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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 4  |  Page : 254-256

A study of clinical profile, etiology, and echocardiographic parameters in atrial fibrillation at a tertiary care hospital


1 Department of General Medicine, St. John's Medical College, Ahmedabad, Gujarat, India
2 Department of General Medicine, Dr. M K Shah Medical College, Ahmedabad, Gujarat, India
3 Medlife Clinic, Bengaluru, Karnataka, India

Date of Submission25-Nov-2021
Date of Decision09-Feb-2022
Date of Acceptance16-Feb-2022
Date of Web Publication25-Oct-2022

Correspondence Address:
Dr. Abdul Mateen Athar
Department of General Medicine, St. John's Medical College, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajim.ajim_121_21

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  Abstract 


Background: Atrial fibrillation (AF) being the most common arrhythmia encountered clinically is associated with increased mortality and morbidity. Hence, this study was conducted to find the clinical profile, etiology, and echocardiographic factors of AF for the secondary prevention of known complications.Materials and Methods: This was an observational hospital-based study done on 60 patients with AF in the Department of Medicine, St. John's Medical College Hospital, Bengaluru, India. Results: Out of 60 patients with AF, the mean age was found to be 63 years in our study. Female sex (61.67%) had more preponderance to AF than male sex (38.33%). The most common presenting complaint was breathlessness (50%), followed by asymptomatic (25%) and palpitations (21.6%). Surprisingly, a significant number of patients were asymptomatic (25%) during the episode of AF. Hypertension (58.3%) was found to be more prevalent than rheumatic heart disease (RHD) (31.6%) in our patients, the most common complications were noted as heart failure (45%) rather than cerebrovascular accident (CVA) (15%). Nonvalvular AF (68.33%) exceeded the number of patients with valvular AF (31.66%). Ten percent of our subjects had dilated left atrium and 30% of our subjects had ejection fraction of <50%. The most common valvular lesion was found to be mitral regurgitation (45%) followed by mitral stenosis (28.3%). Conclusion: This study has provided insight into the changes in trends pertaining to the clinical profile of AF. The most common predisposing condition is hypertension rather than RHD. Although the most common presenting complaint was breathlessness, there was a significant subset of individuals who were asymptomatic during the AF episode. A significant number of individuals had heart failure and CVA as complications of AF.

Keywords: Atrial fibrillation, clinical profile, etiology, echocardiographic parameters


How to cite this article:
Athar AM, Suleman KZ, Davis D, Begum G A. A study of clinical profile, etiology, and echocardiographic parameters in atrial fibrillation at a tertiary care hospital. APIK J Int Med 2022;10:254-6

How to cite this URL:
Athar AM, Suleman KZ, Davis D, Begum G A. A study of clinical profile, etiology, and echocardiographic parameters in atrial fibrillation at a tertiary care hospital. APIK J Int Med [serial online] 2022 [cited 2022 Dec 4];10:254-6. Available from: https://www.ajim.in/text.asp?2022/10/4/254/359444




  Introduction Top


Atrial fibrillation (AF) is a supraventricular arrhythmia characterized by low-amplitude baseline oscillations (fibrillatory or F-waves from the fibrillating atria) and an irregularly irregular ventricular rhythm.[2] It is characterized by disorganized, rapid, and irregular atrial activation with loss of atrial contraction and with an irregular ventricular rate that is determined by atrioventricular nodal conduction.[1] Most AF originates in one or more of the pulmonary veins (PVs), and because of disparate atrial refractory periods, the rapid firing focus in the left atrium (LA) cannot be conducted in a 1:1 manner to the right atrium, which leads to fibrillatory conduction.[3]

AF is the most common sustained arrhythmia and is a major public health problem. Globally, the overall prevalence as estimated from 2010 data of the Global Burden of Disease Study (also performed from administrative databases) is 0.59% for males and 0.37% for females.[5] The prevalence of AF in Indian scenario is 0.196.[6] Prevalence increases with age, and >95% of AF patients are >60 years of age. The prevalence by age 80 is ~10%. The lifetime risk of developing AF for men 40 years old is ~25%. AF is slightly more common in men than women and and more common in white ethnic groups compared to black ethnic groups.[1]

Risk factors for developing AF in addition to age and underlying cardiac disease include hypertension, diabetes mellitus, obesity, and sleep apnea.[1]

AF is associated with a 1.5-to 1.9-fold increased risk of mortality after controlling for underlying heart disease. AF is also associated with a risk of developing heart failure and vice versa ‒ patients with heart failure have an increased risk of developing AF. AF increases the risk of stroke by fivefold and is estimated to be the cause of 25% of strokes. It also increases the risk of dementia and silent strokes detected by magnetic resonance imaging. Since AF is a marker for other predictors of mortality and morbidity, such as the severity of heart disease, it is difficult to determine the extent to which AF itself contributes to associated increased mortality and morbidity.[1]

Hence, it is important to look into the clinical profile, etiology, and echocardiographic factors of AF for the secondary prevention of these complications. The surveillance of AF in India is important to identify opportunities for intervention.

