Ritmo cardíaco y embolias sistémicas en la evolución alejada de pacientes con fibrilación auricular paroxística no valvular / Cardiac rhythm and systemic emboli during long term follow up of patients with non-valvular paroxysmal atrial fibrillation

ABSTRACT

Background: Paroxysmal atrial fibrillation may predispose to systemic embolism. There is little information about the evolution of cardiac rhythm and the occurrence of new embolic events in these patients. Aim: To report the results of a long term follow up of patients with paroxysmal atrial fibrillation. Patients and methods: Patients consulting for non valvular paroxysmal atrial fibrillation were followed for a mean period of 5 years. An EKG, 2D echocardiogram and brain CT scans were performed on admission and at the end of the follow up period to all patients. Results: Sixty eight patients aged 65 ñ 1.5 years were studied. Thirty two had an idiopathic atrial fibrillation, 28 had a history of mild hypertension and 8 had a history of coronary artery disease. Evidence of systemic emboli was found in 17 patients at entry (to the brain in 14 patients). During the follow up 87 per cent of patients required antiarrhythmics, 27 per cent were anticoagulated and 28 per cent received aspirin. Five patients had new embolic episodes. Of these, four had a history of prior embolism. Forty one percent of patients continued in sinus rhythm and remained asymptomatic, 32 per cent had at least one recurrence of paroxysmal atrial fibrillation and nine patients evolved to chronic atrial fibrillation. Five patients required a permanent pacemaker due to symptomatic bradycardia. Conclusions: Most patients with non valvular paroxysmal atrial fibrillation remain in sinus rhythm but one third have recurrences of the arrhythmia. A main risk factor for embolism is the history of previous embolic episodes