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[A retrospective study of a population with intermittent atrial fibrillation]
Insights
Patients with idiopathic intermittent atrial fibrillation are younger and have smaller left atria but are more resistant to anti-arrhythmic therapy. They also show fewer thromboembolic complications, suggesting anticoagulation may not be necessary.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Intermittent atrial fibrillation (AF) presents diagnostic and therapeutic challenges.
- Distinguishing idiopathic AF from AF with structural pathology is crucial for management.
Purpose of the Study:
- To compare clinical characteristics of patients with idiopathic intermittent AF versus those with structural pathology.
- To evaluate treatment efficacy and complication rates between the two groups.
Main Methods:
- Retrospective analysis of 59 intermittent AF patients from an arrhythmology clinic.
- Comparison of idiopathic AF group (n=18) with structural pathology group (n=41).
- Analysis of clinical, echocardiographic parameters, ECG, Holter monitoring, and treatment outcomes.
Main Results:
- Idiopathic AF patients were younger (36 vs. 45.2 years) with smaller left atrium dimensions (38.1 vs. 42.5 mm).
- Idiopathic AF group showed lower response to anti-arrhythmic therapy (33.3% vs. 70.7%) but fewer thromboembolic complications (0% vs. 9.8%).
- Mitral valvulopathy was associated with larger left atrium dimensions compared to idiopathic AF.
Conclusions:
- Idiopathic intermittent AF patients are younger with smaller left atria but less responsive to anti-arrhythmic drugs.
- Lower rates of thromboembolic events in idiopathic AF suggest anticoagulation may not be routinely indicated.
- Understanding these differences aids in personalized treatment strategies for intermittent atrial fibrillation.
Objective:
To analyse a population with intermittent atrial fibrillation, comparing the clinical characteristics of patients with the idiopathic form with those with structural pathology.
Design:
Intermittent atrial fibrillation retrospective study.
Setting:
Arrhythmology outpatients clinic of the cardiac department.
Patients And Methods:
Retrospective study of a population of 59 patients with intermittent atrial fibrillation referred to the arrhythmology outpatients clinic of the cardiac department. Forty patients were male and nineteen female with a mean age of 51 +/- 13 years. Idiopathic atrial fibrillation group with 18 patients was compared with the 41 patients group with identifiable pathology. Atrial fibrillation was recognised by 12 lead ECG and 24 hours ambulatory Holter monitoring. Clinical and echocardiographic parameters were analysed. Complications and the efficacy of anti-arrhythmic therapy were referred.
Main Results:
In the studied population, mean age at the identification of atrial fibrillation was lower in the idiopathic group than in the group with identifiable pathology. It was 36 +/- 12 years in the first group and 45.2 +/- 13 in the second. Left atrium dimension was 38.1 +/- 4 mm in the first group and 42.5 +/- 9 mm in the second (p = 0.04). In the group with mitral valvulopathy, left atrium dimension was 45.5 +/- 11 mm, also significantly different from patients with the idiopathic form (p = 0.012). Statistically significative difference between those groups was not found for left ventricular end-diastolic dimension and shortening fraction. Mean follow-up was 3 years with a range between 7 months and 10 years. Effective therapeutic control was obtained in 35 of 59 patients (59.3%). Six were from the idiopathic group (33.3%) and 29 from the group with identifiable pathology (70.7%). Control was not reached or was only partial in 24 patients (40.7%), belonging 66.7% to the first group and 29.3% to the second (p = 0.016). No embolic phenomenon was documented in the idiopathic not anti-coagulated group. Four embolic complications (9.8%) were observed in the group of identified pathology. Three of then were related with mitral valvulopathy and were submitted to effective anti-coagulation therapy.
Conclusions:
Patients with idiopathic intermittent atrial fibrillation are younger, with smaller left atrium dimension (mainly in relation to those with mitral valve disease) but are more resistant to anti-arrhythmic therapy. They have a trend to less thromboembolic complications and anti-coagulation is probably not justified.