Atrial Fibrillation: Consequential Diseases

The following are the most important diseases or complications that may be contributed to by atrial fibrillation (VHF):

Respiratory system (J00-J99)

  • Sleep-related respiratory disorders:
    • Obstructive sleep-associated breathing disorders (obstructed airways).
    • Central sleep-associated respiratory disorders, in which the airways remain open but the breathing pattern changes with decreased breathing and apnea (sleep apnea)

Cardiovascular system (I00-I99).

  • Acute arterial occlusion of the extremities.
  • Acute right ventricular failure (RHV) due to preload increase
  • Angina pectoris (“chest tightness”; sudden onset of pain in the heart area).
  • Apoplexy (stroke) apoplexy: 2.42-fold; ischemic apoplexy: 2.33-fold); see also prognostic factors] → risk of dementia ↑
    • Women are affected twice as often as men (rate ratio 1.99; 95 percent confidence interval: 1.46 to 2.71)
    • Coexisting diabetes mellitus increases the risk of apoplexy:
      • Patients with >3 years of diabetes had a relative 74% higher risk than patients with shorter duration (hazard ratio: 1.74)
      • Neither poor glycemic control with HbA1c levels above 9% (adjusted hazard ratio: 1.04) nor less severe hyperglycemia with HbA1c levels between 7- 8.9% (hazard ratio: 1.21) resulted in a significantly increased risk of ischemic stroke (relative to normoglycemia)
    • Atrial fibrillation after bypass surgery (independent predictor of apoplexy (hazard ratio [HR]: 1.53, 95% confidence interval [CI]: 1.06-2.23, p=0.025))
  • Heart failure (cardiac insufficiency; 6-fold increased risk).
    • Tachycardic VHF (VHF with a heart rate >100 beats/min) (VHF can severely affect cardiac output and left ventricular function); women are affected 16% more often than men
    • Heart failure development associated factors are (here: 62% involved in risk increase):
      • Smoking
      • Obesity (body mass index ≥30 kg/m2)
      • Diabetes mellitus
      • Elevated blood pressure (systolic blood pressure > 120 mm Hg)
  • Cardiac arrhythmias:
    • Tachycardic conduction with high ventricular rate.
    • Ventricular fibrillation (life-threatening pulseless cardiac arrhythmia in which disordered excitations occur in the ventricles and the heart muscle no longer contracts in an orderly fashion)
  • Cerebral infarcts, silent → dementia risk ↑ (increased up to threefold).
  • Coronary heart disease (CHD) (1.61-fold).
  • Myocardial infarction (heart attack)
    • Most common cause of coronary embolism (occlusion of coronary arteries) leading to myocardial infarction without CHD involvement (coronary artery disease; coronary artery disease); women are affected 55% more often than men
    • Risk reduction with non-vitamin K-dependent oral anticoagulants (NOAKs): absolute 1-year rates for myocardial infarction ranged from 1.1-1.2
  • Peripheral arterial occlusive disease (pAVD) – progressive narrowing or occlusion of the arteries supplying the arms/ (more commonly) legs, usually due to atherosclerosis (arteriosclerosis, hardening of the arteries) (1.31-fold).
  • Sudden cardiac death (PHT) (1.88-fold).
  • Pulmonary embolism – occlusion of a pulmonary artery.
  • Thromboembolism of extracranial vessels (1 in 10 cases) with acute ischemia in lower extremities (58%), upper extremities (10%), or other internal organs (32% in visceral-esenteric vascular territory); incidence of 0.24% per year (rate for ischemic stroke: 1.92% per year); 30-day mortality was as high after systemic embolism as after apoplexy (24 versus 25%)

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

  • Intestinal ischemia (in 40-50% of cases, it is an arterial embolism (vascular occlusion by an embolus/vascular plug), usually in the area of the A. mesenterica; symptoms: severe abdominal pain, distended abdomen, soft and doughy (now 12 hours remain from symptomatology with acute pain and soft abdomen (rotten peace) to shock symptomatology); diagnosis: angiography; multislice spiral CT; therapy: laparatomy (abdominal incision), revealing a pale light-colored intestine with “zebra markings” that must be resected.Note: In no case suture surgical wound immediately again, because of the high intra-abdominal pressure would cause additional damage, therefore laparostoma (artificially created connection between the abdominal cavity and the outside world), so that a “second look” is possible).

Psyche – Nervous System (F00-F99; G00-G99).

  • Anxiety disorders
  • Depression
  • Insomnia (sleep disorders)
  • Cognitive deficits or dementia (without apoplexy).

