Conventional treatment of atrial fibrillation in the Czech Republic managed by outpatient cardiologists. Overview of diagnostic and treatment procedures, pharmacological treatment and hospitalisation.

Česká verzia

Authors: V. Bulková ^1,2; M. Fiala ³; J. Chovančík ³; D. Wichterle ⁴; R. Čihák ⁴; M. Branny ³; J. Kautzner ⁴
Authors place of work: II. interní klinika 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Aleš Linhart, DrSc. ¹; Ústav sociálního lékařství a zdravotní politiky Lékařské fakulty UP Olomouc, přednosta prof. MUDr. Ivan Gladkij, CSc. ²; Oddělení kardiologie Nemocnice Podlesí, a. s., Třinec, přednosta prim. MUDr. Marian Branny ³; Klinika kardiologie IKEM Praha, přednosta prof. MUDr. Jan Kautzner, CSc., FESC ⁴
Published in the journal: Vnitř Lék 2008; 54(1): 36-44
Category: Original Contributions

Summary

Objective:
The aim of the study was to analyse general health data, diagnostic and therapeutic procedures, pharmacological treatment and hospitalization of patients with atrial fibrillation (AF) who did not undergo AF catheter ablation and were in the care of outpatient cardiologists.

Method:
Data concerning 306 patients (of which 94 women, aged 64 ± 11 years) for the preceding 2 years were acquired through a questionnaire containing a set of standardized questions on a simple form sent out to outpatient cardiologists.

Results:
AF was paroxysmal, persistent or permanent in 141 (46 %), 77 (25 %) or 88 (28%) patients, respectively. The higher the age, the lower the proportion of paroxysmal AF and the higher the proportion of the permanent form of AF. AF was asymptomatic in 122 (39%) of patients. The most frequent among cardiovascular diseases was hypertension, detected in 220 patients (72 %), IHD was present in 83 patients (27 %). The mean LV EF was 55 ± 11 % and was significantly lower in patients with permanent AF than in patients with paroxysmal AF (∅ 51 ± 13 % vs. ∅ 58 ± 9 %, P < 0,001). The mean left atrium transversal diameter was 47 ± 7 mm and was significantly higher in patients with permanent AF than in those with paroxysmal AF (50 ± 8 mm vs. 44 ± 6 mm, P < 0,001). 230 patients (75 %) received anticoagulation treatment and 43 patients (14%) received antiaggregation treatment. 274 patients (90 %) were taking antiarrhythmic drugs (AA); 93 patients were taking 1, 168 patients 2 and 13 patients 3 AA drugs. 167 patients (55%) underwent electrical cardioversion in 362 procedures, 106 patients (35%) underwent pharmacological cardioversion in 239 procedures. Coronarography was performed in 79 patients (26 %) of which 59 (75 %) had normal results for coronary arteries. Pacemaker due to concomitant sinus node dysfunction was implanted to 27 patients (9%). Ablation for concomitant atrial flutter of type I was performed in 42 patients (14 %). AF and associated conditions caused 250 hospitalisations in 144 patients (47%). The average length of hospitalisation was 4.2 ± 3.2 days. Cardioembolic event was the cause of hospitalisation of 25 patients (8 %) out of 29 hospitalisations with the mean length of hospital stay 8.2 ± 2.9 days.

Conclusion:
The study has shown, in the first place, very high standards of anticoagulation and antiarrhythmic treatment. It has also shown a relatively frequent indication for coronarography, pacemaker implant for relative sinus node dysfunction or ablation for concomitant atrial flutter of type I, i.e. intervention procedures with limited benefit for AF patients.

Keywords:
atrial fibrillation – diagnostic procedures – treatment procedures – pharmacological treatment – hospitalisation

Zdroje

1. Benjamin EJ, Wolf PA, D’Agostino RB et al. Impact of atrial fibrillation on the risk of death: The Framingham Heart Study. Circulation 1998; 98: 946-952.

2. Hagens VE, Vermeulen KM, TenVerget EM et al. Rate control is more cost-effective than rhythm control for patients with persistent atrial fibrillation - results form the Rate Control versus Electrical cardioversion (RACE) study. Eur Heart J 2004; 25: 1542-1549.

3. Haïssaguerre M, Jais P, Shah DC et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659-666.

4. Israel CW, Gronefeld G, Ehrlich JR et al. Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: implications for optimal patient care. J Am Coll Cardiol 2004; 43: 47-52.

5. Kerr CR, Conolly SJ, Abdollah H et al. Canadian Trial of Physiologic Pacing: effects of physiological pacing during long-term follow-up. Circulation 2004; 109: 357-362.

6. Le Heuzey JY, Paziaud O, Piot O et al. Cost of care distribution in atrial fibrillation patients: the COCAF study. Am Heart J 2004; 147: 121-126.

7. Lévy S, Maarek M, Coumel P et al. Characterization of different subsets of atrial fibrillation in general practice in France. The ALFA Study. Circulation 1999; 99: 3028-3035.

8. Miyasaka Y, Barnes ME, Gersh BJ et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projection for future prevalence. Circulation 2006; 114: 119-125.

9. Pappone C, Augello G, Sala S et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxyzmal atrial fibrillation. The APAF study. J Am Coll Cardiol 2006; 48: 2340-2347.

10. Pappone C, Rosanio S, Augello G et al. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol 2003; 42: 185-197.

11. Schotten U, Ausma J, Stellbrink C et al. Cellular mechanisms of depressed atrial contractility in patients with chronic atrial fibrillation. Circulation 2001; 103: 691-698

12. Stabile G, Bertaglia E, Senatore G et al. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective multi-centre, randomized, controlled study (Catheter Ablation For The Cure Of Atrial Fibrillation Study). Eur Heart J 2006; 27: 216-221.

13. Tsang TS, Petty GW, Barnes ME et al. The prevalence of atrial fibrillation in incident stroke cases and matched population controls in Rochester, Minnesota: changes over three decades. J Am Coll Cardiol 2003; 42: 93-100.

14. Wazni OM, Marrouche NF, Martin DO et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA 2005; 293: 2634-2640.

15. Wolf PA, Benjamin EJ, Belanger AJ et al. Secular trends in the prevalence of atrial fibrillation: the Framingham Study. Am Heart J 1996; 131: 790-795.

16. Wolf PA, Mitchell JB, Baker CS et al. Impact of atrial fibrillation on mortality, stroke, and medical costs. Arch Intern Med 1998; 158: 229-234.

17. Wyse DG, Waldo AL, DiMarco MC et al. The Atrial Fibrillation Follow up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002; 347: 1825-1833.

18. Fiala M, Chovančík J, Neuwrith R et al. Katetrová ablace pro chronickou fibrilaci síní metodou obkružujících a komplexních lineárních lézí v levé srdeční síni. Ukončení arytmie při ablaci a dlouhodobé klinické výsledky. Vnitř Lék 2007; 53: 231-241.

19. Fiala M, Chovančík J, Heinc P et al. Léčba symptomatické intermitentní fibrilace síní katetrovou ablací v levé srdeční síni. Bezprostřední a dlouhodobé výsledky u 150 pacientů. Vnitř Lék 2005; 51: 971-983.