The most common etiology of AF was found to be rheumatic heart disease (RHD) – 60%–70% of patients studied had underlying RHD.[4],[5] Since there is a significant reduction in the prevalence of RHD in India over the decade,[6] this study looks into the potential changes in the trends of underlying etiology of AF. This study looks into the different types of presentations underlying clinical and echocardiographic predisposing factors for AF in a tertiary care hospital in South India as there is not much literature in this area in South India.


  Materials and Methods Top


This was an observational descriptive hospital-based study. A total of 60 patients were enrolled into this study. Patients with electrocardiographically proven AF with age of more than 18 years were included in the study.

The diagnosis of AF was made on the basis of history clinical examination and confirmation with 12-leads electrocardiogram. A 2D echocardiography to assess the echocardiographic parameters in patients with AF was taken. Patients' routine investigations were reviewed. Informed consent was obtained from all subjects for the research and patient confidentiality was maintained. Data were then entered into Microsoft Excel sheet and analyzed with the IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.


  Results Top


Out of 60 patients of AF studied, majority were aged between 60 and 80 years (51.67%). The incidence of AF is more in females (61.67%) compared to males (38.33%) [Table 1]. About 50% of our patients presented with breathlessness, 25% were asymptomatic, 27.6% of patients had palpitations, 11.6% of patients presented with cerebrovascular accident (CVA), and the rest of the symptoms include fever (10%), giddiness (3.3%), syncope (1.6%), and pedal edema (6.6%) [Graph 1]. The most common comorbid condition in our study was hypertension (58.3%), followed by diabetes mellites (41.6%), ischemic heart disease (33.3%), and RHD (31.6%) [Graph 2]. Heart failure was the most common complication (45%), followed by CVA (15%). About 41 patients had nonvalvular AF (90.24%) and among these 41 nonvalvular AF patients, 37 patients had CHA2DS2-VASc score of >2. In patients with valvular AF, mitral regurgitation (47%) was the most common valvular disease. The most common type of AF was paroxysmal AF (56.67%) followed by persistent AF (41.67%). Echocardiographically about 30% of our patients had reduced ejection fraction (EF) of <50% and 50% of our patients in this study had dilated LA. Ten percent of our patients had LA clot [Table 2].
Table 1: Age-and gender-wise distribution of patient

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Table 2: Ejection fraction of patients in our study

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  Discussion Top


In this study, out of the 60 patients with AF, the mean age was 63.133. Majority of the patients (51.67%) were in the age group of 61–80 years which is consistent with Indian study done by Singh et al.[4] Majority of the patients were female (61.67%) in our study. Similar observations were noted in the Framingham heart study[7] and Indian study done by Sastry et al.[5] In this study, breathlessness was common presentation (50%). Surprisingly, a significant number of patients (25%) were asymptomatic during the index presentation in our study which is contrary to the other studies. However, a few Western studies (Ballatore et al.,[10] Chugh et al.[11]) have observed more evidence of asymptomatic AF, especially in the elderly. Considering the fact that in our study, most patients are elderly, the reason for a higher asymptomatic AF could be because of the above difference in mean age compared to other Indian studies. The most common predisposing condition in our study for AF is hypertension. This observation was contrary to most Indian studies[8],[12],[13] where RHD was identified as the most common predisposing condition. This trend in our study may be due to increase in overall incidence and prevalence of hypertension and aging of the population (Carla Study[14]) and overall decrease in RHD burden in India.[6] Heart failure was found to be the most common complication prevalent in our patients which is consistent with other Indian and International Studies.[9],[15] Forty-one cases (68.33%) had nonvalvular AF in our study which is consistent with the study done by Roby and KKM.[16] In contrast to other studies,[13] percentage of patient with CHA2DS2-VASc score of two and more was found to be more than other studies probably because of higher mean age of study subjects as most of our subjects are elderly. Most of our patients had paroxysmal AF (56.67%) which is consistent with the study done by Mayank Jain et al.[17] In our study, 30% of subjects had EF <50% and six patients (10%) had LA clot in the echocardiogram. These findings are consistent with Indian study done by Mohan et al.[18]


  Conclusion Top


The study has provided insight into the changes in trends pertaining to the clinical profile of AF. Hypertension is the most common predisposing factor for AF in this study which is important preventable and treatable cause of atrial fibrillation. Heart rate control can be achieved in most of the patients with AF and anticoagulation is the mainstay of treatment in most patients to prevent thromboembolic complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J(Eds.), (2018). Harrison's Principles of Internal Medicine, 20e. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2129&sectionid=159213747.  Back to cited text no. 1
    
