Abstract

Atrial fibrillation is the most common sustained arrhythmia encountered in clinical practice. Its prevalence is higher among older individuals, the most rapidly growing segment of population in Indian subcontinent. Also, different ethnic groups have different risk factors for the development of atrial fibrillation, with valvular heart disease being the most common cause in India and non valvular heart disease in Western countries. Atrial fibrillation may be associated with decreased functional capacity, increased medical expenditures and increased late mortality due to cerebrovascular accident or aggravation of heart failure. Totally new approaches to therapy in form of antiarrhythmics and anticoagulation are also emerging. Ablation or modification of atrioventricular conduction with adoptive rate pacing now permits effective rate control in virtually any patient. In context with recent advances in management and aggressive approach to patient with atrial fibrillation, all patients should be subjected to extensive investigations. MATERIAL & METHODS: Present study was performed in 50 patients who had clinical features, suggestive of atrial fibrillation like Difficulty in breathing, Palpitation, Irregularly irregular pulse - confirmed by ECG. Patients were evaluated and examined in detail. Routine investigations were carried out including haemogram, RFT, LFT, S.electrolytes, ECG, chest X rays, PT with INR and echocardiography. The special investigations like Thyroid function tests, lipid profile, CPK MB, digoxin level, coronary angiography, Holter monitoring and NCCT brain were also done. Treatment was given to the patients in the form of antiarrhythmic drugs, oral anticoagulant, cardioversion and supportive treatment. RESULTS: The incidence of atrial fibrillation increases after the age of 40 years and higher in females. Rheumatic heart disease was the commonest etiology for atrial fibrillation. The cases were due to mitral stenosis and Mitral stenosis + mitral regurgitation. The most common non-valvular causes of atrial fibrillation were Ischemic heart disease. The most common presenting complaint was found to be palpitation followed by chest pain. LVH in ECG was found in 36% of cases with rheumatic heart disease, while 92% in patients with HT + IHD. RVH was presents in 11% (n=3) of patients with rheumatic heart disease. LA clot was found in 29% of cases of rheumatic heart disease. LV clot was detected in 15% of HT+IHD. CONCLUSION: IN India rheumatic mitral valve disease is the commonest cause of atrial fibrillation, unlike in Western studies, where ischemic heart disease is the commonest cause. 2D echocardiography is very helpful to detect the cause of atrial fibrillation, LA size, LV function and LV or LA clot detection. In rheumatic heart disease, LA size co-relates well with incidence of atrial fibrillation, while in ischaemic heart disease low LV function is a better correlating factor. For management of AF diltiazem was used commonly. For antithrombotic therapy warfarin was preferred.

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