Little is known about the long-term prognosis of or predictors for the different clinical types of atrial fibrillation (AF) in Korean populations. The aim of this study was to validate a risk stratification to assess the probability of AF progression from paroxysmal AF (PAF) to persistent AF (PeAF) or permanent AF. A total of 434 patients with PAF were consecutively enrolled (mean age; 71.7 +/- 10.7 yr, 60.6% male). PeAF was defined as episodes that are sustained > 7 days and not self-terminating, while permanent AF was defined as an ongoing long-term episode. Atrial arrhythmia during follow-up was defined as atrial premature complex, atrial tachycardia, and atrial flutter. During a mean follow-up of 72.7 +/- 58.3 months, 168 patients (38.7%) with PAF progressed to PeAF or permanent AF. The mean annual AF progression was 10.7% per year. In univariate analysis, age at diagnosis, body mass index, atrial arrhythmia during follow-up, left ventricular ejection fraction, concentric left ventricular hypertrophy, left atrial diameter (LAD), and severe mitral regurgitation (MR) were significantly associated with AF progression. In multivariate analysis, age at diagnosis (P = 0.009), atrial arrhythmia during follow-up (P = 0.015), LAD (P = 0.002) and MR grade (P = 0.026) were independent risk factors for AF progression. Patients with younger age at diagnosis, atrial arrhythmia during follow-up, larger left atrial chamber size, and severe MR grade are more likely to progress to PeAF or permanent AF, suggesting more intensive medical therapy with close clinical follow-up would be required in those patients.
Aged ; Atrial Fibrillation/epidemiology/mortality/*pathology ; Atrial Flutter/*epidemiology/mortality/pathology ; Atrial Premature Complexes/*epidemiology/mortality/pathology ; Disease Progression ; Echocardiography ; Female ; Heart Atria/pathology/ultrasonography ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; Tachycardia, Ectopic Atrial/*epidemiology/mortality/pathology ; Tachycardia, Paroxysmal/*epidemiology/mortality/pathology ; Thromboembolism/epidemiology/mortality ; Treatment Outcome

OBJECTIVETo investigate the relation between atrial fibrillation (AF) and coronary heart disease according to the pathological data.

METHODTotal 540 out of 1012 anatomic older cases were admitted to our study, according to the clinical and pathological data in our hospital.

RESULTS(1) The incidence of AF increased significantly with aging (Cochran-Armitage trend test, P<0.01). (2) The AF patients were more likely to accompany coronary heart disease (P=0.0028) based on the anatomical documentation; the incidence of myocardial infarction in the AF group was statistically significant higher than that in the sinus rhythm group (P=0.0144). The level of coronary artery lesion in AF group was statistically significant severe than that in the sinus rhythm group. (3) Age (OR=1.34, 95% CI 1.11 - 1.60), male (OR=5.71, 95% CI 1.87 - 17.39) and chronic heart failure (OR=1.87, 95% CI 1.27 - 2.76) were independent risk factors of AF based on multivariant logistic analysis, while coronary heart disease (OR=1.47, 95% CI 0.91 - 2.39) was not an independent risk factor.

CONCLUSIONSThe incidence of AF increases significantly with aging in the elderly. The AF patients seem more likely to accompany coronary heart disease but coronary heart disease may be not the independent risk factor of AF in the elderly.

Age Factors ; Aged ; Aged, 80 and over ; Atrial Fibrillation ; epidemiology ; Coronary Disease ; epidemiology ; Humans ; Incidence ; Middle Aged ; Pathology, Clinical ; statistics & numerical data ; Risk Factors

Atrial fibrillation (AF) is a common arrhythmia that is a potent independent risk factor for stroke. The incidence of AF increase with age and most affected people have underlying cardiac disease. This study aimed to describe the prevalence of and risk factors for AF in Korean. In this study, 14,540 adults (male 6,573/female 7,967) > or =40 yr old received screening test for general health between April 2000 and December 2000. Participants answered questionnaires and underwent examinations that included blood pressure, electrocardiogram (ECG), total cholesterol, and fasting glucose. Data analysis was done by SPSS 10.0 for Windows. The prevalence of AF was 0.7% in people older than 40 yr and 2.1% in those older than 65 yr. The prevalence in men was 1.2% and women was 0.4% in people older than 40 yr. The prevalence in men was 3.3% and women was 1.1% in people older than 65 yr. Approximately 56.6% of individuals with AF are older than 65 yr. The prevalence of AF was higher at all age group in men than in women. Also, the prevalence of AF was highest in people older than 80 yr. In univariate analysis, male sex, old age (> or =65 yr), hypertension, diabetes mellitus, left ventricular hypertrophy in ECG, stroke, and cardiac disease were associated with an increased risk of AF. In multivariate analysis, however, risk factors of AF were male (odds ratio, OR 4.1; 95% confidence interval [CI] : 2.6 to 6.5; p=0.000), old age (OR 5.3; 95% CI:3.5 to 7.9; p=0.000), and cardiac disease (OR 19.8; 95% CI:12.3 to 31.8; p=0.000). In this study, the most potent risk factors of AF was cardiac disease.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Atrial Fibrillation/*epidemiology/*pathology ; Cholesterol/metabolism ; Electrocardiography ; Female ; Glucose/metabolism ; Heart Diseases/pathology ; Humans ; Hypertrophy, Left Ventricular ; Incidence ; Korea ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Prevalence ; Risk ; Risk Factors

INTRODUCTIONThe treatment of aortic valve stenosis (AS) is seeing renewed interest mainly due to the availability of transcatheter therapies. However, the number of epidemiological studies of this disease in Singapore is limited. We aimed to describe the aetiology and clinical presentation of AS in Singapore, as well as patients' attitudes toward it. Our findings may facilitate the future planning and utilisation of resources to better manage these patients.

METHODS249 consecutive patients who underwent transthoracic echocardiography (from April 1999 to April 2008) and diagnosed with severe AS were assessed. Demographic and clinical data were collected, and patients' decisions on surgery were determined.

RESULTSThe mean patient age was 71 (range 23-98) years. 50.2% of patients were male. The commonest presenting symptom was dyspnoea, and 40 (16.0%) patients had coexistent atrial fibrillation. The aetiology of AS was degenerative in 216 (86.7%), rheumatic in 11 (4.4%) and related to a bicuspid valve in 22 (8.9%) patients. The average peak velocity across the aortic valve was 4.2 ± 0.8 m/s and the mean aortic valve area was 0.76 ± 0.13 cm2. The overall mean logistic EuroSCORE was 10.7 ± 12.3. 105 (42.2%) patients who were offered surgery refused. 87 (35%) deaths were seen during the follow-up period (mean duration 14.5 months), which also saw 68 (27%) patients undergo surgery and 86 (34%) patients hospitalised for heart failure.

CONCLUSIONDegenerative AS was the commonest aetiology in this contemporary cohort of patients. Despite the known benefits of surgery, the refusal rate for surgery remained high.

Adult ; Aged ; Aged, 80 and over ; Aortic Valve ; pathology ; Aortic Valve Stenosis ; complications ; diagnosis ; epidemiology ; Asian Continental Ancestry Group ; Atrial Fibrillation ; complications ; diagnosis ; Cohort Studies ; Dyspnea ; complications ; diagnosis ; Echocardiography ; methods ; Electrocardiography ; methods ; Female ; Humans ; Male ; Middle Aged ; Singapore