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Symptoms of Atrial Fibrillation

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Short Stay Management of Atrial Fibrillation

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Atrial fibrillation (AF) is the most common clinically significant arrhythmia and is associated with significant morbidity and mortality. Symptoms linked to atrial fibrillation are variable and commonly include palpitations, dyspnea, chest pain, or an incidental electrocardiographic finding. Other less common presentations include anxiety or depression. Understanding the many possible presenting signs and symptoms of atrial fibrillation is critical when evaluating patients in the short stay unit as they can be associated with other commonly coexisting cardiac conditions such as heart failure. Long-term clinical outcomes based on rate versus rhythm control are similar; therefore, an individualized treatment approach directed at symptoms may be most beneficial. The objectives of this chapter are to describe the wide range of symptoms associated with atrial fibrillation, to review the proposed mechanisms responsible for these symptoms, to list atrial fibrillation symptom scoring tools, and to summarize targeted symptom management strategies.

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References

  1. Colilla S, Crow A, Petkun W, et al. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013;112:1142–7.

    Article  PubMed  Google Scholar 

  2. Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015;386(9989):154–62. doi:http://dx.doi.org/S0140-6736(14)61774-8.

  3. Aggarwal S, Gupta V. Burden of atrial fibrillation on the hospitals in USA: analysis of nationwide emergency department sample data. Circulation. 2014;130 Suppl 2:A15749.

    Google Scholar 

  4. Flaker GC, Belew K, Beckman K, et al. Asymptomatic atrial fibrillation: demographic features and prognostic information from the atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study. Am Heart J. 2005;149(4):657–63.

    Article  PubMed  Google Scholar 

  5. Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347:1825–33.

    Article  CAS  PubMed  Google Scholar 

  6. Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002;347:1834–40.

    Article  PubMed  Google Scholar 

  7. Roy D, Talajic M, Nattel S, et al. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med. 2008;358:2667–77.

    Article  CAS  PubMed  Google Scholar 

  8. Nieuwlaat R, Capucci A, Camm AJ, et al. Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart survey on atrial fibrillation. Eur Heart J. 2005;26:2422–34.

    Article  PubMed  Google Scholar 

  9. Nabauer M, Gerth A, Limbourg T, et al. The registry of the German competence network on atrial fibrillation: patient characteristics and initial management. Europace. 2009;11:423–34.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lévy S, Maarek M, Coumel P, et al. Characterization of different subsets of atrial fibrillation in general practice in France: the ALFA study. Circulation. 1999;99:3028–35.

    Article  PubMed  Google Scholar 

  11. Lok NS, Lau CP. Presentation and management of patients admitted with atrial fibrillation: a review of 291 cases in a regional hospital. Int J Cardiol. 1995;48:271–8.

    Article  CAS  PubMed  Google Scholar 

  12. Lip GYH, Tean KN, Dunn FG. Treatment of atrial fibrillation in a district general hospital. Br Heart J. 1994;71:92–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Barsky AJ, Ahern DK, Brener J, et al. Palpitations and cardiac awareness after heart transplantation. Psychosom Med. 1998;60:557–62.

    Article  CAS  PubMed  Google Scholar 

  14. Funk M, Richards SB, Desjardins J, et al. Incidence, timing, symptoms, and risk factors for atrial fibrillation after cardiac surgery. Am J Crit Care. 2003;12:424–35.

    PubMed  Google Scholar 

  15. Alboni P, Scarfo S, Fuca G, et al. Hemodynamics of idiopathic paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 1995;18:980–5.

    Article  CAS  PubMed  Google Scholar 

  16. Rienstra M, Lubtiz SA, Mahida S, et al. Symptoms and functional status of patients with atrial fibrillation: state of the art and future research opportunities. Circulation. 2012;125:1933–43.

    Article  Google Scholar 

  17. Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiov Res. 2002;54:230–46.

    Article  CAS  Google Scholar 

  18. Singh SN, Tang XC, Singh BN, et al. Quality of life and exercise performance in patients in sinus rhythm versus persistent atrial fibrillation: a veterans affairs cooperative studies program substudy. J Am Coll Cardiol. 2006;48:721–30.

    Article  PubMed  Google Scholar 

  19. Ueshima K, Myers J, Graettinger WF, et al. Exercise and morphologic comparison of chronic atrial fibrillation and normal sinus rhythm. Am Heart J. 1993;126:260–1.

