Cardiovascular risk factors, myocardial structure and function in hospitalized patients with atrial flutter in one-center registry

Main Article Content

U. P. Chernyaha-Royko
A. V. Aker
I. M. Tumak
O. J. Zharinov

Abstract

The aim – to compare cardiovascular risk factors, clinical characteristics, myocardial structure and function in patients with isolated AFL to those in patients with AFL combined with AF; to summarize management data of hospitalized patients with atrial flutter in real-life clinical practice.
Material and methods. The study included 126 hospitalized patients with atrial flutter, 86 men (68.3 %) and 40 women (31.7 %), median age 65.5 (quartiles 55–73) years. All patients were divided into two groups. The first group consisted of 58 (46.0 %) patients with isolated AFL, second group – 68 (54.0 %) patients with AFL combined with AF. Cardio­­­vascular risk factors, concomitant diseases, anthropometric data, laboratory and echocardiographic parameters were compared between two groups.
Results. Рatients with isolated AFL were older than patients with AFL combined with AF (69.5 (60–75) vs 60.5 (50.5–72.5), Р=0.003); more of them were males (46 (79.3 %) vs 40 (58.8 %), Р=0.02). No differences regarding prevalence of concomitant disease and cardiovascular risk factors in the compared groups were revealed, but significant prevalence of chronic lung disease in patients with isolated AFL. There was no significant differences between the
CHA2DS2-VASc cardiovascular risk factors found [2.97 (1.48–4.5) vs 2.62 (1.31–4.3), Р=0.26]. Patients with AFL combined with AF had longer history of arrhythmias [84 (10–192) vs. 10 (1–48) weeks, Р=0.006]. Concomitant AF was significantly less common in patients with first-detected AFL (17 (29.3 %) versus 10 (14.7 %), Р=0.05). Warfarin use was less frequent in patients with isolated AFL (15 (25.9 %) versus 31 (45.6 %), Р=0.02), despite the same high cardiovascular risk of thromboembolic events in both groups.
Conclusions. AFL coexists with AF in 54 % of consecutively hospitalized patients. The results showed the difficulties of rhythm control in patients with AFL, high prevalence of concomitant diseases, high risk of thromboembolic events. Study showed underuse of anticoagulant therapy in patients with isolated AFL, low frequency of catheter ablation.

Article Details

Keywords:

atrial flutter, atrial fibrillation, cardiovascular risk, morphofunctional characteristics

References

Ардашев А.В. Типичное трепетание предсердий: классификация, клинические проявления, диагностика и лечение // Кардиология.– 2010.– № 4.– С. 57–65.

Дзяк Г.В., Жарінов О.Й. Фібриляція передсердь.– К.: Чет­­верта хвиля, 2011.– 192 с.

Жарінов О.Й., Куць В.О., Грицай О.М. Діагностика та лікування тріпотіння передсердь // Медицина світу.– 2010.– № 10.– С. 21–26.

Зінченко Ю.В. Оптимізація тактики лікування хворих з типовим тріпотінням передсердь неклапанного генезу в залежності від клінічних та електрофізіологічних характеристик аритмії: Автореф. дис. …д. мед. н.– К., 2015.– 38 с.

Зінченко Ю.В., Бородай А.О., Ікоркін М.Р. Частота виявлення ознак тромбоутворення у хворих з тріпотінням передсердь // Кровообіг та гемостаз.– 2013.– № 3.– С. 45–51.

Карпенко Ю.І. Антикоагулянтна терапія у хворих з тріпотінням передсердь // Укр. кардіол. журн.– 2005.– № 4.– С. 112–118.

Руководство по кардиологии / Под ред. В.Н. Коваленко.– К.: Морион, 2008.– 1424 с.

Brembilla-Perrot B., Girerd N., Sella Jean M. et al. Risk of atrial fibrillation after atrial flutter ablation // J. Cardiovasc. Electrophysiol.– 2014.– Vol. 25 (8).– P. 813–820.

