Arrhythmia-provoking factors and symptoms at the onset of paroxysmal atrial fibrillation: A study based on interviews with 100 patients seeking hospital assistance

BMC Cardiovascular Disorders

S Bertil Olsson¹  Bjarne Madsen-Härdig¹  Anders Hansson¹ 

[1]Department of Cardiology, University Hospital, Lund, Sweden

关键词: alcohol.;    symptoms;    triggering factors;    Paroxysmal atrial arrhythmia;   

Others  :  1088596
DOI  :  10.1186/1471-2261-4-13

 received in 2004-03-26, accepted in 2004-08-03,  发布年份 2004

【 摘 要 】

Background

Surprisingly little information on symptoms of paroxysmal atrial fibrillation is available in scientific literature. Using questionnaires, we have analyzed the symptoms associated with arrhythmia attacks.

Methods

One hundred randomly-selected patients with idiopathic paroxysmal atrial fibrillation filled in a structured questionnaire.

Results

Psychic stress was the most common factor triggering arrhythmia (54%), followed by physical exertion (42%), tiredness (41%) coffee (25%) and infections (22%). Thirty-four patients cited alcohol, 26 in the form of red wine, 16 as white wine and 26 as spirits. Among these 34, red wine and spirits produced significantly more episodes of arrhythmia than white wine (p = 0.01 and 0.005 respectively).

Symptoms during arrhythmia were palpitations while exerting (88%), reduced physical ability (87%), palpitations at rest (86%), shortage of breath during exertion (70%) and anxiety (59%). Significant differences between sexes were noted regarding swollen legs (women 21%, men 6%, p = 0.027), nausea (women 36%, men 13%, p = 0.012) and anxiety (females 79%, males 51%, p = 0.014).

Conclusion

Psychic stress was the commonest triggering factor in hospitalized patients with paroxysmal atrial fibrillation. Red wine and spirits were more proarrhythmic than white wine. Symptoms in women in connection with attacks of arrhythmia vary somewhat from those in men.

