, the international normalized ratio (INR) value, the existence of hemorrhagic or thromboembolic events.
Results. The group of patients was composed of 70 female and 74 male with the mean age of 70 ±11 years. From the total number of patients 13 (11.7%) had a history of stroke and the CHA2DS2-VASc score revealed that these 13 were in the high risk class. The presence of arterial hypertension and vascular disease were statistically associated with stroke. Hemorrhagic events were encountered in 19 patients (13.19%) and 16 of them had a higher than 3 HAS-BLED score. A history of bleeding, anemia and labile INR were the factors statistically associated with bleeding.
Conclusions. The CHA2DS2-VASc score is useful in stratifying patients with AF in risk groups for thromboembolic events while the HAS-BLED score proved to be a useful tool in predicting bleeding events in anticoagulated patients.
The Grade of Left Ventricular Diastolic Dysfunction as a Predictive Factor for Permanent Atrial Fibrillation
The objective of this study was to find a link between the grade of left ventricular diastolic dysfunction (LVDD) and the progression to permanent non-valvular atrial fibrillation (AF), in a group of patients with left ventricular diastolic dysfunction and paroxysmal or persistent atrial fibrillation.
Methods: A bidirectional study on 57 patients meeting the inclusion criteria was conducted; each patient was admitted in a university -based hospital between January 1st – June, 30, 2013, with a follow up 3 and 6 months later. Permanent atrial fibrillation development was followed.
Results: Out of the 57 patients, 23 had paroxysmal AF and 34 were with persistent AF. After six months, 21 patients progressed to permanent AF, representing 36.84% of the total patients. Female patients with age over 65 had more often atrial fibrillation, but more men progressed to a sustained form of AF. No statistically significant difference regarding the grade of diastolic dysfunction, the left atrial size or volume, or the left ventricular ejection fraction was observed between the patients with progression, compared to those without progression.
Conclusions: The grade of left ventricular diastolic dysfunction did not prove to be a predictive factor for permanent atrial fibrillation, neither the left atrial size or volume, or the left ventricular ejection fraction.