Dr. Murtadha Kudhur Hammod
Context: Atrial fibrillation is the most common sustained arrhythmia, increases with age, and presents with highly variable symptoms and severity. Paroxysmal, persistent, and permanent form require very individualized approaches to management. The most important aspect of diagnosis is the causes, the risk groups and risk stratification with respect to risk of thromboembolism. The general goals treatment are, in order of importance: Prevention of thromboembolism, control of ventricular response, restoration of sinus rhythm, and maintenance of sinus rhythm by preventing recurrence.
Objective: To assess the characters, causes, risk groups thromboembolism of AF patients.
Patient and method: 150 patients were included in this study all have permanent AF. The final diagnosis was based on careful evaluation of clinical data and the results of various investigations, all were studied by history, examination, ECG, radiology, echocardiography and biochemical tests when indicated, ischemic heart disease was diagnosed by the history of chest pain typical of chest pain of myocardial ischemia and electrocardiographic criteria of myocardial ischemia. The number of complicated cases of AF by thromboembolism and types of their complication were determined. The relationship between thromboembolism and age, previous stoke and TIA, diabetes mellitus, heart failure, left atrial size, mortality assessed.
Results: The complicated cases with thromboembolism were 30 cases, (80%) of them were stroke, (13.4%) were visceral thromboembolism, and (6.6%) were ischemic limb. Thromboembolism was increasing with age with peak age 61-70 year old (46.6%). 20 cases (66.6%) were IHD,7 cases (23.3%) were valvular heart disease, 3 cases (10%) were HPT and significantly related to left atrial dilatation 25 cases (83.3%) (p=0.001), heart failure 23 cases (76.7%) (p<0.001), DM 11 cases (30%) (p=0.016), age >65 year 24 cases (80%) (p=0.008) and previous stroke 13 cases (34.3%) (p=0.002). There was a highly increase in mortality with AF and thromboembolism (23.3%) (p<0.001) in compared with those without thromboembolism (3.4%). The treated patients were (20%), and the non-treated patients were (80%) which mean there was under prescription of anticoagulant.
Conclusion:
1. The majority of our patients with AF were from high risk group and all need anticoagulation.
2. There is significant number of cases complicated by thromboembolism with high mortality (p<0.001).
3. Under prescription of warfarin was very clear in very high (p=0.035) and high risk groups (p=0.003).
4. There is significant relationship between thromboembolism and the age (p=0.008), left atrial dilatation (p=0.001), heart failure (p<0.001), diabetes mellitus (p=0.016), previous stroke (p=0.002).
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