1Aga Khan University, Karachi, Pakistan
Atrial fibrillation (AF) is a supraventricular tachycardia which is produced by a micro re-entry circuit in atria or structures related to the atria. On surface EKG it is characterized by the absence of identifiable P wave with irregular ventricular rate due to variable AV conduction. It is the most frequent sustained arrhythmia in clinical practice. In this study, we aim to identify the characteristics of patients with atrial fibrillation admitted in a tertiary care hospital in Pakistan.
This is a retrospective observational study. Data analysis was performed by reviewing the patient’s hospital records after approval by the hospital ethical review committee. Initially, hospital records of 636 patients admitted with AF from July 11st 2018 to December 31st, 2018 were studied.
Out of 636 patients, 49.5 % (315) were males and the mean age was 68.5 ±12.09 years. The majority of patients, 90.6 %( 576) were admitted via the emergency room. The mean hospital stay was 6.27 ± 5.23 days. Admission diagnosis included Infection/sepsis in 36.8%(234) patients, congestive cardiac failure in 11.8%(75), acute coronary syndrome in 8.5%(54), cerebrovascular accident (CVA) in 8.5%(54) and chronic lung disease 8%(51) patients. Only 1.9% (12) patients were admitted with atrial fibrillation as a primary diagnosis. Comorbidities include hypertension 85.4 %( 543) of the patients. hyperthyroidism 1.9 %( 12), diabetes mellitus 58.5 %( 372) and coronary artery disease 31.6 %( 201). Among valvular heart disease, mitral stenosis 5.7% (36), mitral regurgitation 62.7% (399), aortic stenosis 2.8 %( 18), and tricuspid regurgitation 33% (210). Only 9% (57) patients had rheumatic heart disease. The mean left ventricular ejection fraction was 48.67% and the mean left atrial volume index was 38.83ml/m2.
Mean CHA2DS2VASC was 3.64, it was ≥2 in 93.4 % (594), ≥ 3 in 78.8% (501), ≥ 4 in 58.55 % (372). In-hospital mortality was 8% (51) and sepsis was the most common cause of death.
In Pakistan, patients with AF presenting to a tertiary care hospital are elderly, they are sick and have multiple co-morbid conditions. The majority of patients present with sepsis and have a high stroke risk score as well as higher bleeding risk.