Clinical evaluation of paroxysmal and permanent atrial fibrillation patients in cardiac inpatient unit: Cross-sectional study

Abstract

Aim: Atrial fibrillation (AF), a supra-ventricular arrhythmia, is characterized by a rapid and irregular heart rate, for which electrocardiography is the diagnostic tool. Hypertension is the most common cause of AF. In this study, we aimed to evaluate the paroxysmal AF and permanent AF patients’ symptoms, medical history, and clinical characteristics in the inpatient unit.

Methods: 115 patients (30 patients with paroxysmal AF and 85 patients with permanent AF) were enrolled in the study. All patients’ detailed histories were taken; physical examination, routine biochemical tests, electrocardiographies, and transthoracic echocardiographies were performed. CHA2DS2-VASc (Congestive heart failure/left ventricular dysfunction, Hypertension, Age ≥75 years, Diabetes Mellitus, Stroke/transient ischemic attack/systemic embolism, Vascular Disease, Age 65-74 years, Sex Category) scores were recorded. 

Results: Permanent AF patients were older (70.0 (10.5) vs 61.4 (15.8); P=0.01) and had a lower ejection fraction (41.0 (11.9) vs 53.3 (11.2); P=0.01) than paroxysmal AF patients. CHA2DS2-VASc scores were similar between the two groups (3.0 (1.5) vs 2.7 (1.3); P=0.24). In hematological analysis, prothrombin time (15.3(1.3-106.4) vs 13.6(11.0-75.5); P=0.03) and international normalized ratio (1.2(0.9-16.0) vs 1.1(0.9-6.0); P=0.01) values were higher in permanent AF patients compared to those with paroxysmal AF. Rhythm regulation was performed to paroxysmal AF patients. Rate regulation was performed significantly more frequently in permanent AF patients than paroxysmal AF patients (74(87%)) vs (12(40%)); P=0.01). 

Conclusion: This study demonstrated that permanent AF patients had more comorbidities compared to paroxysmal AF patients. Rhythm control was the principal treatment strategy in paroxysmal AF, whereas rate control was the treatment of choice in permanent AF.

Keywords

• Paroxysmal atrial fibrillation,Permanent atrial fibrillation,Anticoagulation

Paroksismal ve sürekli atriyal fibrilasyon hastalarının kardiyoloji servisinde klinik olarak değerlendirilmesi: Kesitsel çalışma

Öz

Amaç: Atriyal fibrilasyon (AF) hızlı ve düzensiz kalp atım hızı ile karakterize supra-ventriküler bir aritmidir. Elektrokardiyografi AF için tanı koyma aracıdır. Hipertansiyon AF'nin en sık nedenidir. Bu çalışmada, paroksismal AF ve sürekli AF hastalarının semptomlarını, tıbbi öykülerini ve klinik özelliklerini yatan hasta ünitesinde değerlendirmeyi amaçladık.

Yöntemler: Çalışmaya toplam 115 hasta (paroksismal AF'li 30 hasta ve sürekli AF'li 85 hasta) dahil edildi. Tüm hastalar ayrıntılı öykü, klinik muayene, rutin biyokimya, elektrokardiyografi ve transtorasik ekokardiyografi ile değerlendirildi. CHA2DS2-VASc (Konjestif kalp yetmezliği/sol ventrikül disfonksiyonu, Hipertansiyon, Yaş ≥75 yıl, Diabetes mellitus, İnme/geçici iskemik atak/sistemik emboli, Vasküler hastalık, 65-74 yaş, Cinsiyet kategorisi) skorları kaydedildi.

Bulgular: Sürekli AF hastaları paroksismal AF hastalarından daha yaşlıydı (70.0 (10.5) vs 61.4 (15.8); P=0.01) ve daha düşük ejeksiyon fraksiyonuna sahipti (41.0 (11.9) ve 53.3 (11.2); P=0.01). CHA2DS2-VASc skorları çalışma grupları arasında benzerdi (3.0 (1.5) vs 2.7 (1.3); P=0.24). Hematolojik analizde, protrombin zamanı (15.3(1.3-106.4) vs 13.6(11.0-75.5); P=0.03) ve uluslararası normalleştirilmiş oranı (1.2(0.9-16.0) vs 1.1(0.9-6.0); P=0.01) paroksismal AF ile karşılaştırıldığında sürekli AF hastalarında daha yüksekti. Paroksismal AF hastalarına ritim kontrolü yapıldı. Hız kontrolü sürekli AF hastalarında paroksismal AF hastalarından anlamlı derecede yüksekti (74 (87%)) ve (12 (40%)); P=0.01).

Sonuç: Bu çalışma sürekli AF hastalarının paroksismal AF hastalarıyla karşılaştırıldığında daha fazla komorbiditeye sahip olduğunu gösterdi. Ritim kontrolü paroksismal AF’de, hız kontrolü ise kalıcı AF’de esas tedavi stratejisiydi.

Anahtar Kelimeler

• Paroksismal atriyal fibrilasyon,Sürekli atriyal fibrilasyon,Antikoagülasyon

Kaynakça

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