| Abstract |
Background: Atrial fibrillation (AF) is one of the most common arrhythmias with incidence 0.3-0.5% in the general population, 3-5% over 20 years of age, 9% after the age of 80. The most common risk factors are aging, male sex, smoking and alcohol, obesity, metabolic syndrome, coronary heart disease, and valvular disease. It is classified into acute, paroxysmal, persistent, long persistent and permanent AF. Also, more recent guidelines refer to the management of ABC pathways of AF, namely the avoidance of stroke which may include anticoagulation treatment (Avoid stroke / Anticoagulation), better symptom control and optimization of cardiovascular risk and comorbidity (Cardiovascular risk and comorbidity optimization).
Objective: To investigate the characteristics of patients with atrial fibrillation and the clinical results from the application of therapeutic methods for the treatment of atrial fibrillation with amiodarone administration, electrical reduction and cryo-ablation with catheter. Also the causes of failure of the above methods in the reduction of atrial fibrillation, alternative therapies in treatment-resistant atrial fibrillation. Finally, to study any complications and the final outcome of patients with vaginal surgery.
Methods: Retrospective observational study of patients over 18 years of age admitted to the Cardiology Clinic of the University General Hospital of Heraklion (C/C UGHH) during the period 2017-2023 with atrial fibrillation as the cause of admission. The following were recorded: demographic characteristics, history of atrial fibrillation, clinical data, medication, response to drug therapy, interventional therapy, complications, outcome, exit treatment and use of the CHA2DS2-VASc index.
Results: 100 patients were studied. Pharmacological treatment was received by the majority of patients, namely, 87 (87%) patients received antiarrhythmic therapy, 97 (97%) patients received anticoagulant therapy, 80 received β-blockers, 32 patients received calcium antagonists, 19 patients received digoxin, and 11 patients received intravenous magnesium administration, combined or not with cryocatalysis or cardioversion. Patients who successfully responded to medication (alone) were 52 (52%) and 48 patients did not respond to medication and proceeded to cardioversion (N=36), cryocatalysis (N=14). Of the 48 patients, cardioversion and cryocautery were applied to two. Variations of laboratory tests (WCC, PT, INR, aPTT) during hospitalization differed from each other over time (all p<0.001). Response or non-response to medication was associated with the type of AF, with medication having a greater response in the Acute form, and non-response being more common in the Paroxysmal form (p<0.001). The duration of hospitalization for each episode in the Cardiology Clinic was on average 3.11±1.9 days and did not differ between the two sexes, and the response or not to the medication treatment. Survival was excellent.
Conclusion: AF patients who did not respond to drug therapy compared to responders did not differ in terms of sex, obesity, smoking, alcohol use, comorbidity, risk of thromboembolic event as assessed by VAS-score, the appearance of specific symptoms, the function of the left ventricle affected or not, the placement of a pacemaker, the administration of anticoagulant and antiarrhythmic therapy, the findings of the ECG and ultrasound examination, the response to the fatigue test, and the findings of the scintigraphy. Response or non-response to medication was significantly related to the type of atrial fibrillation, with the Acute form having a greater response to medication, and non-response being more common in the Paroxysmal form.
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