Women hospitalized with atrial fibrillation: gender differences, trends and outcome from a 20-year registry in a Middle Eastern country (1991-2010). Gender-related differences in catheter ablation of atrial fibrillation. Atrial fibrillation: an observational study with outpatients. Asymptomatic or "silent" atrial fibrillation: frequency in untreated patients and patients receiving azimilide. Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Differences in Clinical and Functional Outcomes of Atrial Fibrillation in Women and Men: Two-Year Results From the ORBIT-AF Registry. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Management of Newly Detected Atrial Fibrillation: A Clinical Practice Guideline from the American Academy of Family Physicians and the American College of Physicians Outcomes of Medicare Beneficiaries Undergoing Catheter Ablation for Atrial Fibrillation Prevalence of atrial fibrillation in an urban population in India: the Nagpur pilot study Prevalence of atrial fibrillation and association of atrial fibrillation with prior and new thromboembolic stroke in older patients. Unexpected low prevalence of atrial fibrillation in cryptogenic ischemic stroke: a prospective study Characteristics of patients undergoing atrial fibrillation ablation: trends over a seven-year period 1999-2005. Sex-specific increase in the prevalence of atrial fibrillation (The Copenhagen City Heart Study). Radiofrequency Catheter Ablation and Antiarrhythmic Drug Therapy: A Prospective, Randomized, 4-Year Follow-Up Trial: The APAF Study Opportunistic screening for atrial fibrillation versus detecting symptomatic patients aged 65 years and older: A cluster-controlled clinical trial. Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study)
BACKGROUND Most of the published research on atrial fibrillation ( AF ) is limited to studies in the developed world and included mainly Caucasian patients . Data about women with AF among other ethnicities is very limited . OBJECTIVES The aim of this study was to compare the clinical characteristics , treatment and outcome of women to men hospitalized with AF in a middle-eastern country . METHODS Retrospective analysis of prospect i ve registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made . Clinical characteristics , management , and outcomes of AF patients were compared according to gender . RESULTS During the 20-years period ; 1417 women and 2432 men were hospitalized for AF . Women were 5 years older and more likely to have diabetes mellitus , hypertension , and chronic renal impairment and were also less likely to be current smokers and to have ischemic heart disease and impaired left ventricular function when compared to men . There was no gender preference in the use of anticoagulation . The prevalence of concomitant ischemic heart disease and hypertension increased , while the prevalence of valvular heart disease and heart failure decreased among patients hospitalized with AF over the study period . In-hospital mortality and stroke rates were comparable between the two groups . CONCLUSIONS Women hospitalized with atrial fibrillation were older in age and had higher prevalence of co-morbid cardiovascular risk factors compared to men whereas , mortality and stroke rates were comparable AIMS Women have an increased risk for atrial fibrillation (AF)-related complications and there is evidence towards a reduced efficacy of the rhythm control strategy than men . A catheter-based strategy is therefore widely attractive , but the impact of gender on catheter ablation ( CA ) of AF remains undefined . METHODS AND RESULTS We included 221 consecutive patients ( 150 men ) who underwent CA of drug-refractory AF .  Gender differences in clinical presentation and outcomes were compared . Women were older ( P = 0.002 ) , had a longer history of AF ( P = 0.04 ) , and were more likely to have hypertension ( P = 0.04 ) . Moreover , a concomitant valvular heart disease tended to be more common in women ( 32.4 vs. 23.3 % ; P = 0.28 ) and left atrium dimensions were significantly larger ( P = 0.003 ) . However , acute success rate and complications rate were similar between genders . After 22.5 + /- 11.8 months of follow-up , the overall freedom from arrhythmia recurrences was similar ( 83.1 vs. 82.7 % in men ) , and a similar improvement in SF-36 quality of life scores was achieved in both groups . CONCLUSION Women are referred for AF ablation later with a more complex clinical pre-operative presentation . Despite this higher risk profile in women , no differences were detected in clinical outcomes . Our findings indicate that CA of AF appears to be safe and effective in women as in men BACKGROUND Atrial fibrillation ( AF ) is the most common sustained arrhythmia with serious clinical