1. Etiological Distribution of Chronic and Transient Atrial Fibrillation in Patients at Cantonal Hospital Zenica Enes Abdović 10 yrs Prospective Study, 29 40pts from J une 2000 to May 20 10 5 th Congress of Cardiologists and Angiologists of Bosnia and Herzegovina

4. Background Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia in developed countries. It is a disease of the elderly and it is common in patients (pts) with organic heart disease. Hypertension, diabetes mellitus, heart failure and valvular heart disease are predisposing factors to AF.

5. Aim To evaluate relationship of different types of AF (transitory/chronic) with underlying heart disease and demographic characteristics of pts as well

6. Godtfresen J. Atrial fibrillation: course and prognosis. A follow-up study of 1212 cases. In: Kulbertus HE, Olsson SB, Schlepper M, eds. Atrial Fibrillation. Mölndal, Sweden: AB Hässle; 1982:134–145. Godtfredsen, retrospectively analyzed the charts of 1212 patients with AF hospitalized in Slagelse, Denmark, during the years 1940 to 1967. Chronic AF cases represented 65% of his patients.

7. The ALFA Study Samuel Lévy et al. Circulation 1999 The relative prevalences of paroxysmal, chronic, and recent onset AF were 22.1%, 51.4%, and 26.4%, respectively. Underlying heart disease was present in 534 patients (70.6%). An absence of underlying heart disease referred to as lone AF was observed in 29.4% of the total patient population despite the wide use of echocardiography. Hypertension was the most common underlying condition (39.4%), and hypertensive heart disease was found in 21.4% of the total patient population. Of interest is the fact that the incidence of coronary artery disease (16.6%) and myocardial diseases (15.3%) have reached or exceeded the incidence of valvular heart disease in the total cohort (15.2%).

8. The ALFA Study, 756 pts Samuel Lévy et al. Circulation 1999 Median age 68.6 y rs (1 9 -9 5 ) Male gender 57,7% (4 3 6) Chronic AF 51, 4 % ( 389 ) Hypertension 39, 4 % ( 298 ) Diabetes mellitus1 0. 7 % ( 81 ) Thyroid gland diseases 3,1% ( 24 ) Lone AF 29, 4 % ( 221 )

9. Am Heart J 2008;155:197-9 The development of atrial fibrillation (AF) is a relatively common complication of acute myocardial infarction (AMI) present in ~10% to 15% of AMIs and generally thought to be a marker of adverse prognosis.

10. “Non pathologic AF” Taggar JS and Lip GYH “Risk Predictors for Atrial Fibrillation” Ed. Europace 2008 It is estimated that in ~2 – 10% (and possibly as much as 30%) of people presenting with AF there is no identifiable aetiology and this subset of patients is often to reffered as “Lone AF(LAF)” LAF is more likely among younger populations. In one study, the mean age at diagnosis of LAF was 46.8 years.

11. Etiological distribution of pts with AF

12. Results Median age72 years (16-96) Male gender48,7% (1426) Chronic AF69,9% (2045) Hypertension7 1, 1 % ( 2089 ) Diabetes mellitus17.2% (503) Thyroid gland diseases6,1% (197) IV block29,1% (853)

13. Age Distribution of pts with AF

14. Sex and Age Distribution of pts with AF

15. Median age (IQ range) of pts with AF The median age was 7 2 years, ranged between 16 and 96 years

17. Sex Female’s predominance in: HA, VHD, DM, Male’s predominance in: Lone FA, DCM

19. Transitory vs. Chronic AF

20. Transitory AFChronic AF Females OR=1.28 95% CI=1.00-1.64 Sex Males Younger pts OR=1.04 95% CI=1.02-1.05 Age Older pts LoneAF OR=3.85 95% CI=1.64-9.04 Concomitant/ Underlying Disease DCM OR=2.19 95% CI=1.20-4.01 Hypertension OR=1.47 95% CI=1.07-2.04 VHD OR=4.27 95% CI=2.24-8.15

21. Chronic-transitory AF ratio distribuated by age of patients

22. Intraventricular Block Distribution

23. Distribution of IVB(%) 20 10 40 1 5 10 4

26. Summary FrequencyAgeSexDiabetesIV block HHD the most common (3 9 %) DCM the oldest (71±9 yrs) males (63%) the most common (36%) CHD highest (23%) VHD the youngest (66±11 yrs) females (63%) lowest (4%) only 18% Lone only 2.5% mostly in younger males (men 72%, average age 56±13 yrs)

27. A Proposed Model for the Pathogenesis of AF Experimental and clinical studies have shown that AF is maintained by multiple reentrant wavelets within the atrial muscle. It has been estimated that a critical number of wavelets (from 3 to 6) is necessary for perpetuation of AF...

29. Conclusion(1) The classical risk factors for developing AF include HA, diabetes mellitus, valvular disease, ischaemic cardiomyopathy, CHF and thyroid disease. HHD was by far the most prevalent associated medical condition. Chronic AF was predominant in groups with advanced cardiac remodeling such as DCM and VHD. On the contrary to transient AF, it is a disease of the elderly.

30. Conclusion(2) In order to prevent or postpone the development of AF an optimal treatment of hypertension and diabetes mellitus is necessery