【 授权许可】

   
2004 Hansson et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Task Force Rapport: ACC/AHA/ESC Guidelines for the management of patients with atrial fribrillation. Eur Heart J 2001, 22:1852-1923.
• [2]Alpert JS, Petersen P, Godtfredsen J: Atrial fibrillation; Natural history, complications and management. Ann Rev Med 1988, 39:41-52.
• [3]Parkinson J, Campbell M: Paroxysmal auricular fibrillation. A record of 200 patients. Quart J Med 1930, 24:67-100.
• [4]Ostrander LD, Brandt RL, Kjelsberg MO, Epstein FH: Electrocardiographic findings among the adult population of a total natural community, Tecumseh, Michigan. Circulation 1965, 31:888-898.
• [5]Kennel WB, Abbot RD, Savage DD, Mc Namara PM: Coronary heart disease and atrial fibrillation: The Framingham study. Am Heart J 1983, 106:389-396.
• [6]Celik S, Erdol C, Baykan M, Kaplan S, Kasap H: Relation between paroxysmal atrial fibrillation and left ventricular diastolic function in patients with acute myocardial infarction. Am J Cardiol 2001, 88(2):160-162.
• [7]Ristic AD, Maisch B, Hufnagel G, Seferovic PM, Pankuweit S, Ortojic M, Moll R, Olsen E: Arrhythmias in acute pericarditis. An endomyocardial biopsy study. Herz 2000, 25(8):729-733.
• [8]Leather RA, Kerr Charles R: Atrial fibrillation in the absence of overt cardiac disease. In Atrial Fibrillation. Mechanisms and Management. Edited by Falk RH, Podrid PJ. New York: Raven Press, Ltd; 1992:93-108.
• [9]Freedberg AS, Papp JG, Williams EMV: The effects of altered thyroid state on atrial intracellular potentials. J Physiol 1970, 207:357-369.
• [10]Levy S: Epidemiology and classification of atrial fibrillation. J Cardiovasc Electrophysiol 1998, 9(8 Suppl):S78-82.
• [11]Coumel P: Neural aspects of paroxysmal atrial fibrillation. In Atrial Fibrillation. Mechanisms and Management. Edited by Falk RH, Podrid PJ. New York: Raven Press, Ltd; 1992:109-125.
• [12]Viskin S, Golovner M, Malov N, Fish R, Alroy I, Vila J, Laniado S, Kaplinsky E, Roth A: Circadian variation of symptomatic paroxysmal atrial fibrillation. Data from almost 10 000 episodes. Eur Heart J 1999, 20(19):1429-1434.
• [13]Rawles JM, Metcalfe MJ, Jennings K: Time of occurrence, duration, and ventricular rate of paroxysmal atrial fibrillation: the effect of digoxin. Br Heart J 1990, 63(4):225-227.
• [14]Yamashita T, Murakawa Y, Hayami N, Sezahi K, Inone M, Futuri E, Ornata M: Relation between aging and circadian variation of paroxysmal atrial fibrillation. Am J Cardiol 1998, 82(11):1364-1367.
• [15]Bettoni M, Zimmermann M: Autonomic tone variations before the onset of paroxysmal atrial fibrillation. Circulation 2002, 105(23):2753-2759.
• [16]Rich EC, Siebold C, Campion B: Alcoholrelated acute atrial fibrillation: a case control study and review of 40 patients. Arch Intern Med 1985, 145:830-833.
• [17]Ettinger PO, Wu CF, De La Cruzc , Weisse AB, Ahmed SS, Regan TJ: Arrhythmias and the holiday heart: Alcohol associated cardiac rhythm disorders. Am Heart J 1978, 95:555-562.
• [18]Koskinen P, Kupari M: The role of alcohol in atrial fibrillation. In Atrial Fibrillation Mechanisms and Therapeutic Strategies. Edited by Olsson SB, Allessie M, Campbell R. Armonk, NY: Futura Publishing Company, Inc; 1994:225-236.
• [19]Chen Y-J, Chen S-A, Chen Y-C, Yeh HI, Chan P, Chang MS, Lin CI: Effects of rapid atrial pacing on the arrhytmogenic activity of single cardiomyocytes from pulmonary veins. Implication in initiation of atrial fibrillation. Circulation 2001, 04:2849-2854.
• [20]Chen Y-J, Chen Y-C, Yeh H-I, Lin C-I, Chen S-A: Electrophysiology and arrhythmogenic activity of single cardiomyocytes from canine superior vena cava. Circulation 2002, 105:2679-2685.
• [21]Neutel J, Smith D, Jankelow D, Pretorius J, Myburgh P: The aeromedical implications of atrial fibrillation. Aviation, Space, and Environmental Medicine 1990, 1036-1038.
• [22]Jung W, Herwig S, Camm J, Dorian P, Newman D, Akhtar M, Wood K, Ayers G, Luderitz B: Are there differences in quality of life measures depending on clinical type of atrial fibrillation? PACE 1998, 21(Part II):890.
• [23]Bhandari A, Anderson J, Gilbert E, Alpert B, Henthorn R, Waldo A, Cullen M, Hawkinson R, Pritchett E: 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, 124(2):381-386.
• [24]Van den Berg M, Hassink R, Tuinenburg A, van Sonderen E, Lefrandt J, de Kam P, van Gelder I, Smit A, Sanderman R, Crijns H: Quality of life in patients with paroxysmal atrial fibrillation and its predictors: importance of the autonomic nervous system. Eur Heart J 2001, 22:247-253.
• [25]Lau CP, Leung WH, Wong CK, Cheng CH: Haemodynamics of induced atrial fibrillation; A comparative assessment with sinus rhythm, atrial and ventricular pacing. Eur Heart J 1990, 11:219-224.
• [26]Schlepper M, Weppner HG, Merie H: Haemodynamic effects of supraventricular tachycardias and their alterations by electrically and verapamil induced termination. Cardiovasc Res 1978, 12:28-33.
• [27]Hnatkova K, Waktare J, Murgatroyd F, Xiahoua G, Camm J, Malik M: Age and gender influences on rate and duration of paroxysmal atrial fibrillation. PACE 1998, 21(Pt II):2455-2458.
• [28]Anderson JL, Gilbert EM, Alpert BL, Henthorn R, Waldo A, Bhandari A, Hawkinson R, Pritchett E: Prevention of symptomatic recurrences of paroxysmal atrial fibrillation in patients initially tolerating antiarrhythmic therapy. Circulation 1989, 1557-1570.
• [29]Allessie MA, Boyden PA, Camm AJ, et al.: Pathophysiology and prevention of atrial fibrillation. Circulation 2001, 103:769-777.