[Clinical profile of idiopathic paroxsysmal atrial fibrillation. (FAP registry)]

Epidemiology of atrial fibrillation in Spain in the past 20 years

Atrial fibrillation is the most common sustained arrhythmia. Because of its potentially serious clinical consequences (heart failure, stroke, and cognitive impairment), atrial fibrillation has important socioeconomic and health implications. This article reviews the major studies on the epidemiology of atrial fibrillation in Spain. Recent data suggest that in people older than 40 years, the prevalence of atrial fibrillation may be more than 4%. Given the current Spanish demography, these data would imply that more than 1 million people in Spain have atrial fibrillation.

Efficacy of circumferential pulmonary vein ablation of atrial fibrillation in endurance athletes

Aims

Long-term endurance sport practice has been increasingly recognized as a risk factor for lone atrial fibrillation (AF). However, data on the outcome of circumferential pulmonary vein ablation (CPVA) in endurance athletes are scarce. The aim of the study was to evaluate the efficacy of CPVA in AF secondary to endurance sport practice.

Methods and results

Patients submitted to CPVA answered a questionnaire about lifetime history of endurance sport practice. Endurance athletes were defined as those who engaged in >3 h per week of high-intensity exercise for at least the 10 years immediately preceding their AF diagnosis. A series of 182 consecutive patients was included (51 ± 11 years, 65% with paroxysmal AF, 81% men, 42 ± 6 mm mean left atrial diameter); 107 (59%) patients had lone AF, and 42 of them (23% of the study population) were classified as endurance athletes (lone AF sport group). Freedom from arrhythmia after a single CPVA was similar in the lone AF sport group compared with the remaining patients (P = 0.446). Left atrial size and long-standing AF were the only independent predictors for arrhythmia recurrence after ablation.

Conclusion

Circumferential pulmonary vein ablation was as effective in AF secondary to endurance sport practice as in other aetiologies of AF.

Physical activity, height, and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals

AIMS

The aetiology of atrial fibrillation (AF) remains unknown in some patients. The aim of the study was to identify new risk factors for developing lone AF (LAF).

METHODS AND RESULTS

A series of 107 consecutive patients younger than 65, seen in the emergency room for an episode of LAF of <48 h duration were included in the study. A group of 107 healthy volunteers matched for age and sex were recruited as controls. All subjects answered a validated questionnaire concerning leisure and occupational activities performed throughout their lifetimes to estimate accumulated hours of physical effort, classified in four levels of intensity. Demographic and echocardiographic measurements were also recorded. There were 69% of males and mean age was 48 +/- 11 years. AF was paroxysmal in 57% and persistent in the remaining 43%. Patients with AF performed more hours of both moderate and heavy intensity physical activity. They also were taller, and had a larger left atria, ventricle, and body surface area. At the multivariable analysis, only moderate and heavy physical activity, height, and anteroposterior atrial diameter were independently associated with LAF.

CONCLUSIONS

Accumulated lifetime physical activity, height, and left atrial size are risk factors for LAF in healthy middle-aged individuals.

Prevención de la fibrilación auricular en el paciente hipertenso

A large percentage of patients with hypertension suffer from atrial fibrillation (AF). The presence of hypertension increases the risk of AF, which in turn aggravates hypertension. The ability of drugs to interfere with specific signal transduction pathways easing the presence of AF in hypertensive patients is promising. To date, the most effective mechanism appears to be the inhibition of the renin-angiotensin-aldosterone system with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-II receptor blockers (ARBs). This approach is under active investigation. Several trials have assessed the effectiveness of these drugs in the prevention of AF. Data show that both, ACEIs and ARBs, appear effective to prevent AF. However, a lack of prospective randomized double-blind trials data limits their application in absence of any other indication.

Sport practice and the risk of lone atrial fibrillation: A case–control study

BACKGROUND

Lone atrial fibrillation (LAF) is characterized by the presence of atrial fibrillation in the absence of structural heart disease or other identifiable cause of arrhythmia. In a recent study, we reported sport practice to be more frequent in LAF patients than in the general population. The aim of the study was to determine the association between sport practice and the prevalence of LAF in men.

METHODS

An age-matched case-control study was designed. Cases were identified from consecutive patients who attended an outpatient clinic; 51 men with LAF were included, 20 of them with vagal characteristics. Controls were selected from the general population (n=109). A questionnaire to assess former and current sport practice and the number of lifetime hours of sport practice was administered. Conditional logistic regression was used for statistical analysis.

RESULTS

The proportion of patients with LAF who reported current sport practice (31%) was higher than that observed in controls (14%). In the logistic regression, current practice of sport was associated with a higher prevalence of LAF (OR=3.13; 95% CI: 1.39-7.05). The practice of more than 1500 lifetime hours of sport appears to be the threshold for the observed association. Current practice of sport with a lifetime practice greater than 1500 h was associated with LAF (OR=2.87; 95% CI: 1.20-6.91).

CONCLUSION

In men, the combination of current and prolonged lifetime sport practice is associated with higher risk of LAF.

[The efficacy of scheduled cardioversion in atrial fibrillation. Comparison of two schemes of treatment: electrical versus pharmacological cardioversion]

INTRODUCTION AND OBJECTIVES

Atrial fibrillation is an arrhythmia with high morbidity and mortality. Restoring sinus rhythm is one of the principle objectives in its management. The present study aimed to assess the efficacy of scheduled cardioversion on atrial fibrillation by comparing two different therapeutic approaches: electrical vs. pharmacological cardioversion.

PATIENTS AND METHOD

Two hundred thirty patients with atrial fibrillation of more than 48 hours duration and requiring sinus rhythm restoration were included. One hundred forty-four patients underwent external electrical cardioversion and 86 patients received quinidine. We analyzed the rate of success, duration of hospital stay, complications and clinical and echocardiographic variable that might predict success.

RESULTS

Sinus rhythm was restored in 181 of 230 patients (79%). The rate of success was 77% (111/144 patients) in the electrical group and 81% (70 of 86 patients) in the pharmacological group (ns). In 13 pharmacological group patients for whom the first attempt failed attempt, a second attempt with electrical cardioversion was made and was successful in 8 patients (61%). No embolic complication was recorded and only two electrical disturbances were seen. Only atrial fibrillation lasting less than 8 weeks was associated with a higher success rate (p < 0.01).

CONCLUSIONS

Scheduled cardioversion in atrial fibrillation is an effective technique with a high success rate and a very low rate of complication. Electrical cardioversion and pharmacological cardioversion with quinidine are similarly effective, although the latter involves a longer hospital stay.