consequences in the absence of treatment . However , there are limited data on the treatment of these patients in Argentina . The objective was to describe the therapeutic management of patients with nonacute AF by Argentinean cardiologists and to determine the incidence of clinical events after 12 months follow-up . METHODS The Atrial Fibrillation study in Argentina ( FARAON ) was an observational , descriptive , prospect i ve , national , and multicentric study that included out patients with AF , followed for 12 months . The study included 38 sites in Argentina . Each research er included the first 10 patients who met the inclusion criteria of being over 21 and also being an AF carrier documented by electrocardiogram or Holter within 12 months prior to or at the time of enrollment . RESULTS A total of 373 patients were included , mean age 70 ± 11.5 years , 40 % women ; 65 % had AF rhythm at the time of inclusion , 57 % had permanent AF , and 56 % were asymptomatic . At the time of enrollment , 40 % of physicians opted for rhythm control strategy . β-blockers and amiodarone were the most used drugs . Patients with rhythm control drugs had higher success rate than those with frequency control drug therapy ( 80 % vs 57 % ) . CONCLUSION Cardiologists in Argentina receive patients with AF that are mostly permanent AF . More than half of the patients are asymptomatic . They opt primarily by controlling the pace . When choosing antiarrhythmic drugs , nearly half of them indicated amiodarone BACKGROUND Asymptomatic , or " silent " atrial fibrillation could increase the risk of stroke . Little is known about the frequency of asymptomatic atrial fibrillation in patients who also have symptomatic atrial fibrillation ; similarly , little is known about the effect of antiarrhythmic drug therapy on asymptomatic atrial fibrillation . METHODS AND RESULTS Patients in sinus rhythm with a history of symptomatic atrial fibrillation or atrial flutter received placebo or azimilide ( 35 to 125 mg ) once daily for 6 or 9 months in 4 similar double-blind trials . The end point was the first recurrence of a symptomatic ECG-documented supraventricular arrhythmia . Routine transtelephonic electrocardiograms , in the absence of symptoms , were recorded for 30 seconds every 2 weeks until patients completed follow-up or documented a symptomatic supraventricular arrhythmia . Of the 1380 patients , 489 received placebo .  Among these patients receiving placebo , 303 transmitted at least one routine ECG while asymptomatic . Asymptomatic atrial fibrillation was recorded in 50 ( 17 % ) within 6 months and before recurrence of symptomatic supraventricular arrhythmia . In the 3 trials evaluating azimilide in therapeutic doses ( 100 and 125 mg ) , asymptomatic atrial fibrillation occurred in 49 of 382 ( 13 % ) receiving azimilide and 43 of 233 ( 18 % ) receiving placebo . Although drug effect on time to first asymptomatic event was not statistically significant ( hazard ratio , 0.70 ; P=0.09 ) , there was a 40 % reduction in asymptomatic atrial fibrillation on azimilide compared with placebo ( P=0.03 ) when repeated observations were considered . CONCLUSIONS Asymptomatic atrial fibrillation is common in untreated patients with a history of symptomatic atrial fibrillation ( and is likely underestimated by this analysis ) . Azimilide may reduce the occurrence of this silent arrhythmia OBJECTIVE Atrial fibrillation is often asymptomatic , but outcomes require further characterization . The study objective was to investigate the clinical presentation , management , and outcomes in asymptomatic and symptomatic patients with atrial fibrillation who were prospect ively enrolled in the EurObservational Research Programme - Atrial Fibrillation ( EORP-AF ) Pilot General Registry . METHODS A total of 3119 patients were enrolled , and 1237 ( 39.7 % ) were asymptomatic ( European Heart Rhythm Association [ EHRA ] score I ) . Among symptomatic patients , 963 ( 51.2 % ) had mild symptoms ( EHRA score II ) and 919 ( 48.8 % ) had severe or disabling symptoms ( EHRA III-IV ) . Permanent atrial fibrillation was 3-fold more common in asymptomatic patients than in symptomatic patients . RESULTS On multivariate analysis , male gender ( odds ratio [ OR ] , 1.630 ; 95 % confidence interval [ CI ] , 1.384 - 1.921 ) , older age ( OR , 1.019 ; 95 % CI , 1.012 - 1.026 ) , previous myocardial infa rct ion ( OR , 1.681 ; 95 % CI , 1.350 - 2.093 ) , and limited physical activity ( OR , 1.757 ; 95 % CI , 1.495 - 2.064 ) were associated significantly with asymptomatic ( EHRA I ) atrial fibrillation . Fully asymptomatic atrial fibrillation ( absence of current and previous symptoms ) was present in 520 patients ( 16.7 % ) and was associated independently with male gender , age , and previous myocardial infa rct ion . Appropriate guideline -based prescription of oral anticoagulants  was lower in these patients , and  aspirin  was prescribed more frequently . Mortality at 1 year was more than 2-fold higher in asymptomatic patients compared with symptomatic patients ( 9.4 % vs 4.2 % , P < .0001 ) and was associated independently with older age and comorbidities , including chronic kidney disease and chronic heart failure . CONCLUSIONS Asymptomatic atrial fibrillation is common in daily cardiology practice and is associated with elderly age , more comorbidities , and high thromboembolic risks . A higher 1-year mortality was found in asymptomatic patients compared with symptomatic patients IMPORTANCE Despite the frequency of  atrial fibrillation ( AF )  in clinical practice , relatively little is known about sex differences in symptoms and quality of life and how they may affect treatment and outcomes . OBJECTIVE To determine whether symptoms , quality of life , treatment , and outcomes differ between women and men with AF . DESIGN , SETTING , AND PARTICIPANTS This observational cohort study included 10 135 patients with AF . The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation is a prospect i ve , nationwide , multicenter outpatient registry of patients with incident and prevalent AF enrolled at 176 sites between June 2010 and August 2011 . MAIN OUTCOMES AND MEASURES Symptoms , quality of life as measured by Atrial Fibrillation Effects on Quality of Life scores , AF treatment , cardiovascular outcomes , stroke or non- central nervous system embolism , and all-cause mortality . RESULTS Overall , 4293 of the cohort ( 42 % ) were female . Compared with men , women were older ( 77 years ; interquartile range [ IQR ] , 69 - 83 , vs 73 years ; IQR , 65 - 80 ; P < .001 ) and had higher median CHA2DS2-VASc scores ( 5 ; IQR , 4 - 6 , vs 3 ; IQR , 2 - 5 ; P < .001 ) , but less sleep apnea ( 578 [ 13.5 % ] vs 1264 [ 21.6 % ] ; P < .001 ) . Only 32.1 % of women ( n = 1378 ) were asymptomatic ( European Heart Rhythm Association class I ) compared with 42.5 % of men ( n = 2483 ) in unadjusted analyses ( P < .001 ) . Women had lower ( more severe ) unadjusted baseline overall Atrial Fibrillation Effects on Quality of Life scores ( n = 2007 ; 80 ; IQR , 62 - 92 vs 83 ; IQR , 69 - 94 ; P < .001 ) . Women had similar rates of anticoagulation and similar time in therapeutic range . In follow-up , women experienced lower risk-adjusted all-cause mortality ( adjusted hazard ratio , 0.57 ; 95 % CI , 0.49 - 0.67 ) and cardiovascular death ( adjusted hazard ratio , 0.56 ; 95 % CI , 0.44 - 0.72 ) ; however , they had a higher risk for stroke or non- central nervous system embolism ( adjusted hazard ratio , 1.39 ; 95 % CI , 1.05 - 1.84 ; P = .02 ) compared with men . CONCLUSIONS AND RELEVANCE Women with AF have more symptoms and worse quality of life . Despite higher risk , women have lower risk-adjusted all-cause and cardiovascular death compared with men , but higher stroke rates . Future studies should focus on how treatment and interventions specifically affect AF-related quality of life and cardiovascular outcomes in women . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01165710 Atrial  fibrillation ( AF ) is a common arrhythmia in elderly persons and a common cause of embolic stroke . Most studies of the prevalence and correlates of AF have used selected , hospital-based population s. The Cardiovascular Health Study is a population -based , longitudinal study of risk factors for coronary artery disease and stroke in 5,201 men and women aged > or = 65 years .  AF  was diagnosed in 4.8 % of women and in 6.2 % of men at the baseline examination , and prevalence was strongly associated with advanced age in women . Prevalence of AF  was 9.1 % in men and women with clinical cardiovascular disease , 4.6 % in patients with evidence of sub clinical but no clinical cardiovascular disease , and only 1.6 % in subjects with neither clinical nor sub clinical cardiovascular disease . A history of congestive heart failure , valvular heart disease and stroke , echocardiographic evidence of enlarged left atrial dimension , abnormal mitral or aortic valve function , treated systemic hypertension , and advanced age were independently associated with the prevalence of AF .  