目的:本研究的目的是确定达喀尔医院负责人心内科的房颤患病率,然后评估临床,临床旁,房颤的病因和进化概况,最后确定在我们的背景下其管理的局限性。
方法:这是一个回顾性研究,描述性,描述性分析,2019年1月至2021年8月在达喀尔医院负责人进行的单中心研究。包括在内,所有因房颤入院的患者,或住院期间出现心房颤动的患者,在研究期间通过心电图或长期心电图记录证实。
结果:与医院人群相比,我们研究期间房颤的患病率为7.71%,性别比为1.03.平均年龄为67.88±14.09岁。我们注意到83.64%的患者至少有一个心血管危险因素,56.36%的人患有高血压,50.91%的久坐的人和23.64%的糖尿病患者。临床上,92.72%的患者有症状,以呼吸困难为主(70.91%)。85.45%的患者出现心律失常,充血性心力衰竭占47.27%。对10例患者进行了长期心电图记录,显示50%的阵发性心房颤动。63例患者(57.27%)有永久性房颤,23例患者(20.91%)有持续性房颤,14例患者(12.73%)有长期持续性房颤,10例患者(9.09%)有阵发性房颤。经胸超声心动图显示57.27%的左心房扩张和72.3%的左心室射血分数降低。心脏病的病因以扩张型心肌病为主(21.82%),其次是缺血性心脏病(17.27%)。在治疗方面,最常用的分子是比索洛尔(38.18%),其次是地高辛(21.81%)。85.46%的病例使用抗凝剂。69.09%的患者单独使用Acenocoumarol。在2例患者中尝试药物诱导的心脏复律均未成功,4例患者从外部电击中受益,3例成功。大多数患者都有良好的结果,但34.54%的患者有血流动力学并发症(18.18%)和血栓栓塞并发症(16.36%)。我们系列的住院死亡率为20%。这与心力衰竭有很大关系,左心室射血分数<35%(p<0.001)。
结论:心房颤动是严重的,因为它的血流动力学,血栓栓塞和节律性并发症。高死亡率是由潜在的疾病解释的,而且由于延迟诊断和管理延迟,最重要的是,在我们的背景下,消融程序的不可用性。
OBJECTIVE: The aim of the study was to determine the prevalence of AF in the cardiology department of the Hospital Principal of
Dakar, then to evaluate the clinical, paraclinical, etiological and evolutionary profiles of AF and finally to identify the limits of its management in our context.
METHODS: This was a retrospective, descriptive, analytical, mono-centric study carried out at Hospital Principal of
Dakar from January 2019 to August 2021. Were included, all patients admitted for atrial fibrillation, or patients who presented an atrial fibrillation during hospitalization, confirmed by electrocardiogram or long-term electrocardiographic recording during the study period.
RESULTS: The prevalence of atrial fibrillation during the period of our study compared to the hospital population was 7.71%, with a sex ratio of 1.03. The mean age was 67.88 ± 14.09 years. We noted that 83.64% of patients had at least one cardiovascular risk factor, with 56.36% suffering from hypertension, 50.91% of sedentary person and 23.64% of diabetics. Clinically, 92.72% of the patients were symptomatic, with dyspnea predominating (70.91%). Cardiac arrhythmia was present in 85.45% of patients, and congestive heart failure in 47.27%. Long-term electrocardiographic recording was performed in 10 patients, showing 50% of paroxysmal atrial fibrillation. Sixty-three patients (57.27%) had permanent AF, twenty-three patients (20.91%) had persistent AF, fourteen patients (12.73%) had long-term persistent AF and ten patients (9.09%) had paroxysmal AF. Transthoracic echocardiography showed 57.27% of left atrial dilatation and 72.3% of reduced left ventricular ejection fraction. Etiologies for cardiac causes were dominated by dilated cardiomyopathy (21.82%), followed by ischemic heart disease (17.27%). In terms of treatment, the most commonly used molecule was bisoprolol (38.18%), followed by digoxin (21.81%). Anticoagulants were used in 85.46% of cases. Acenocoumarol alone was used in 69.09% of patients. Drug-induced cardioversion was attempted in 2 patients without success, and 4 patients benefited from external electric shock with 3 successes. Most patients had a favorable outcome, but 34.54% suffered hemodynamic complications (18.18%) and thromboembolic ones as well (16.36%). In-hospital mortality in our series was 20%. It was significantly related to heart failure, with a left ventricular ejection fraction < 35% (p < 0.001).
CONCLUSIONS: Atrial fibrillation is serious because of its hemodynamic, thromboembolic and rhythmic complications. The high mortality is explained by the underlying condition, but also by the delay in management with late diagnosis and, above all, the unavailability of ablation procedures in our context.