Risk of stroke with paroxysmal and permanent atrial fibrillation is the same
The article highlights importance of basic clinical skills in
identifying a cardiac condition accounting for most of the
hospitalizations related to cardiac arrhythmias. This study has some
interesting aspects like,
Part of the general examination itself is a screening procedure and its
confirmation with most effective test EKG, other thing is its cost
effectiveness. So it is once again proven that how important is basic
clinical skills in day to day clinical life and its impact on the outcome
of health care. This should be emphasized not only in primary care
setting but also in medical school and residency training which helps
them to become perfect when they enter in to practice .
Coming to this
article how many times we ‘ll be successful in identifying an irregular
pulse in atrial fibrillation. The most common type of atrial fibrillation
is paroxysmal atrial fibrillation, which is characterized by repeated,
self terminating episodes of arrhythmia. This can progress to either
persistent atrial fibrillation, in which an intervention such as direct
current cardio version may restore sinus rhythm, or permanent atrial
fibrillation, which is resistant to cardio version.
So the question is
with this simple screening method can we identify asymptomatic pts with
paroxysmal atrial fibrillation who are about to get in to permanent
fibrillation .Inviting pts for electrocardiography based on irregular
pulse may miss some pts with PAF because the change in rate, rhythm and
character of their pulse depends on how often they get episodes of AF but
the risk of stroke is same with both paroxysmal and permanent AF.Hence
stopping further investigation based on absence irregular pulse may not
properly guide further management in some subset of pts unless
symptomatic.
Some other effective screening methods which needs further
studies are “heart rate variability, circulating levels of natriuretic
peptide, Circulating levels of collagen type I degradation marker (depend
on the type of atrial fibrillation).
So in my opinion even though pulse
taking with EKG would be a cost effective and quick screening method when
compared to above we need further studies to have a best screening method
to identify all kinds of asymptomatic pts.
References
1.Onset mechanism of paroxysmal atrial fibrillation detected by ambulatory
Holter monitoring Antonio Vincenti*, Roberta Brambilla, Maria Grazia
Fumagalli, Rita Merola and Stefano Pedretti Electrophysiology and Cardiac
Pacing Unit, Cardiology DepartmentSt Gerardo Hospitalvia Donizetti 106,
20052 Monza (MI) Italy
2.Dimitrios N. Tziakas1,*, Georgios K. Chalikias1, Nikolaos Papanas2,
Dimitrios A. Stakos1, Sofia V. Chatzikyriakou1 and Efstratios Maltezos21
University Cardiology Department, Democritus University of Thrace,
Voulgaroktonou 23, 68100 Alexandroupolis, Evros, Greece; 2 Second
University Internal Medicine Department, Democritus University of Thrace,
Alexandroupolis, Evros, Greece
3.Antithrombotic therapy to prevent stroke in patients with atrial
fibrillation: a meta-analysis.
Hart RG, Benavente O, McBride R, Pearce LA.Department of Medicine
(Neurology), University of Texas Health Science Center, San Antonio 78284,
USA.
Rapid Response:
Risk of stroke with paroxysmal and permanent atrial fibrillation is the same
The article highlights importance of basic clinical skills in
identifying a cardiac condition accounting for most of the
hospitalizations related to cardiac arrhythmias. This study has some
interesting aspects like,
Part of the general examination itself is a screening procedure and its
confirmation with most effective test EKG, other thing is its cost
effectiveness. So it is once again proven that how important is basic
clinical skills in day to day clinical life and its impact on the outcome
of health care. This should be emphasized not only in primary care
setting but also in medical school and residency training which helps
them to become perfect when they enter in to practice .
Coming to this
article how many times we ‘ll be successful in identifying an irregular
pulse in atrial fibrillation. The most common type of atrial fibrillation
is paroxysmal atrial fibrillation, which is characterized by repeated,
self terminating episodes of arrhythmia. This can progress to either
persistent atrial fibrillation, in which an intervention such as direct
current cardio version may restore sinus rhythm, or permanent atrial
fibrillation, which is resistant to cardio version.
So the question is
with this simple screening method can we identify asymptomatic pts with
paroxysmal atrial fibrillation who are about to get in to permanent
fibrillation .Inviting pts for electrocardiography based on irregular
pulse may miss some pts with PAF because the change in rate, rhythm and
character of their pulse depends on how often they get episodes of AF but
the risk of stroke is same with both paroxysmal and permanent AF.Hence
stopping further investigation based on absence irregular pulse may not
properly guide further management in some subset of pts unless
symptomatic.
Some other effective screening methods which needs further
studies are “heart rate variability, circulating levels of natriuretic
peptide, Circulating levels of collagen type I degradation marker (depend
on the type of atrial fibrillation).
So in my opinion even though pulse
taking with EKG would be a cost effective and quick screening method when
compared to above we need further studies to have a best screening method
to identify all kinds of asymptomatic pts.
References
1.Onset mechanism of paroxysmal atrial fibrillation detected by ambulatory
Holter monitoring Antonio Vincenti*, Roberta Brambilla, Maria Grazia
Fumagalli, Rita Merola and Stefano Pedretti Electrophysiology and Cardiac
Pacing Unit, Cardiology DepartmentSt Gerardo Hospitalvia Donizetti 106,
20052 Monza (MI) Italy
2.Dimitrios N. Tziakas1,*, Georgios K. Chalikias1, Nikolaos Papanas2,
Dimitrios A. Stakos1, Sofia V. Chatzikyriakou1 and Efstratios Maltezos21
University Cardiology Department, Democritus University of Thrace,
Voulgaroktonou 23, 68100 Alexandroupolis, Evros, Greece; 2 Second
University Internal Medicine Department, Democritus University of Thrace,
Alexandroupolis, Evros, Greece
3.Antithrombotic therapy to prevent stroke in patients with atrial
fibrillation: a meta-analysis.
Hart RG, Benavente O, McBride R, Pearce LA.Department of Medicine
(Neurology), University of Texas Health Science Center, San Antonio 78284,
USA.
Competing interests:
None declared
Competing interests: No competing interests