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Dyspnea (shortness of breath)
  • Syncope (brief loss of consciousness; in chronic atrial fibrillation).
  • Vertigo (dizziness)

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Chronic kidney disease (1.64-fold).

More

  • Increased mortality (1.7-fold); (1.46-fold).
  • All-cause mortality (all-cause mortality rate) 4.63% per year in participants receiving anticoagulants (each a NOAK (new oral anticoagulants) or warfarin):
    • 46% deaths with cardiac causes:
      • 28% sudden cardiac death/arrhythmias.
      • 15 % heart failure (cardiac insufficiency)
      • 6% Apoplexy/systemic embolism and bleeding.
      • 3 % Myocardial infarction (heart attack)
    • 13% malignant diseases (tumor diseases).
    • 9 % infections

    NOAKs moderately but more significantly reduced all-cause mortality (all-cause mortality rate) compared with warfarin 4.46% vs. 4.87%/year; relative risk reduction: 10%; rate for fatal bleeding complications (primarily intracerebral hemorrhage (ICB; cerebral hemorrhage)) was halved (0.19% vs. 0.38%/year

  • Course of over 17,100 VHF patients over two years:
    • 30% increased mortality in the first 4 months (adjustment problems with vitamin K antagonists, VKA).
    • Within two years: 7% of patients dead:
      • 40% cardiovascular cause of death:
        • 11 % heart failure
        • 7.5% sudden cardiac death
        • Heart attacks and ischemic strokes: 5-6%.
    • CONCLUSION: Most patients died from causes that could not be influenced by anticoagulants:
      • 36% tumors, respiratory failure, or infections.
      • 24% was not an exact cause to determine
  • Cardiovascular mortality (heart and blood vessel related mortality):
    • Cardiovascular mortality (2.03-fold).
    • Women have a 93% higher cardiovascular mortality risk than men

Prognostic factors

  • Short atrial tachycardia/atrial fibrillation (AT/AF) episodes, ie, at least three premature atrial complexes in a row on electrocardiogram (ECG), in a collective of 300 pacemakers and 300 ICD carriers, had no increased risk of clinical events compared with patients without AT/AF episodes.ICD carriers with long AT/AF episodes had significantly increased risk (OR 1.57, p = 0.006).
  • Subclinical AHRE (atrial high rate episode)-Any subclinical AHRE (atrial high rate episode; atrial rate >190 beats/minute for at least six minutes) was recorded for 3 months in patients with pacemaker or ICD implants using pacemaker or ICD systems. In a 2.5-year follow-up period, the occurrence of ischemic insults and systemic emboli were recorded.Results: Patients in whom asymptomatic AHRE had been detected in the first three months had a 2.5-fold higher risk of apoplexy in the follow-up period (hazard ratio, 2. 50; 95% CI, 1.28 to 4.89; P=0.008)In a new analysis of data from the ASSERT trial, only >24 hours of sustained subclinical AF was associated with a significant increase in the risk of apoplexy (stroke) and systemic embolism (adjusted hazard ratio: 3.24, p=0.003).
  • The more pronounced the left atrial fibrosis (fibrosis in the left atrium) in patients with VCF, the higher the risk of apoplexy. Left atrial fibrosis was quantified by contrast-enhanced cardiac MRI examination. The group with the most gradual atrial fibrosis (stage IV) had a 67% higher risk of cardiovascular events (apoplexes/strokes or TIAs, myocardial infarctions/heart attacks, heart failure/heart failure) than the group with the lowest degree of fibrosis (stage I).CONCLUSION: It is possible that atrial cardiomyopathy (atrial myocardial disease) – left atrial fibrosis – rather than heart rhythm is the trigger for the sequelae (complications) associated with atrial fibrillation.
  • In a study of more than 6,500 patients with AF treated with acetylsalicylic acid (ASA), the rate of ischemic apoplexy was 2.1% per year for paroxysmal AF, 3.0% for persistent AF, and 4.2% for permanent AF. Even when age was taken into account, the classification of atrial fibrillation proved to be a strong independent risk predictor.
  • The highest rate of apoplexy in elderly AF patients was seen in the first 30 days after initiation of warfarin therapy (agent of the 4-hydroxycoumarin group; belongs to the vitamin K antagonists; (6.0% per person-year; 95% confidence interval, 5.5-6.4% versus control group: 1.6% per person-year; 95% confidence interval, 1.5-1.6%).
  • Depression exacerbates physical symptoms of AF.