De Loma-Osorio F., Diaz-Infante E., Gallego M. Spanish Catheter Ablation Registry. 12th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2012) // Rev. Esp. Cardiol (Engl. Ed.).– 2013.–Vol. 66.– P. 983–992.

Go A.S., Hylek E.M., Phillips K.A. et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study // JAMA.– 2001.– Vol. 285.– P. 2370–2375.

Goette A., Kalman J.M., Aguinaga L. et al. EHRA/HRS/APHRS/SOLAECE expert consensus on аtrial cardiomyopathies: definition, characterization, and clinical implication // J. Ar­­­­rhythmia.– 2016.– Vol. 32 (4).– P. 247–1278.

Granada J., Uribe W., Chyou P. et al. Incidence and predictors of atrial flutter in the general population // J. Am. Coll. Cardiol.– 2000.– Vol. 36.– P. 2242–2246.

Halligan S.C., Gersh B.J., Brown R.D. et al. The natural history of lone atrial flutter // Ann. Intern. Med.– 2004.– Vol. 140.– P. 265–268.

Kirchhof P., Benussi S., Kotecha D. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS // Eur. Heart J.– 2016.– Vol. 37.– P. 2893–2962.

Lickfett L., Mittmann-Braun E., Weiss C. et al. Differences in Clinical and Echocardiographic Parameters between Paroxysmal and Persistent Atrial Flutter in the AURUM 8 Study: Targets for Prevention of Persistent Arrhythmia? // Pacing and Clin. Electrophysiology.– 2013.– Vol. 36 (2).– P. 194–202.

Mareedu R.K., Abdalrahman I.B., Dharmashankar K.C. et al. Atrial flutter versus atrial fibrillation in a general population: differences in comorbidities associated with their respective onset // Clin. Med. Res.– 2010.– Vol. 8 (1).– P. 1–6.

Natale A., Newby K.H., Pisanó E. et al. Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter // J. Am. Coll. Cardiol.– 2000.– Vol. 35.– P. 1898–1904.

Page R., Joglar J., Caldwell M. et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia // J. Am. Coll. Cardiol.– 2016.– Vol. 67 (13).– P. 1575–1623.

Pérez F. J., Schubert C. M., Parvez B. et al. Long-term outcomes after catheter ablation of cavo-tricuspid isthmus dependent atrial flutter: a meta-analysis // Circ. Arrhythm Electrophysiol.– 2009.– Vol. 2 (4).– P. 393–401.

Peyrol M., Sbragia P., Bonello L. et al. Characteristics of isolated atrial flutter versus atrial flutter combined with atrial fibrillation // Archives Cardiovasc. Diseases.– 2011.– Vol. 104 (10).– P. 530–535.

Schmieder S. Acute and long-term results of radiofrequency ablation of common atrial fl utter and the influence of the right atrial isthmus ablation on the occurrence of atrial fibrillation // Еur. Нeart J.– 2003.– Vol. 24 (10).– Р. 956–962.

Spector P., Reynolds M., Calkins H. et al. Meta-analysis of ablation of atrial flutter and supraventricular tachycardia // Am. J. Cardiol.– 2009.– Vol. 104.– P. 671–677.

Saoudi N., Cosío F., Waldo A. et al. A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases // Eur. Heart J.– 2001.– Vol. 22.– P. 1162–1182.

Starek Z., Lehar F., Jez J. et al. Hybrid therapy in the management of atrial fibrillation // Curr. Cardiol. Rev.– 2015.–

Vol. 11 (2).– P. 167–179.

Steinberg J., Romanov A., Musat D. et al. Prophylactic pulmonary vein isolation during isthmus ablation for atrial flutter: the PReVENT AF Study // Heart Rhythm.– 2014.– Vol. 11 (9).– P. 1567–1572.

Van der Hooft С., Heeringa J., van Herpen G. et al. Drug-induced atrial fibrillation // J. Am. Coll. Cardiol.– 2004.– Vol. 44 (11).– P. 2117–2124.

Waldo AL. The interrelationship between atrial fibrillation and atrial flutter // Prog. Cardiovasc. Dis.– 2005.– ol. 48.– P. 41–56.

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