(Circulation. 1999;99:3028-3035.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Characterization of Different Subsets of Atrial Fibrillation in General Practice in France
The ALFA Study
From the Division of Cardiology, University of Marseille, School of Medicine, France.
Correspondence to Professor S. Lévy, University of Marseille, School of Medecine, Hôpital Nord, Division of Cardiology, Marseille, 13015 France.
Background—The clinical presentation and causes of atrial fibrillation (AF) in the 1990s may differ from AF seen 2 to 3 decades ago. It was the objective of this prospective study to characterize various clinical presentations and underlying conditions of patients with AF observed in general practice in France.
Methods and Results—The study population comprised 756 patients (19 to 95 years of age) with electrocardiographically documented AF subdivided into paroxysmal (<7 days), chronic (last episode >1 month) and recent onset AF(persistent >7 days and<1 month). Symptoms were present in 670 patients (88.6%). The relative prevalences of paroxysmal, chronic, and recent onset AF were 22.1%, 51.4%, and 26.4%, respectively. Cardiac disorders, present in 534 patients (70.6%), included hypertension (39.4%), coronary artery disease (16.6%), and myocardial diseases (15.3%) as the most common. Rheumatic valvular disease represented a common cause in women (25.0%) but not in men (8.0%). The paroxysmal group differed by a high percentage of palpitations (79.0%) and a low percentage of underlying heart disease (53.9%). With a mean follow-up of 8.6±3.7 months, 28 patients (3.7%) died, including 6 fatal cerebrovascular accidents. Among the 728 patients who survived, congestive heart failure occurred in 30 patients (4.1%), and embolic complications occurred in 13 patients (1.8%). In the paroxysmal AF group, 13 patients (8.0%) developed chronic AF and 51 (31.3%) had AF recurrences. At the time of follow-up, 53 patients (14.3%) from the chronic AF group and 108 patients (55.7%) from the recent onset AF group were in sinus rhythm.
Conclusions—This large-scale study establishes the current demographic profile of out-of-hospital patients with AF and highlights some of the changes that have occurred in the past decades, including a particular shift in cardiac causes toward nonrheumatic AF. This study also demonstrates significant differences between various subsets of AF.
Key Words: fibrillation • embolism • atrial • antiarrhythmia agents
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Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology Eur. Heart J., October 2, 2001; 22(20): 1852 - 1923. [PDF]
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V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1231 - 1265. [Full Text] [PDF]
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P. Coumel Sotalol: a fool's deal? Eur. Heart J., August 2, 2001; 22(16): 1370 - 1373. [PDF]
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T. H. Everett IV, J. R. Moorman, L.-C. Kok, J. G. Akar, and D. E. Haines Assessment of Global Atrial Fibrillation Organization to Optimize Timing of Atrial Defibrillation Circulation, June 12, 2001; 103(23): 2857 - 2861. [Abstract] [Full Text] [PDF]
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S.H. Hohnloser and K.-H. Kuck Randomized trial of rhythm or rate control in atrial fibrillation: the Pharmacological Intervention in Atrial Fibrillation Trial (PIAF) Eur. Heart J., May 2, 2001; 22(10): 801 - 802. [PDF]
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J.S. Alpert Atrial fibrillation: a growth industry in the 21st century Eur. Heart J., August 1, 2000; 21(15): 1207 - 1208. [PDF]
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H.J.G.M Crijns, G Tjeerdsma, P.J de Kam, F Boomsma, I.C van Gelder, M.P van den Berg, and D.J van Veldhuisen Prognostic value of the presence and development of atrial fibrillation in patients with advanced chronic heart failure Eur. Heart J., August 1, 2000; 21(15): 1238 - 1245. [Abstract] [PDF]
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D.C. Shah The effectiveness and timing of elective pharmacological cardioversion for paroxysmal atrial fibrillation Eur. Heart J., December 2, 1999; 20(24): 1768 - 1769. [PDF]
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