    Article  CAS  PubMed  Google Scholar 

  20. MacRae CA. Symptoms in atrial fibrillation. Circ Arrhythmia Electrophysiol. 2009;2:215–7.

    Article  Google Scholar 

  21. Range FT, Schafers M, Acil T, et al. Impaired myocardial perfusion and perfusion reserve associated with increased coronary resistance in persistent idiopathic atrial fibrillation. Eur Heart J. 2007;28:2223–30.

    Article  PubMed  Google Scholar 

  22. Goette A, Bukowska A, Dobrev D, et al. Acute atrial tachyarrhythmia induces angiotensin II type 1 receptor-mediated oxidative stress and microvascular flow abnormalities in the ventricles. Eur Heart J. 2009;30:1411–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. van den Berg MP, Hassink RJ, Tuinenburg AE, et al. Quality of life in patients with paroxysmal atrial fibrillation and its predictors: importance of the autonomic nervous system. Eur Heart J. 2001;22:247–53.

    Article  PubMed  Google Scholar 

  24. Thrall G, Lip GY, Carroll D, et al. Depression, anxiety, and quality of life in patients with atrial fibrillation. Chest. 2007;132:1259–64.

    Article  PubMed  Google Scholar 

  25. Lange HW, Herrmann-Lingen C. Depressive symptoms predict recurrence of atrial fibrillation after cardioversion. J Psychosom Res. 2007;63:509–13.

    Article  PubMed  Google Scholar 

  26. Vesely DL. Atrial natriuretic peptides in pathophysiological diseases. Cardiovasc Res. 2001;51:647–8.

    Article  CAS  PubMed  Google Scholar 

  27. Asberg S, Henriksson KM, Farahmand B, et al. Ischemic stroke and secondary prevention in clinical practice: a cohort study of 14,529 patients in the Swedish stroke register. Stroke. 2010;41:1338–42.

    Article  PubMed  Google Scholar 

  28. Savelieta I, Paquette M, Dorian P, et al. Quality of life in patients with silent atrial fibrillation. Heart. 2001;85:216–7.

    Article  Google Scholar 

  29. Frykman V, Frick M, Jensen M, et al. Asymptomatic versus symptomatic persistent atrial fibrillation: clinical and noninvasive characteristics. J Intern Med. 2001;250:390–7.

    Article  CAS  PubMed  Google Scholar 

  30. Page RL, Wilkinson WE, Clair WK, et al. Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. Circulation. 1994;89:224–7.

    Article  CAS  PubMed  Google Scholar 

  31. Glotzer TV, Hellkamp AS, Zimmerman J, et al. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the atrial diagnostics ancillary study of the Mode Selection Trial (MOST). Circulation. 2003;107:1614–9.

    Article  PubMed  Google Scholar 

  32. Bhanderi AK, Anderson JL, Gilbert EM, et al. Correlation of symptoms with occurrence of paroxysmal supraventricular tachycardia or atrial fibrillation: a transtelephonic monitoring study: the flecainide supraventricular tachycardia study group. Am Heart J. 1992;24(2):381–6.

    Article  Google Scholar 

  33. Defaye P, Dournaux F, Mouton E. Prevalence of supraventricular arrhythmias from the automated analysis of data stored in the DDD pacemakers of 617 patients: the AIDA study. The AIDA multicenter study group. Automatic interpretation for diagnosis assistance. Pacing Clin Electrophysiol. 1998;21:250–5.

    Article  CAS  PubMed  Google Scholar 

  34. Patten M, Maas R, Karim A, et al. Event-recorder monitoring in the diagnosis of atrial fibrillation in symptomatic patients: subanalysis of the SOPAT trial. J Cardiovasc Electrophysiol. 2000;4:369–82.

    Article  Google Scholar 

  35. Cooper HA, Bloomfield DA, Bush DE, et al. Relation between achieved heart rate and outcomes in patients with atrial fibrillation (from the atrial fibrillation follow-up investigation of rhythm management [AFFIRM] study). Am J Cardiol. 2004;93:1247–53.

    Article  PubMed  Google Scholar 

  36. Crijns HJ. Rate versus rhythm control in patients with atrial fibrillation: what the trials really say. Drugs. 2005;65:1651–67.

    Article  CAS  PubMed  Google Scholar 

  37. Maglio C, Sra J, Paquette M, et al. Measuring quality of life and symptom severity in patients with atrial fibrillation. Pacing Clin Electrophysiol. 1998;21:839.

