Profile of Atrial Fibrilation in Prof. R.D. Kandou Hospital Manado From September 2012 – February 2013

Abstract

Abstrak: Fibrilasi atrial merupakan gangguan irama jantung menetap yang paling sering dijumpai di praktek sehari-hari, ditandai oleh adanya aktivasi atrium yang tidak terorganisasi dan kontraksi atrium dan ventrikel yang tidak terkoodinasi. Meskipun banyak laporan mengenai fibrilasi atrial di Indonesia, tetapi hal ini belum pernah dilaporkan di Sulawesi Utara. Penelitian ini bertujuan untuk mendapatkan profil fibrilasi atrial di Manado. Data diambil dari pasien fibrilasi atrial di Bagian Jantung dan Pembuluh Darah, Prof R D Kandou, Manado, sejak September 2012-Februari 2013. Variabel yang diamati ialah jenis kelamin, usia, penyakit penyerta, ekokardiografi, dan terapi. Sebanyak 84 pasien diikutsertakan dalam penelitian ini, terdiri dari 42 laki-laki dan 42 perempuan dengan usia 21-84 tahun dengan rincian 53 pasien berusia ≥60 tahun dan 30 pasien <60 tahun. Pada 59 pasien yang dilakukan ekokardiografi, 39 pasien (66,1%) mempunyai fraksi ejeksi ≥55%; dan 20 pasien (33,9%) <55% (rerata 55,8%). Pembesaran atrium kiri ditemukan pada 33 pasien (55,9%) dan trombus pada 13 pasien (22%). Penyakit penyerta yang ditemukan ialah: hipertensi pada 35 pasien (41,7%); gagal jantung 40 pasien (40,76%); penyakit jantung koroner 20 pasien (23,8%); penyakit jantung katub 21 pasien (25%); penyakit paru 6 pasien (7%); hipertiroid 5 pasien (6%); dan tanpa penyakit penyerta 1 pasien (1,2%). Pada 70 pasien (83,3%) diberikan terapi bisoprolol; 2 pasien (2,4%) digoksin; 3 pasien (3,5%) amiodaron; 7 pasien (8,4%) bisoprolol dan digoksin; dan 2 (2,4%) bisoprolol dan amiodaron. Obat antikoagulan oral diberikan pada 28 pasien (33,03%), dan aspirin pada 40 pasien (47,6%). Stroke ditemukan pada 4 pasien (4,8%); satu orang diantaranya meninggal akibat stroke. Simpulan: Fibrilasi atrial lebih sering ditemukan pada usia lanjut. Gagal jantung dan hipertensi merupakan penyakit penyerta yang tersering, sehingga perlu diwaspadai. Bisoprolol merupakan pilihan terapi yang tersering diberikan, dan angka komplikasi dan kematiannya rendah. Kata kunci: fibrilasi atrial, penyakit penyerta, terapi. Abstract: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice characterized by disorganized atrial activation and uncoordinated contraction of the atria and ventricle. Although there are many reports regarding the profile of atrial fibrillation (AF) in Indonesia, none have been published in North Sulawesi. This study aimed to provide epidemiological data regarding atrial fibrillation profile in Manado. We reviewed medical records of outpatients diagnosed with AF in the Department of Cardiology and Vascular Medicine, Prof. Dr. R.D. Kandou Hospital, Manado, from September 2012-February 2013. Relevant variables such as gender, age, co-morbids, echocardiography, and medical therapy were documented. The results showed that a total of 84 patients with AF were enrolled in the study. There were 42 males (50%) and 42 females (50%) with age ranges from 21 to 84 years (mean 60.74 years), of these 53 patients (63%) were ≥60 years and 31 patients (37%) <60 years. From the total 84 patients, 59 patients underwent echocardiography examinations: 39 patients (66.1%) had ejection fraction (EF) ≥55%; and 20 patients (33.9%) had EF <55% (mean 55.8%). Left atrial enlargement was found in 33 patients (55.9%) and thrombus was found in 13 patients (22%). Besides suffering from AF, 35 patients (41.7%) had hypertension, 40 (40.76%) had congestive heart failure, 20 (23.8%) had coronary artery disease, 21 (25%) had valvular heart diseases, 6 (7%) had pulmonary diseases, 5 (6%) had hyperthyroidism, and 1 (1.2%) had no comorbid. Seventy patients (83.3%) were treated with bisoprolol, 2 (2.4%) with digoxin, 3 (3.5%) with amiodarone, 7 (8.4%) with bisoprolol and digoxin, and 2 (2.4%) with bisoprolol and amiodarone. Oral anticoagulant was used in 28 patients (33.3%), and aspirin in 40 patients (47.6%). Strokes were found in four patients (4.8%); one died due to stroke. Conclusion: The prevalence of AF was higher in the elderly. Congestive heart failure and hypertension were the most common co-morbids found, thus, greater awareness is needed. Bisoprolol was used as the highest proportion of treatment in AF patients, and the complication and mortality rates were low. Keywords: atrial fibrillation, comorbids, therapy.