regional medical center: Palpitations May Mean Looming Atrial Fibrillation

Palpitations May Mean Looming Atrial Fibrillation

Main Category: Heart Disease
Also Included In: Cardiovascular / Cardiology
Article Date: 17 May 2012 - 11:00 PDT

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The European Journal of Preventive Cardiology reveals that the emergence of palpitations is a risk factor for atrial fibrillation (AF). Findings of a large population study reveal the strongest risk factors for atrial fibrillation in both men and women to be a history of palpitations and hypertension. Although it is a well-known fact that hypertension is a risk factor for AF, the researchers say, that "the impact of self-reported palpitations on later occurrence of AF has not been documented earlier".

Atrial fibrillation is the most common type of arrhythmia, a problem with the rate or rhythm of the heart in which the heart either beats too fast, too slow or irregularly. AF is a major risk for heart failure at triple the risk. The risk of stroke is also almost five times higher and the risk of overall mortality in those suffering from AF is double as high as compared with those who do not suffer from AF. According to a recent consensus statement, AF has been described as "one of the major common and chronic disorders in modern cardiology", in addition to stating that the mortality and morbidity rate linked to AF "remain unacceptably high".

Between 1994 and 1995, the researchers recruited 22,815 eligible participants in the Norwegian TromsÃ¸ Study, which included all inhabitants in the region over the age of 25 to 96 years old. The average age of the participants at baseline was 46 years, with the average follow-up period consisting of 11.1 years.

The team noted each participant's data on palpitations at baseline, together with their height, weight, blood pressure, heart rate, total cholesterol and high-density lipoprotein cholesterol. The researchers then cross-linked the data to the local diagnostic registry and to the national death register for information on AF documented by electrocardiogram (ECG). They also searched the participants' hospital records for diagnoses of cerebrovascular or cardiovascular events without a recorded diagnosis of arrhythmia.

During the 11.1-year follow up, 361 women or 3% were found to suffer from AF, as well as 461 or 4.2% of men. This translates into an incidence rate of 2.71 per thousand per year for women and 3.87 for men. The strongest risk factors for AF was age, hypertension and self-reported palpitations. Frequent palpitations were observed to elevate the risk of AF by 62% in women, i.e. a hazard ratio (HR) of 1.62 and by 91% in men, a HR of 1.91. To ensure that no common risk factors were overlapping, the researchers also individually assessed the markers for palpitations and AF.

The findings revealed that palpitations were linked to numerous substantial risk factors related to lifestyle, whilst the most significant risk factors for AF were found to be biological factors, like age, height, blood pressure, BMI and diabetes. Regardless of the fact that height, coronary heart disease and antihypertensive treatments were observed as risk factors for both AF and palpitations, the researchers concluded, "that palpitations are probably causally associated with atrial fibrillation."

First author, Dr Audhild Nyrnes from the Department of Community Medicine at the University of TromsÃ¸ in Norway explained:

"Although the occurrence of palpitations was assessed before a diagnosis of AF and the association remained significant even after adjustment for other AF risk factors, we cannot conclude with certainty that the association is causal. However, in this case it is not unreasonable to propose a causal relationship. 'Palpitations' are used subjectively to describe irregular heart beats or accelerated heart rate, and it is likely that a proportion of palpitations also represent cases of irregular heart rhythm, which is a main characteristic of AF."

In a well known US study of 190 patients who sought medical care because of palpitations, 40% of cases were identified with cardiac arrhythmias as the underlying cause, whilst the remainder occurred to either varied or unknown causes. This study and other previous studies indicate that the underlying causes for palpitations are heterogeneous mechanisms that have various strong clinical implications.

Dr Nyrnes said:

"However, palpitations per se are not harmful. They are in fact mostly harmless; the challenge is to detect those, which might signify an underlying condition and future AF. He concluded, saying: "Thus, while palpitations might be reduced by modifying lifestyle factors, such as alcohol consumption and smoking, both of which increase heart rate, it is still unclear if this will reduce the risk of AF. It was interesting that our study found no significant association between lifestyle factors and future AF - and only with palpitations."

The study did confirm hypertension as a considerable risk factor for AF. An elevated blood pressure at baseline, defined as higher than 140/90 mmHg nearly doubled the AF risk in women (HR 1.98) and increased the risk of AF in men by 40% (HR 1.40). According to the researchers, the clinical implications would be "to emphasize the importance of adequate treatment of high blood pressure," adding that those with palpitations could have paroxysms of AF and should therefore undergo further investigation with extended ECG monitoring.

Written By Petra Rattue

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Palpitations May Mean Looming Atrial Fibrillation

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