Atrial fibrillation in the military patient: a review

Hunter, Alys H.; Cox, Andrew T; d’Arcy, Joanna; Rooms, Martin

doi:10.1136/jramc-2015-000505

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…The atrial only tachyarrhythmias, known collectively as supraventricular tachycardias (SVT), include AF, atrial flutter, atrial tachycardia (AT) and atrioventricular nodal re-entry tachycardia (AVNRT). AF is the most common sustained atrial tachyarrhythmia and is discussed elsewhere in this edition 4. An additional SVT is the atrioventricular re-entry tachycardia (AVRT), seen when an accessory pathway, additional to the atrioventricular (AV) node, conducts between the atria and ventricles and it has a conduction pathway that involves both atria and ventricles.…”

Section: Mechanisms Of Cardiac Arrhythmiasmentioning

confidence: 99%

Atrial and ventricular tachyarrhythmias in military personnel

Posselt¹,

Cox

d’Arcy

et al. 2015

J R Army Med Corps

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Although rare, sudden cardiac death does occur in British military personnel. In the majority of cases, the cause is considered to be a malignant ventricular tachyarrhythmia, which can be precipitated by a number of underlying pathologies. Conversely, a tachyarrhythmia may have a more benign and treatable cause, yet the initial clinical symptoms may be similar, making differentiation difficult. This is an overview of the mechanisms underlying the initiation and propagation of arrhythmias and the various pathological conditions that predispose to arrhythmia genesis, classified according to which parts of the heart are involved: atrial tachyarrhythmias, atrial and ventricular, as well as those affecting the ventricles alone. It encompasses atrial tachycardia, atrial flutter, supraventricular tachycardias and ventricular tachycardias, including the more commonly encountered inherited primary electrical diseases, also known as the channelopathies. The clinical features, investigation and management strategies are outlined. The occupational impact-in serving military personnel and potential recruits-is described, with explanations relating to the different conditions and their specific implication on continued military service.

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Section: Mechanisms Of Cardiac Arrhythmiasmentioning

confidence: 99%

Atrial and ventricular tachyarrhythmias in military personnel

Posselt¹,

Cox

d’Arcy

et al. 2015

J R Army Med Corps

Self Cite

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“…Acute management will depend on both the patient's haemodynamic condition and underlying rhythm (Figure 1). A more detailed treatment of both supraventricular tachyarrhythmias, in general, and AF, in particular, is available in other reviews within this edition 16 17…”

Section: Acute Managementmentioning

confidence: 99%

Managing palpitations in the military patient

Evans

Holdsworth

Jackson³

et al. 2015

J R Army Med Corps

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'Palpitations' include a broad range of symptoms relating to the perception of abnormal activity of the heart. They may reflect an underlying arrhythmia or a hyperawareness of normal cardiac activity caused by stress or anxiety. The challenge to a clinician assessing patients with palpitations is to assess the likely cause of symptoms, to stratify the individual patient risk and to choose the correct management strategy delivered with appropriate urgency. The young military population, subject to increased exposure to environmental stress, is at an increased risk of palpitations. Due to the distracting nature of this symptom and the frequently sudden and unheralded onset, a common consequence is medical downgrading. This article will provide a guide to assessing the heterogeneous group presenting with palpitations and how to both establish the cause and identify the correct treatment for each patient in a timely manner.

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“…[11][12][13] Occupational physical fitness requirements coupled with athletic lifestyles is theorised to place many AD service members at increased risk for AF, similar to the civilian athletic population. 14 The morbidity of AF for AD personnel is a recognised entity but the demographic profiles of service members with AF have not been previously reported. Further, the therapies delivered and offered to military personnel have not been described in light of larger discussions surrounding treatment strategies in the general population.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of US military personnel with atrial fibrillation and associated deployment and retention rates

et al. 2021

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IntroductionAtrial fibrillation (AF) is an arrhythmia impacting military occupational performances. Despite being a recognised disqualifying condition, there is no literature describing US military service members with AF. This study aims to describe members with AF diagnoses, the distribution of treatment strategies and associated deployment and retention rates.MethodsActive duty service members identified with AF from 2004 to 2019 were investigated. Cardiovascular profiles, AF management strategies and military dispositions were assessed by electronic medical record review.Results386 service members (mean age 35.0±9.4 years; 94% paroxysmal AF) with AF diagnoses were identified. 91 (24%) had hypertension followed by 75 (19%) with sleep apnoea. Mean CHA2DS2-VASc scores were low (0.39±0.65). Rhythm treatments were used in 173 (45%) followed by rate control strategies in 155 (40%). 161 (42%) underwent pulmonary vein isolation (PVI). In subgroup analysis of 365 personnel, 147 (40%) deployed and 248 (68%) remained active duty after AF diagnosis. Deployment and retention rates did not differ between those who received no medical therapy, rate control or rhythm strategies (p=0.9039 and p=0.6192, respectively). PVI did not significantly impact deployment or retention rates (p=0.3903 and p=0.0929, respectively).ConclusionService members with AF are young with few AF risk factors. Rate and rhythm medical therapies were used evenly. Over two-thirds met retention standards and 40% deployed after diagnosis. There were no differences in deployment or retention between groups who receive rate therapy, rhythm medical therapy or PVI. Prospective evaluation of the efficacy of specific AF therapies on AF burden and symptomatology in service members is needed.

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Atrial fibrillation in the military patient: a review

Cited by 5 publications

References 29 publications

Atrial and ventricular tachyarrhythmias in military personnel

Atrial and ventricular tachyarrhythmias in military personnel

Managing palpitations in the military patient

Characteristics of US military personnel with atrial fibrillation and associated deployment and retention rates

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