    Google Scholar 

  38. Dorian P, Jung W, Newman D, et al. The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy. J Am Coll Cardiol. 2000;36:1303–9.

    Article  CAS  PubMed  Google Scholar 

  39. Kirchhof P, Auricchio A, Bax J, et al. Outcome parameters for trials in atrial fibrillation: recommendations from a consensus conference organized by the German Atrial Fibrillation Competence Network and the European Heart Rhythm Association. Europace. 2007;9:1006–23.

    Article  PubMed  Google Scholar 

  40. Dorian P, Guerra PG, Kerr CR, et al. Validation of a new simple scale to measure symptoms in atrial fibrillation: the Canadian Cardiovascular Society Severity in Atrial Fibrillation (CCS-SAF) Scale. Circ Arrhythm Electrophysiol. 2009;2:268–75.

    Article  Google Scholar 

  41. Harden M, Nystrom B, Kulich K, et al. Validity and reliability of a new, short symptom rating scale in patients with persistent atrial fibrillation. Health Qual Life Outcomes. 2009;7:65–75.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Hohnloser SH, Kuck KH, Lilienthal J. Rhythm or rate control in atrial fibrillation: Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomized trial. Lancet. 2000;356:1789–94.

    Article  CAS  PubMed  Google Scholar 

  43. Carlsson J, MIketic S, Windeler J, et al. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol. 2003;41:1690–6.

    Article  PubMed  Google Scholar 

  44. Atwood JE, Myers J, Sullivan M, et al. The effect of cardioversion on maximal exercise capacity in patients with chronic atrial fibrillation. Am Heart J. 1993;126:1021–4.

    Article  PubMed  Google Scholar 

  45. Van Gelder IC, Crijns HJ, Blanksma PK, et al. Time course of hemodynamic changes and improvement of exercise tolerance after cardioversion of chronic atrial fibrillation unassociated with cardiac valve disease. Am J Cardiol. 1993;72:560–6.

    Article  PubMed  Google Scholar 

  46. Kay GN, Ellenbogen KA, Giudici M, et al. The ABLATE and PACE trial: a prospective study of catheter ablation of the AV conduction system and permanent pacemaker implantation for treatment of atrial fibrillation: APT investigators. J Interv Card Electrophysiol. 1998;2:121–35.

    Article  CAS  PubMed  Google Scholar 

  47. Wood MA, Brown-Mahoney C, Kay GN, et al. Clinical outcomes after ablation and pacing therapy for atrial fibrillation: a meta-analysis. Circulation. 2000;101:1138–44.

    Article  CAS  PubMed  Google Scholar 

  48. Jais P, Cauchemez B, Macle L, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation. 2008;118:2498–505.

    Article  PubMed  Google Scholar 

  49. Reynolds MR, Walczak J, White SA, et al. Improvements in symptoms and quality of life in patients with paroxysmal atrial fibrillation treated with radiofrequency catheter ablation versus antiarrhythmic drugs. Circ Cardiovasc Qual Outcomes. 2010;3:615–23.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Cardiology, Presence Saint Francis Hospital, Evanston, IL, USA

    Shahriar Dadkhah MD, MBA, FACP, FACC, FSCAI

  2. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Korosh Sharain MD

Authors
  1. Shahriar Dadkhah MD, MBA, FACP, FACC, FSCAI
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  2. Korosh Sharain MD
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Corresponding author

Correspondence to Shahriar Dadkhah MD, MBA, FACP, FACC, FSCAI .

Editor information

Editors and Affiliations

  1. Baylor College of Medicine, Department of Emergency Medicine Baylor College of Medicine, HOUSTON, Texas, USA

    W. Frank Peacock

  2. Department of Emergency Medicine, Beaumont Health System, William Beaumont Hospital, William Beaumont School of Medicine, Oakland University, Royal Oak, Michigan, USA

    Carol L. Clark

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Dadkhah, S., Sharain, K. (2016). Symptoms of Atrial Fibrillation. In: Peacock, W., Clark, C. (eds) Short Stay Management of Atrial Fibrillation. Contemporary Cardiology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-31386-3_5

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  • DOI: https://doi.org/10.1007/978-3-319-31386-3_5

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  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-31384-9

  • Online ISBN: 978-3-319-31386-3

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