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

Yıl 2019, Cilt: 3 Sayı: 9, 659 - 662, 01.09.2019

Ramazan Asoğlu , Mahmut Özdemir Nesim Aladağ , Sevdegül Karadaş , Emin Asoğlu

https://doi.org/10.28982/josam.610221

Öz

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.

Anahtar Kelimeler

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

• 1. Kannel WB, Abbott RD, Savage DD, McNamara PM. Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med. 1982;306(17):1018–22.
• 2. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837–47.
• 3. Burstein B, Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol. 2008;51(8):802–9.
• 4. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016 07;37(38):2893–962.
• 5. Steinberg BA, Kim S, Fonarow GC, Thomas L, Ansell J, Kowey PR, et al. Drivers of hospitalization for patients with atrial fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Am Heart J. 2014;167(5):735–42.
• 6. Atzema CL, Austin PC, Miller E, Chong AS, Yun L, Dorian P. A population-based description of atrial fibrillation in the emergency department, 2002 to 2010. Ann Emerg Med. 2013;62(6):570–7.
• 7. Atzema CL, Dorian P, Fang J, Tu JV, Lee DS, Chong AS, et al. A clinical decision instrument for 30-day death after an emergency department visit for atrial fibrillation: the Atrial Fibrillation in the Emergency Room (AFTER) study. Ann Emerg Med. 2015;66(6):658–68.
• 8. Bassand J-P, Accetta G, Camm AJ, Cools F, Fitzmaurice DA, Fox KA, et al. Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF. Eur Heart J. 2016;37(38):2882–9.
• 9. Marijon E, Le Heuzey J-Y, Connolly S, Yang S, Pogue J, Brueckmann M, et al. Causes of death and influencing factors in patients with atrial fibrillation: a competing-risk analysis from the randomized evaluation of long-term anticoagulant therapy study. Circulation. 2013;128(20):2192–201.
• 10. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. The Lancet. 2014;383(9921):955–62.
• 11. American Diabetes Association. American College of Endocrinology and American Diabetes Association consensus statement on inpatient diabetes and glycemic control: a call to action. Diabetes Care. 2006;29(8):1955–62.
• 12. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr. 1989 Mar;2(5):358–67.
• 13. Thrall G, Lane D, Carroll D, Lip GY. Quality of life in patients with atrial fibrillation: a systematic review. Am J Med. 2006;119(5):448-e1.
• 14. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):e1–76.
• 15. Van Gelder IC, Hagens VE, Bosker HA, Kingma JH, Kamp O, Kingma T, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002;347(23):1834–40.
• 16. Chung MK, Shemanski L, Sherman DG, Greene HL, Hogan DB, Kellen JC, et al. Functional status in rate-versus rhythm-control strategies for atrial fibrillation: results of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Functional Status Substudy. J Am Coll Cardiol. 2005;46(10):1891–9.
• 17. Authors/Task Force Members, Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33(21):2719–47.
• 18. Kim MH, Johnston SS, Chu B-C, Dalal MR, Schulman KL. Estimation of total incremental health care costs in patients with atrial fibrillation in the United States. Circ Cardiovasc Qual Outcomes. 2011;4(3):313–20.
• 19. Page RL, Wilkinson WE, Clair WK, McCarthy EA, Pritchett E. Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. Circulation. 1994;89(1):224–7.
• 20. Friberg L, Hammar N, Rosenqvist M. Stroke in paroxysmal atrial fibrillation: report from the Stockholm Cohort of Atrial Fibrillation. Eur Heart J. 2009;31(8):967–75.
• 21. Banerjee A, Taillandier S, Olesen JB, Lane DA, Lallemand B, Lip GY, et al. Pattern of atrial fibrillation and risk of outcomes: the Loire Valley Atrial Fibrillation Project. Int J Cardiol. 2013;167(6):2682–7.
• 22. Al-Khatib SM, Thomas L, Wallentin L, Lopes RD, Gersh B, Garcia D, et al. Outcomes of apixaban vs. warfarin by type and duration of atrial fibrillation: results from the ARISTOTLE trial. Eur Heart J. 2013;34(31):2464–71.
• 23. Steinberg BA, Hellkamp AS, Lokhnygina Y, Patel MR, Breithardt G, Hankey GJ, et al. Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial. Eur Heart J. 2014;36(5):288–96.
• 24. Boriani G, Laroche C, Diemberger I, Fantecchi E, Popescu MI, Rasmussen LH, et al. ‘Real-world’management and outcomes of patients with paroxysmal vs. non-paroxysmal atrial fibrillation in Europe: the EURObservational Research Programme–Atrial Fibrillation (EORP-AF) General Pilot Registry. Ep Eur. 2016;18(5):648–57.
• 25. Vanassche T, Lauw MN, Eikelboom JW, Healey JS, Hart RG, Alings M, et al. Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES. Eur Heart J. 2014;36(5):281–8.
• 26. Conen D, Tedrow UB, Koplan BA, Glynn RJ, Buring JE, Albert CM. Influence of systolic and diastolic blood pressure on the risk of incident atrial fibrillation in women. Circulation. 2009;119(16):2146.
• 27. Blum S, Meyre P, Aeschbacher S, Berger S, Auberson C, Briel M, et al. Incidence and predictors of atrial fibrillation progression: A systematic review and meta-analysis. Heart Rhythm. 2019;16(4):502–10.
• 28. Padfield GJ, Steinberg C, Swampillai J, Qian H, Connolly SJ, Dorian P, et al. Progression of paroxysmal to persistent atrial fibrillation: 10-year follow-up in the Canadian Registry of Atrial Fibrillation. Heart Rhythm. 2017;14(6):801–7.
• 29. Developed with the special contribution of the European Heart Rhythm Association (EHRA), Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), Authors/Task Force Members, Camm AJ, Kirchhof P, Lip GY, 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(19):2369–429.
• 30. Hohnloser SH, Pajitnev D, Pogue J, Healey JS, Pfeffer MA, Yusuf S, et al. Incidence of stroke in paroxysmal versus sustained atrial fibrillation in patients taking oral anticoagulation or combined antiplatelet therapy: an ACTIVE W Substudy. J Am Coll Cardiol. 2007;50(22):2156–61.