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10 yrs Prospective Study, 29 40pts from J une 2000 to May 20 10

5 th Congress of Cardiologists and Angiologists of Bosnia and Herzegovina. Etiological Distribution of Chronic and Transient Atrial Fibrillation in Patients at Cantonal Hospital Zenica Enes Abdović. 10 yrs Prospective Study, 29 40pts from J une 2000 to May 20 10. Background.

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10 yrs Prospective Study, 29 40pts from J une 2000 to May 20 10

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  1. 5 th Congress of Cardiologists and Angiologists of Bosnia and Herzegovina Etiological Distribution of Chronic and Transient Atrial Fibrillation inPatients at Cantonal Hospital ZenicaEnes Abdović 10 yrs Prospective Study, 2940pts from June 2000 to May 2010

  2. Background • Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia in developed countries.  • It is a disease of the elderly and it is common in patients (pts) with organic heart disease. • Hypertension, diabetes mellitus, heart failure and valvular heart disease are predisposing factors to AF.

  3. Aim • To evaluate relationship of different types of AF (transitory/chronic) with underlying heart disease and demographic characteristics of pts as well

  4. Godtfresen J. Atrial fibrillation: course and prognosis. A follow-up study of 1212 cases. In: Kulbertus HE, Olsson SB, Schlepper M, eds. Atrial Fibrillation. Mölndal, Sweden: AB Hässle; 1982:134–145. • Godtfredsen,retrospectively analyzed the charts of 1212 patients with AF hospitalized in Slagelse, Denmark, during the years 1940 to 1967. • Chronic AF cases represented 65% of his patients.

  5. The ALFA StudySamuel Lévy et al. Circulation 1999 • The relative prevalences of paroxysmal, chronic, and recent onset AF were 22.1%, 51.4%, and 26.4%, respectively. • Underlying heart disease was present in 534 patients (70.6%). An absence of underlying heart disease referred to as lone AF was observed in 29.4% of the total patient population despite the wide use of echocardiography. • Hypertension was the most common underlying condition (39.4%), and hypertensive heart disease was found in 21.4% of the total patient population. • Of interest is the fact that the incidence of coronary artery disease (16.6%) and myocardial diseases (15.3%) have reached or exceeded the incidence of valvular heart disease in the total cohort (15.2%).

  6. The ALFA Study, 756 ptsSamuel Lévy et al. Circulation 1999

  7. Am Heart J 2008;155:197-9 • The development of atrial fibrillation (AF) is a relativelycommon complication of acute myocardial infarction(AMI) present in ~10% to 15% of AMIs and generallythought to be a marker of adverse prognosis.

  8. “Non pathologic AF”Taggar JS and Lip GYH “Risk Predictors for Atrial Fibrillation” Ed. Europace 2008 • It is estimated that in ~2 – 10% (and possibly as much as 30%) of people presenting with AF there is no identifiable aetiology and this subset of patients is often to reffered as “Lone AF(LAF)” • LAF is more likely among younger populations. In one study, the mean age at diagnosis of LAF was 46.8 years.

  9. Etiological distribution of pts with AF

  10. Results

  11. Age Distribution of pts with AF

  12. Sex and Age Distribution of pts with AF

  13. Medianage (IQ range) of pts with AFThe median age was 72 years, ranged between 16 and 96 years

  14. Sex • Female’s predominance in: • HA, VHD, DM, • Male’s predominance in: • Lone FA, DCM

  15. Transitory vs. Chronic AF

  16. Transitory vs. Chronic AF

  17. Chronic-transitory AF ratio distribuated by age of patients

  18. Intraventricular Block Distribution

  19. Distribution of IVB(%) 10 4 20 10 10 5 1 40

  20. Summary

  21. A Proposed Model for the Pathogenesis of AF Experimental and clinical studies have shown that AF is maintained by multiple reentrant wavelets within the atrial muscle. It has been estimated that a critical number of wavelets (from 3 to 6) is necessary for perpetuation of AF...

  22. Conclusion(1) • The classical risk factors for developing AF include HA, diabetes mellitus, valvular disease, ischaemic cardiomyopathy, CHF and thyroid disease. • HHD was by far the most prevalent associated medical condition. • Chronic AF was predominant in groups with advanced cardiac remodeling such as DCM and VHD.On the contrary to transient AF, it is a disease of the elderly.

  23. Conclusion(2) • In order to prevent or postpone the development of AF an optimal treatment of hypertension and diabetes mellitus is necessery

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