Abstract
Background: Atrial Fibrillation (AF) is a common, growing and serious cardiac rhythm disturbance that is responsible for considerable morbidity and mortality. Due to rising prevalence of hypertension and diabetes the number of patients presenting with non-valvular atrial fibrillation is increasing.
Aim: To study the etiology and clinical presentation of patients admitted with non-valvular atrial fibrillation.
Methods: This is a retrospective observational study of non-valvular atrial fibrillation (NVAF) patients admitted under cardiology unit during the period July 2017 to December 2018. Diagnosis of atrial fibrillation was made by 12-lead ECG. Patients underwent thorough physical examination, routine laboratory testing, Echocardiogram and other relevant investigations based on comorbid conditions.
Results: A total of 75 patients with non-valvular atrial fibrillation were enrolled in the study. Many patients had more than one risk factors for AF, which included obesity (69.4%), hypertension (53.3%), diabetes (42.7%), age more than 65 years (41.3%) and coronary artery disease (CAD) (22.7%). Echocardiographic mean left atrial size was 40.2 mm and many patients had elevated LA volume. Septal E/E’ was elevated in 65.3% of patients in this study, and the majority of the patients (89.3%) had a CHA2DS2-VASc score of 2 or more requiring anticoagulation.
Conclusion: Hypertension, obesity, diabetes and age more than 65 years are observed to be major risk factors for non-valvular atrial fibrillation in this study. Enforcing healthy lifestyle, early screening, appropriate evaluation and control of modifiable risk factors can reduce the risk of non- valvular atrial fibrillation and its consequences
Keywords: Non-valvular atrial fibrillation, left atrial volume, Diastolic dysfunction, Anticoagulation.
References
- William B. Kannel, Emelia J. Benjamin, Current Perceptions of the Epidemiology of Atrial Fibrillation. Cardiology Clinics 27 (2009) 13-24.
- Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics—2014 update: a report from the American heart association. Circulation.2014; 129; e28- e292
- Kim MH, Johnston SS, Chu BC, et al. estimation of total incremental health care costs in patients with atrial fibrillation in the United States. Circ Cardiovasc Qual Outcomes.2011; 4: 313-20
- Hori M, Connolly SJ, Zhu J, Liu LS, Lau CP, Pais P, et al. Dabigatran versus warfarin: effects on ischemic and hemorrhagic strokes and bleeding in Asians and non-Asians with atrial fibrillation. Strokes and bleeding in Asians and non-Asians with atrial fibrillation. Stroke 2013; 44:1891-6.
- Oldgren J, Healy JS, Ezekowits M, et al. variations in cause and management of atrial fibrillation in a prospective registry of 15,400 emergency department patients in 46 countries: the RELY-Atrial fibrillation registry. Circulation 2014:129: 1568-76
- Wolf PA, Abott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: The Framingham study. Stroke. 1991: 22: 983-988.
- Boriani G, Cimaglia P et al. non valvular atrial fibrillation: potential clinical implications of the heterozenous definitions used in trials on new oral anticoagulants. J Cardiovasc Med. 2015; 16:491-6
- Sachin Dhungel, Shankar Laudari. Clinical profile of atrial fibrillation in a Tertiary Hospital in Central Nepal; J Nepal med Assoc 2017;56(207):335-40
- Frost L, Hune LJ, Vestergaard P. overweight and obesity as risk factors for atrial fibrillation or flutter: The Danish diet, cancer, and health study. The American journal of medicine. 2005; 118:489-495.
- Mayank Jain et al, Non-valvular atrial fibrillation: a study of epidemiology, demography and clinicoetiological profile in Central India :DOI: http://dx.doi.org/10.18203/2349-3933.ijam 20184754
- Das SS, Dutta SN, Chattopadhyay BP: Atrial fibrillation: a 5-year follow-up study. Indian Heart J 2002 Sep.
- Wanahita N, Messerli FH, Bangalore S, et al. atrial fibrillation and obesity results of a meta-analysis. American Heart Journal. 2008; 155:310-315.
- Go AS, Hylek EM et al. prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: The Anticoagulation and risk factors in Atrial Fibrillation (ATRIA) study. J Am Med Assoc 2001; 285:2370-5
- Huxley RR, Lopez FL et al. absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: The Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2011; 123:1501-8.
- Tsang TS Barnes ME et al, left atrial volume: important risk marker of incident atrial fibrillation in older men and women. Mayo clinic proc.2001 May:76(5):46-75.
- Yutoseko, Takaokato et al, association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodelling. Nature.23 April 2018;8:6366
- Dipak Kotecha, Mohamed et al, Is echocardiography valid and reproducible in patients with atrial fibrillation? A systematic review, europace (2017) 19, 1427-1438.
- Okura H, Takada Y, et al. Tissue Doppler-derived index of left ventricular filling pressure, E/E’, predicts survival of patients with non-valvular atrial fibrillation. Heart 2006; 92:1248-52.
- Ewout J. van den Bos, Alina A. Constantinescu et al; Minor elevations in troponin I are associated with mortality and adverse cardiac events in patients with atrial fibrillation. European Heart Journal (2011) 32, 611-617
- Tongers J, Schwerdtfeger B et al. Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmonary hypertension. Am heart journal 2007; 153: 127-32
Corresponding Author
Dr Dhinakaran Krishnamurthy, DNB (Med), DNB (Cardiology)
Consultant Cardiologist, AMC Super Speciality Hospital, Tirupur, Tamil Nadu, India