抄録
Clinical findings of 427 patients with atrial fibrillation or flutter (243 males. and 184 females), who were examined at the Nagoya National Hospital during the last five years, were reviewed.
As to the chronicity of atrial fibrillation or flutter, it was chronic in 79.0%, paroxysmal in 7.0%, recurrent in 2.8% and unknown in 11.2%.
The underlying diseases were valvular diseases in 39.0%, hypertension or coronary heart disease in 38.3%, hyperthyroidism in 3.3% and miscellaneous conditions in 8.0%. In 5.2% no substantiated diseases existed.
When the ages were represented by those at the time of initial examination, the highest incidence (108 cases, i. e., 25.3%) was seen in the 7th decade. The incidence of atrial fibrillation associated with valvular diseases was highest in the 4th and 5th decades and that associated with hypertension was highest in the 7th decade.
Atrial flutter was seen in 13 cases, that is, 3% of the whole material. It was paroxysmal in 2 and recurrent in the other 2 out of the 13 cases. In atrial flutter the predominant underlying disease was hypertension. Occurrence of atrial flutter in mitral valvular disease was rather rare.
Further, cases with atrial fibrillation or flutter in which the arrhythmias occurred paroxysmal or recurrent were analysed in some detail with regard to etiology and precipitating factors. In 4 out of the 13 cases of hyperthyroidism the arrhythmias were paroxysmal (fibrillation 3, and flutter 1), being the highest rate of paroxysmal occurrence among other underlying diseases. Also, a paroxysmal atrial fibrillation was observed in 3 cases immediately after mitral commissurotomy (among 41 operations in cases with sinus rhythm) and in 3 cases soon after onset of myocardial infarction. There were 3 cases with a poor general condition in which paroxysmal atrial fibrillation occurred.
As to the direct complications of atrial fibrillation, systemic arterial embolization including that in the brain occurred in 33 cases, and 26 of the 33 were cases of valvular disease. Thus, the incidence of embolism in valvular disease was 15.6% (26 among 166).
There were 48 fatal cases including 26 cases with valvular diseases and 5 cases with hypertension or coronary disease. The immediate cause of death was sudden cardiac death in 12, progressive heart failure in 13, cerebral vascular accident in 7 and malignancy in 9.
