Prevalence of unknown atrial fibrillation in patients with risk factors

Samol, Alexander; Masin, M.; Gellner, Reinhold; Otte, Britta; Pavenstädt, Hermann-Joseph; Ringelstein, E. B.; Reinecke, Holger; Waltenberger, Johannes; Kirchhof, Paulus

doi:10.1093/europace/eus366

Cited by 61 publications

(42 citation statements)

References 31 publications

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“…[5][6][7][8]14 Moreover, estimates of AF prevalence based on symptomatic presentations are problematic because AF is silent in ≤5% to 35% of patients. [15][16][17] As such, when factoring in patients with paroxysmal and silent AF, the projected prevalence of AF in the United States in 2050 increases from 5.6 million (excluding paroxysmal and silent AF) to 12.1 to 15.9 million. 9,13 Risk Factors for AF AF is a multifaceted condition ranging from an isolated electrophysiological disorder to a manifestation or consequence of other cardiac and noncardiac pathologies.…”

Section: Incidence and Prevalence Of Afmentioning

confidence: 99%

The Clinical Profile and Pathophysiology of Atrial Fibrillation

Andrade

Khairy

Dobrev

et al. 2014

Circulation Research

954

364

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Atrial fibrillation (AF) is the most common arrhythmia (estimated lifetime risk, 22%–26%). The aim of this article is to review the clinical epidemiological features of AF and to relate them to underlying mechanisms. Long-established risk factors for AF include aging, male sex, hypertension, valve disease, left ventricular dysfunction, obesity, and alcohol consumption. Emerging risk factors include prehypertension, increased pulse pressure, obstructive sleep apnea, high-level physical training, diastolic dysfunction, predisposing gene variants, hypertrophic cardiomyopathy, and congenital heart disease. Potential risk factors are coronary artery disease, kidney disease, systemic inflammation, pericardial fat, and tobacco use. AF has substantial population health consequences, including impaired quality of life, increased hospitalization rates, stroke occurrence, and increased medical costs. The pathophysiology of AF centers around 4 general types of disturbances that promote ectopic firing and reentrant mechanisms, and include the following: (1) ion channel dysfunction, (2) Ca 2+ -handling abnormalities, (3) structural remodeling, and (4) autonomic neural dysregulation. Aging, hypertension, valve disease, heart failure, myocardial infarction, obesity, smoking, diabetes mellitus, thyroid dysfunction, and endurance exercise training all cause structural remodeling. Heart failure and prior atrial infarction also cause Ca 2+ -handling abnormalities that lead to focal ectopic firing via delayed afterdepolarizations/triggered activity. Neural dysregulation is central to atrial arrhythmogenesis associated with endurance exercise training and occlusive coronary artery disease. Monogenic causes of AF typically promote the arrhythmia via ion channel dysfunction, but the mechanisms of the more common polygenic risk factors are still poorly understood and under intense investigation. Better recognition of the clinical epidemiology of AF, as well as an improved appreciation of the underlying mechanisms, is needed to develop improved methods for AF prevention and management.

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Section: Incidence and Prevalence Of Afmentioning

confidence: 99%

The Clinical Profile and Pathophysiology of Atrial Fibrillation

Andrade

Khairy

Dobrev

et al. 2014

Circulation Research

954

364

View full text Add to dashboard Cite

show abstract

“…Additional fishing grounds have also been probed, at least in preliminary data sets: A patient-operated ECG system similar to the one used by Engdahl and colleagues identified silent AF in patients who seek medical help for the treatment of hypertension, diabetes mellitus, or stroke, especially in those who accumulate several stroke risk factors. 19 Blood-based biomarkers, including genetic markers, may in the future help to further define good fishing grounds for silent AF, although their role in clinical practice is yet to be defined. 20 Also, the first step of the screening program may be facilitated by recording an ECG only in those with an irregular pulse rather than recording ECG systematically.…”

Section: Ahmad and Kirchhof Gone Fishing (For Silent Atrial Fibrillatmentioning

confidence: 99%

Gone Fishing (for Silent Atrial Fibrillation)

Ahmad

Kirchhof

2013

Circulation

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“…AF was found in 3% of patients with hypertension without other risk factors, in 7% of patients with two risk factors and in 11% of patients with hypertension, diabetes and stroke. 13 In our cohort, AF was present in 0.6% of cases in the general sample. The group with higher frequency was that of individuals with suspect or diagnosis of coronary disease (4.5%).…”

Section: Discussionmentioning

confidence: 51%