Epidemiologic profile and clinical follow-up of a population with acute atrial fibrillation and age < 60 years old in the emergency room

Introduction

Atrial fibrillation (AF) has a high prevalence in the elderly population. Nevertheless, it has been found in young patients.

Objectives

To show the clinical and epidemiological aspects of a population of patients with AF and age < 60 years old in the emergency room (ER), evaluating symptoms, triggering factors, related diseases and recurrence of AF.

Methods

From March 2000 to October 2002, 236 patients with AF were seen in the ER. Fifty-seven patients (24.1%) were aged < 60 years old. Forty-six patients (80%) were male, mean age 49.4 ± 8.3 years old. The patients were set on an algorithm for AF.

Results

All the patients were hemodynamically stable. Forty-five patients (78.9%) presented palpitation and 10 patients (17.5%) precordial pain to admission. Twelve patients (21%) had the first reported incident of AF; 39 patients (68.3%) had recurrent AF, six patients (10.5%) had > 10 admissions per AF in the past year. Twenty-five patients (43.8%) indicated stress as the main triggering factor of the event and 23 patients (40.3%) indicated alcohol intake. Thirty-nine patients (68.4%) started AF at a rest period, 13 (22.8%) at activity and five patients (8.7%) after food intake. Among the risk factors for embolic events, 20 patients (35.1%) were hypertensive; two patients (3.5%) had previous stroke; three patients (5.2%) had mitral disease; four patients (7%) had hypertrophic cardiomyopathy; four patients (7%) had coronary artery disease; one patient (1.7%) had diabetes mellitus; and seven patients (12.3%) had thyroidal disease. Twenty-two patients (38.5%) had been using anti-arrhythmic medications regularly. Forty-one patients (71.9%) showed < 48 hours of symptoms, and the others an unknown time or > 48 hours. Thirty patients (52.6%) had arrhythmia reversed with oral medication, with mean reversion Δt of 5.7 hours. Thirteen patients (22.8%) had successful ECV with an average charge of 200 J. Ten patients (17.5%) had spontaneous reversion; three (5.26%) had unsuccessful. In a follow-up of 5 months to 2 years, 32 patients were observed. Fifteen patients (46.8%) had recurrence of AF despite use of anti-arrhythmic medication. Eighteen patients (31.5%) did not use anticoagulant or anti-agglutinant. There was an embolic event in one patient (3.1%).

Conclusions

Our patients develop with hemodynamic stability to admission and present an elevated reversion rate in the ER (75.4%) with mean Δt < 6 hours. Hypertension was the main risk factor without correlation to recurrence (P = not significant). Stress was the factor correlated to recurrence (P = 0.038). Patients with Δt < 48 hours showed a higher reversion rate of AF in the ER (P = 0.009). The recurrent rate of AF in this population was high even with anti-arrhythmic medication, but the number of thromboembolic events was low.