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Bonow RO, Mann DL, Zipes DP, Libby P. (2011). Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th edition. Elsevier Science.  Back to cited text no. 2
    
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Walsh R, Fang J, Fuster V, O'Rourke RA. Hurst's the Heart Manual of Cardiology. 13th ed. Blacklick: McGraw-Hill Publishing; 2012. Available from: https://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=4960528. [Last accessed on 2020 Jul 29].  Back to cited text no. 3
    
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Singh R, Kashyap R, Bhardwaj R, Marwaha R, Thakur M, Singh TP, et al. The clinical and etiological profile of atrial fibrillation after echocardiography in a tertiary care centre from North India – A cross sectional observational study. Int J Res Med Sci 2017;5:847-50.  Back to cited text no. 4
    
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Sastry DK, Kumar DL, Anuradha DP, Raj DB. Clinical profile and echocardiographic findings in patients with atrial fibrillation. International Journal of Scientific and Research Publications, Volume 6, Issue 2, February 2016 44 ISSN 2250-3153.  Back to cited text no. 5
    
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Kumar RK, Tandon R. Rheumatic fever & rheumatic heart disease: The last 50 years. Indian J Med Res 2013;137:643-58.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Kannel WB, Abbott RD, Savage DD, McNamara PM. Epidemiologic features of chronic atrial fibrillation: The Framingham study. N Engl J Med 1982;306:1018-22.  Back to cited text no. 7
    
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C Hariharan MD, Venkateswaralu Dhirisala MD. A study of clinical profile of atrial fibrillation and its transthoracic echocardiography presentation: a cross sectional study at a tertiary care hospital. International Journal of Medical and Health Research, Volume 3, Issue 6, 2017, Pages 53-55.  Back to cited text no. 8
    
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A Review of Clinical Profile of Atrial Fibrillation in RMMCH, Chidambaram. Dr. M. Saravanan and Dr. R.Umarani Department of Medicine,Rajah Muthiah Medical College Hospital,Annamalai University, Chidambaram. Int. J. Modn. Res. Revs. Volume 3, Issue 9, pp 760-762, September, 2015.  Back to cited text no. 9
    
10.
Ballatore A, Matta M, Saglietto A, Desalvo P, Bocchino PP, Gaita F, et al. Subclinical and asymptomatic atrial fibrillation: current evidence and unsolved questions in clinical practice. Medicina (Mex) 2019;55:497.  Back to cited text no. 10
    
11.
Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: A global burden of disease 2010 study. Circulation 2014;129:837-47.  Back to cited text no. 11
    
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Gautam Mani, Gautam S, Prasad S, Subramanyam G, Gautam, Usha. (2013). A study of the clinical profile of atrial fibrillation in a tertiary care super-specialty referral centre in Central Nepal. Journal of College of Medical Sciences-Nepal. 8. 10.3126/jcmsn.v8i3.8679.  Back to cited text no. 12
    
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Meeran SS, Saravanan MA, Geetha S, Sangeetha SV, Krishnakumar S. A study on clinical profile of patients with atrial fibrillation. IAIM, 2018; 5(2): 105-110.  Back to cited text no. 13
    
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Lacruz ME, Kluttig A, Hartwig S, Löer M, Tiller D, Greiser KH, et al. Prevalence and incidence of hypertension in the general adult population: Results of the CARLA-cohort study. Medicine (Baltimore) 2015;94:e952.  Back to cited text no. 14
    
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Hinton RC, Kistler JP, Fallon JT, Friedlich AL, Fisher CM. Influence of etiology of atrial fibrillation on incidence of systemic embolism. Am J Cardiol 1977;40:509-13.  Back to cited text no. 15
    
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Roby A, Roby A, Manojan, K. (2019). Etiological and Clinical Profile of Atrial Fibrillation in Clinical Practice. Kerala Medical Journal, 12(3), 60-62. Retrieved from https://www.keralamedicaljournal.com/index.php/KMJ/article/view/566 Vol 12 No 3 (2019): July to September 2019.  Back to cited text no. 16
    
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Jain M, Kiyawat P. Nonvalvular atrial fibrillation: A study of epidemiology, demography and clinicoetiological profile in central India. Int J Adv Med 2018;5:1443-9.  Back to cited text no. 17
    
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Mohan G, Kaur S, Kaur R, Aggarwal A. The study of clinical and echocardiographic assessment of patients with atrial fibrillation. Int J Adv Med 2019;6:1041-5.  Back to cited text no. 18
    



 
 
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