Atrial fibrillation and stroke as initial manifestations of painless type A aortic dissection

Less Known but Clinically Relevant Comorbidities of Atrial Fibrillation: A Narrative Review

BACKGROUND

The important risk factors for atrial fibrillation (AF) in the general population are not always equally important in specific and relatively prevalent diseases.

OBJECTIVE

The main goal of this narrative review is to focus attention on the presence and the relationship of AF with several important diseases, such as cancer or sepsis, in order to: 1) stimulate further research in the field, and 2) draw attention to this relationship and search for AF in clinical practice.

METHODS

We searched PubMed, SCOPUS, Elsevier, Wiley, Springer, Oxford Journals, Cambridge, SAGE, and Google Scholar for less-known comorbidities of AF. The search was limited to publications in English. No time limits were applied.

RESULTS

AF is widely represented in cardiovascular and other important diseases, even in those in which AF is rarely mentioned. In some specific clinical subsets of AF patients (e.g., patients with sepsis or cancer), the general risk factors for AF may not be so important. Patients with new-onset AF have a several-fold increase in relative risk of cancer, deep vein thrombosis, and pulmonary thromboembolism (PTE) during the follow-up.

CONCLUSION

AF presence, prognosis, and optimal therapeutic approach are insufficiently recognised in several prevalent diseases, including life-threatening ones. There is a need for a better search for AF in PTE, pulmonary oedema, aortic dissection, sepsis, cancer and several gastrointestinal diseases. Improved AF detection would influence treatment and improve outcomes.

Bidirectional association between aortic dissection and atrial fibrillation: Findings from a huge national database

OBJECTIVE

To explore the link between aortic dissection (AD) and atrial fibrillation (AF).

METHODS

Using the National Health Insurance Research Database (NHIRD), cohorts were constructed for evaluating the incidence of AF in patients with AD (study 1) and the incident AD among AF patients (study 2) based on propensity matching analysis. Cox proportion hazard regression models were used to examine the effect of AD on the risk of AF, shown as hazard ratios (HRs) with 95% confidence intervals (CIs). Similar statistical procedures were used for study 2.

RESULTS

The study 1 consisted of 11 813 patients in the AD cohort and 11 813 controls in the non-AD cohort and the study 2 consisted of 190 494 patients in the AF cohort and 190 494 controls in the non-AF cohort. The overall incidence density of AF was 1.32-fold higher in the AD cohort than in the non-AD cohort (11.1 and 8.3 per 1000 person-years), with an adjusted HR (aHR) of 1.74 (95% CI = 1.53-1.98). The AF cohort had 1.18-fold higher incidence of AD than the non-AF cohort (0.55 vs 0.47 per 1000 person-years), with an aHR of 1.24 (95% CI = 1.07-1.44).

CONCLUSIONS

Bidirectional association between AD and AF was shown for the first time in this study.