Kapak Dışı Atriyal Fibrilasyonda Uzun Dönem Mortalite

Abstract

Giriş: Kapak dışı atriyal fibrilasyonu (AF) olan hastalarda uzun dönemde gerçekleşen tüm sebeplere bağlı ve kardiyovasküler nedenlere bağlı mortaliteyi belirlemeyi amaçladık.

Hastalar ve Yöntem: 1995 ile 2010 yılları arasında kliniğimize başvuran ve kapak dışı AF tanısı konan 352 hasta (153 erkek, 199 kadın; ort. yaş 62; dağılım 34-82) geriye dönük olarak incelendi. Takip süresi 72-176 ay arasında değişmekteydi (ort. 110 ay).

Bulgular: Atriyal fibrilasyon etkeni veya ilişkili durumu olarak hipertansiyon (%51.1), koroner kalp hastalığı (%29.9), kalp yetersizliği (%48.8), diabetes mellitus (%11.9), pulmoner hipertansiyon (%9.9) saptandı. İzlem sırasında 72 hastanın (%21) öldüğü belirlendi. Ölümler 30 hastada (%41.7) kardiyovasküler nedenli, 20 hastada (%27.8) inme kaynaklı, altı hastada (%8.3) ani ölüm idi; 16 hastada (%22.2) ölümler diğer nedenlere (malignite, kaza, infeksiyon vb.) bağlandı.

Sonuç: Kapak dışı AF’li  hastalarda uzun dönemde ana ölüm nedeninin kardiyovasküler kaynaklı olduğu görüldü. 

Keywords

• Kapak dışı atriyal fibrilasyon,mortalite

Long-Term Mortality of Nonvalvular Atrial Fibrillation

Abstract

Introduction: This study sought to determine long-term all-cause mortality and cardiovascular mortality in patients with nonvalvular atrial fibrillation (AF).

Patients and Methods: The study included 352 patients (153 males, 199 females; mean age 62 years; range 34 to 82 years) who presented to our clinic between 1995 and 2010 and were diagnosed with nonvalvular AF. The follow-up ranged from 72 to 176 months (mean 110 months).

Results: The causes or associated conditions of AF were hypertension (51.1%), coronary heart disease (29.9%), heart failure (48.8%), diabetes mellitus (11.9%), and pulmonary hypertension (9.9%). Seventy-two patients (21%) died during the follow-up period. Cardiovascular death was noted in 30 patients (41.7%). Sudden death was seen in six patients (8.3%). Death from stroke occurred in 20 patients (27.8%), and 16 patients (22.2%) died of other causes (malignancies, accidents, infectious causes, etc.).

Conclusion: The major cause of death was of cardiovascular origin in patients with nonvalvular AF.

Keywords

• Nonvalvular atrial fibrillation,mortality

References

1. 1. Stewart S, Hart CL, Hole DJ, McMurray JJ. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study. Heart 2001;86:516-21.
2. 2. Heeringa J, van der Kuip DA, Hofman A, Kors JA, van Herpen G, Stricker BH, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006;27:949-53.
3. 3. Naccarelli GV, Varker H, Lin J, Schulman KL. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 2009;104:1534-9.
4. 4. Kirchhof P, Auricchio A, Bax J, Crijns H, Camm J, Diener HC, et al. Outcome parameters for trials in atrial fibrillation: executive summary. Eur Heart J 2007;28:2803-17.
5. 5. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983-8.
6. 6. Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825-33.
7. 7. Roy D, Talajic M, Dubuc M, Thibault B, Guerra P, Macle L, et al. Atrial fibrillation and congestive heart failure. Curr Opin Cardiol 2009;24:29-34.
8. 8. Levy S, Maarek M, Coumel P, Guize L, Lekieffre J, Medvedowsky JL, et al. Characterization of different subsets of atrial fibrillation in general practice in France: the ALFA study. The College of French Cardiologists. Circulation 1999;99:3028-35.

9. 9. Potpara T, Grujić M, Marinković J, Ostojić M, Vujisić-Tesić B, Polovina M, et al. Relationship between mortality of patients with atrial fibrillation and mortality of general population in Serbia [Article in Serbian]. Srp Arh Celok Lek 2010;138:177-85.
10. 10. Li D, Fareh S, Leung TK, Nattel S. Promotion of atrial fibrillation by heart failure in dogs: atrial remodeling of a different sort. Circulation 1999;100:87-95.
11. 11. Shinbane JS, Wood MA, Jensen DN, Ellenbogen KA, Fitzpatrick AP, Scheinman MM. Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol 1997;29:709-15.
12. 12. Nieuwlaat R, Capucci A, Camm AJ, Olsson SB, Andresen D, Davies DW, et al. Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur Heart J 2005;26:2422-34.
13. 13. Nabauer M, Gerth A, Limbourg T, Schneider S, Oeff M, Kirchhof P, et al. The Registry of the German Competence NETwork on Atrial Fibrillation: patient characteristics and initial management. Europace 2009;11:423-34.
14. 14. Goette A, Bukowska A, Dobrev D, Pfeiffenberger J, Morawietz H, Strugala D, et al. Acute atrial tachyarrhythmia induces angiotensin II type 1 receptor-mediated oxidative stress and microvascular flow abnormalities in the ventricles. Eur Heart J 2009;30:1411-20.
15. 15. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369-429.
16. 16. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007;146: 857-67.
17. 17. Britton M, Gustafsson C. Non-rheumatic atrial fibrillation as a risk factor for stroke. Stroke 1985;16:182-8.
18. 18. Candelise L, Pinardi G, Morabito A. Mortality in acute stroke with atrial fibrillation. The Italian Acute Stroke Study Group. Stroke 1991;22:169-74.
19. 19. Sandercock P, Bamford J, Dennis M, Burn J, Slattery J, Jones L, et al. Atrial fibrillation and stroke: prevalence in different types of stroke and influence on early and long term prognosis (Oxfordshire Community Stroke Project). BMJ 1992;305:1460-5.
20. 20. Sage JI, van Uitert RL. Risk of recurrent stroke in patients with atrial fibrillation and non-valvular heart disease. Stroke 1983;14:537-40.
21. 21. Hornig CR, Dorndorf W. Early outcome and recurrences after cardiogenic brain embolism. Acta Neurol Scand 1993;88:26-31.