Diagnosis and Characteristics of Lone Atrial Fibrillation

Davidson, Ehud; Rotenberg, Z; Weinberger, I; Fuchs, Jacob; Agmon, Jacob

doi:10.1378/chest.95.5.1048

Cited by 54 publications

(22 citation statements)

References 9 publications

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“…Our subset of patients without CVCs would be similar to what has been defined as “lone AF” between 1.6% and 30%, depending on the patients’ age and criteria used in the study [5, 24, 27] but in the item of the hypertension prevalence that in our study was 62%. We have to consider that the term “lone AF” is still kept being an exclusion diagnosis [7].…”

Section: Discussionmentioning

confidence: 95%

Atrial Fibrillation and Cardiovascular Comorbidities, Survival and Mortality: A Real-Life Observational Study

et al. 2014

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BackgroundAtrial fibrillation (AF) is the most common cardiac tachyarrhythmia encountered in clinical practice affecting up to 10% of the population over 60 years old and its prevalence rises with age. The main goals were to characterize the AF patient population after the initial diagnosis of AF and to determine overall survival.MethodsIt is a real-life observational study of 269 subjects with an AF diagnosis over 60 years old randomly selected. The collected variables were: sociodemographic, cardiovascular complications/comorbidities (CVCs) included in the CHA2DS2-VASc and HAS_BLED scores, drug assigned as clinical treatment, mean range INR and CVCs and death dates (all-cause mortality). The survival curve and the risk of death were assessed using Kaplan-Meier survival curve and comparisons with log-rank.ResultsThe average following time was 6.2 ± 3.7 years (0.2-20.4). Eleven point five percent died. Sixty-five point four percent had some CVCs. There were no differences in the overall incidence of CVCs by gender. The survival probability was 0.86 ± DE 0.03 among men and 0.90 ± DE 0.04 among women without differences. Thirty-six point eight percent (95% CI: 30.8 - 42.7) were diagnosed vascular complications before AF diagnosis, being ischemic cardiopathy (24.2%) and ischemic stroke (23.2%) the most frequent. The mortality is higher (P < 0.036) among those who suffered ≥ 3 vascular complications and significantly lower among those treated with statins (P = 0.032). After AF diagnosis, the most frequent was the cardiac heart failure (46.7%), significantly higher among women (P = 0.037). The mortality is significantly lower in those treated with OAC (P = 0.003).ConclusionsAF is associated with ischemic heart disease, ischemic stroke and congestive heart failure, but the average mortality age is not different from the global population in Spain and Catalonia.

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Section: Discussionmentioning

confidence: 95%

Atrial Fibrillation and Cardiovascular Comorbidities, Survival and Mortality: A Real-Life Observational Study

et al. 2014

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“…It is frequently associated with disabling symptoms and has been shown to increase cardiovascular morbidity and mortality, even in patients without underlying heart disease. [1][2][3][4] Epidemiological studies have shown that paroxysmal AF can progress to chronic AF in patients with or without underlying structural heart disease. 5,6 In addition, the incidence of successful restoration and maintenance of sinus rhythm was higher in patients with recent-onset AF than in those with chronic AF.…”

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confidence: 99%

Tachycardia-Induced Change of Atrial Refractory Period in Humans

et al. 1998

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Background-Atrial fibrillation (AF) has been shown to shorten the atrial effective refractory period (ERP) and make the atrium more vulnerable to AF. This study investigated the effect of atrial rate and antiarrhythmic drugs on ERP shortening induced by tachycardia. Methods and Results-Seventy adult patients without structural heart disease were included. For the first part of the study, right atrial ERP was measured with a drive cycle length of 500 ms before and after 10 minutes of rapid atrial pacing using five pacing cycle lengths (450, 400, 350, 300, and 250 ms) in 10 patients. For the second part of the study, the remaining 60 patients were included to study the effects of antiarrhythmic drugs on changes in atrial ERP induced by AF. Atrial ERP was measured with a drive cycle of 500 ms before and after an episode of pacing-induced AF. After the patients were randomized to receive one of six antiarrhythmic drugs (procainamide, propafenone, propranolol, dl-sotalol, amiodarone, and verapamil), atrial ERP was measured before and after another episode of pacing-induced AF.In the first part of the study, atrial ERP shortened significantly after 10 minutes of rapid atrial pacing, and the degree of shortening was correlated with pacing cycle length. The second part of the study showed that atrial ERP shortened after conversion of AF (172Ϯ15 versus 202Ϯ14 ms, PϽ0.0001) and that ERP shortening was attenuated after verapamil infusion (Ϫ4.6Ϯ1.2% versus Ϫ15.1Ϯ3.4%, PϽ0.001) but was unchanged after infusion of the other antiarrhythmic drugs. Furthermore, all of these antiarrhythmic drugs could decrease the incidence and duration of secondary AF. Conclusions-The atrial ERP shortening induced by tachycardia was a rate-dependent response. Verapamil, but not other antiarrhythmic drugs, could markedly attenuate this effect. However, verapamil and the other drugs could decrease the incidence and duration of secondary AF.

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“…Wide variations in reported prevalence of lone AF (between 1.6%-30% of the examined cohort) are probably due to variable diagnostic criteria used in these studies. [9][10][11][12][13][14][15][16][17] Indeed, diagnosis of lone AF is, by defi nition, a diagnosis of exclusion, but should not be made unless a comprehensive clinical assessment, including detailed medical history, physical examination, laboratory testing with thyroid status, electrocardiogram, echocardiography, and, possibly, chest radiograph and exercise testing, has been performed (Table 1). 6 The overall lifetime risk for development of AF after age 40 years is 1:4 for both men and women, but AF develops in men at 1.5-fold greater rate compared with women.…”

Section: Epidemiology Of Lone Afmentioning

confidence: 99%

Lone Atrial Fibrillation: Where Are We Now?

Potpara

Lip²

2011

Hospital Practice

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There is a growing pandemic of atrial fibrillation (AF), affecting nearly 2% of the general adult population. Atrial fibrillation is commonly associated with structural heart disease, and AF itself causes a sequence of complex processes of electrical, contractile, and structural remodeling of the atrial myocardium, which facilitate further AF progression. Nonetheless, AF may also affect individuals aged ≤ 65 years who have no evidence of associated cardiopulmonary or other disease, including hypertension; this is otherwise referred to as "lone" AF and is considered to have a generally favorable prognosis. The true prevalence of lone AF is unknown. Growing insights into the diversity of numerous mechanisms involved in the pathogenesis of AF, including acute atrial stretch, structural and electrophysiological alterations, systemic inflammation, oxidative stress, autonomic imbalance, genetic predisposition, and many others, and increasing recognition of novel risk factors for AF, including obesity, metabolic syndrome, subclinical atherosclerosis, sleep apnea, alcohol consumption, and endurance sports, suggest that apparently lone AF might not be so "lone" in many patients, which could have important prognostic and therapeutic implications. In this article, we summarize the current knowledge of epidemiology, etiopathogenesis, and pathophysiology of so-called lone AF and discuss the issues of long-term prognosis and management of patients who have an apparently lone AF.

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Diagnosis and Characteristics of Lone Atrial Fibrillation

Cited by 54 publications

References 9 publications

Atrial Fibrillation and Cardiovascular Comorbidities, Survival and Mortality: A Real-Life Observational Study

Atrial Fibrillation and Cardiovascular Comorbidities, Survival and Mortality: A Real-Life Observational Study

Tachycardia-Induced Change of Atrial Refractory Period in Humans

Lone Atrial Fibrillation: Where Are We Now?

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