Clinical and etiological study of atrial fibrillation in elderly in upper Assam

The present study was a hospital based observational study carried out on 354 patients of atrial fibrillation 13 years and above who attended the outpatient department and/or were admitted in various units of the Department of Medicine and Cardiology, Assam Medical College and Hospital, Dibrugarh during a period of 1 year from June 2013 to May 2014. In this study the majority of the patients (78), i.e., 22.03% were in the age group of 61-70 years. Majority of the patients were female (58.19%). Males comprised of 41.81%. The common symptoms of atrial fibrillation in the patients were palpitation 85.31% and breathlessness 82.77%. Next common symptoms were fatigue 73.16%, PND 70.06% and swelling of dependant parts 68.93% respectively. Giddiness 57.91% and orthopnea 53.67% were the next common presenting symptoms. Chest pain was the presenting complaint in 22.32% cases and limb weakness or stroke in 7.34% cases. Involuntary movements 3.95% and sleep apnea 1.97% were among the least common symptoms observed, while 2.82% cases were asymptomatic. Among the clinical signs of atrial fibrillation, the most common signs were pulse deficit 77%, raised JVP 74%, pedal edema 68.9%, CCF 68.6%, (LV or RV) S3 52% respectively. Icterus 9.32%, cyanosis 8.47% and clubbing 4.24% were found as minor signs. Maximum 50.56% AF cases were found in the systolic BP ranging from 121 to 160, followed by 33.05% in 80-120 range. Least 16.38% patients were encountered in the systolic BP ranging from 161 to 200. Maximum 74.01% cases were found in the diastolic BP ranging from 71 to 100, followed by 50-70 range in 25.71% cases. As regard to pulse pressure maximum cases were found in the >40 group amounting to 72.88% cases. In the ≤40 group only 27.12% cases were there. Among the type of AF, persistent 46.9% type of atrial fibrillation was found to be most common followed by permanent 34.7%, paroxysmal 17.79% and lone 0.6% respectively. Most common etiology of AF was RHD in 43.5% cases, COPD in 8.75%, cardiomyopathy in 7.63%, IHD in 7.06%, cardiac surgery in 2.82%, hyperthyroidism in 1.97% cases respectively. Congenital heart disease amounted to 1.41%. There were no familial cases of atrial fibrillation observed. This is the first study conducted in upper Assam of North East region. Among the risk factors, hypertension accounted for 31.92%, smoking in 13.27%, DM in 5.93% and alcohol in 1.41%.