The low prevalence of AF in the absence of clinical and sub clinical cardiovascular disease calls into question the existence and clinical usefulness of the concept of so-called " lone atrial fibrillation " in the elderly Atrial fibrillation is the most common type of arrhythmia in adults . It is more common as patients age ; the prevalence is 1 % among those younger than age 60 years and increases to more than 8 % in those older than age 80 years . When data are adjusted for age , men are affected more often than women . Cardiac conditions associated with the development of atrial fibrillation are hypertension , rheumatic mitral valve disease , coronary artery disease , and congestive heart failure . Noncardiac causes include hyperthyroidism , hypoxic pulmonary conditions , surgery , and alcohol intoxication . Patients with atrial fibrillation may have symptoms of hemodynamic compromise , such as irregular palpitations and lightheadedness , or more vague symptoms , such as malaise , but may be asymptomatic . Patients with atrial fibrillation are at increased risk for thromboembolic disease . The purpose of this guideline is to make recommendations on the pharmacologic management of newly detected atrial fibrillation in primary care . The target patient population is adult patients with first-detected atrial fibrillation , defined as the presence of symptoms or electrocardiographic evidence of atrial fibrillation . The American College of Cardiology/American Heart Association has recommended using first-detected atrial fibrillation regardless of whether it is symptomatic or self-limited , recognizing that there can be uncertainty about the duration of the episode and about previous undetected episodes ( 1 ) . This guideline does not apply to patients with postoperative or postmyocardial infa rct ion atrial fibrillation , patients with class IV heart failure , patients already taking antiarrhythmic drugs , or patients with valvular disease . The target physician audience is internists and family physicians dedicated to primary care . This guideline is based on the accompanying background paper by McNamara and colleagues ( 2 ) and on the evidence report Management of New-Onset Atrial Fibrillation ( 3 ) , which was produced by the Johns Hopkins Evidence -based Practice Center under contract to the Agency for Healthcare Research and Quality ( AHRQ ) , Rockville , Maryl and . The American Academy of Family Physicians ( AAFP ) and the American College of Physicians ( ACP ) created this guideline in collaboration . The Joint AAFP/ACP Panel review ed the evidence and developed and grade d the recommendations ( Table 1 ) . The guideline was then approved by both organizations . The guideline makes recommendations in the following areas : rate control versus rhythm control , stroke prevention and anticoagulation , electrical cardioversion versus pharmacologic cardioversion , the role of transesophageal echocardiography in guiding therapy , and maintenance therapy . Table 1 . The Guyatt Approach to Grading Recommendations * Section 1 : Rate Control versus Rhythm Control One of the fundamental questions in the management of atrial fibrillation is whether to attempt cardioversion . The answer to this question depends on whether rate control or rhythm control provides more effective protection from thromboembolic events , improved mortality , better relief of symptoms , or improved quality of life . Another significant clinical question is whether certain population s , such as women , patients with hypertension or congestive heart failure , or young people with structurally healthy hearts , have better outcomes with one or the other strategy . Four studies have compared rate control with rhythm control . The study sample s have generally involved older patients ( > 65 years of age ) , and women and younger patients with healthy hearts and paroxysmal atrial fibrillation have not been well represented ( 5 ) . The Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) trial compared rhythm control versus rate control , and use of anticoagulation was recommended in both arms ( 6 ) . More than 4000 patients who were at least 65 years of age or who had at least 1 risk factor for stroke or death , such as hypertension , diabetes , previous stroke , or poor ventricular function , were followed for a mean of 3.5 years . Slightly more than one third of the patients were enrolled after their first episode of atrial fibrillation , and more than 90 % had had their qualifying episode within the previous 6 weeks . In more than two thirds of patients , the qualifying episode lasted at least 2 days . The average patient age was 70 years . Sixty-one percent of patients were men , and 89 % were white . Seventy-one percent of patients had hypertension , 38 % had coronary heart disease , 18 % had previously had failure of antiarrhythmic therapy , and 12 % had no apparent heart disease ( lone atrial fibrillation ) . Patients were r and omly assigned to rate or rhythm control , and their physicians chose the specific therapies ( pharmacologic first , then nonpharmacologic if needed ) . Anticoagulation was continued indefinitely in the rate-control group and was encouraged in the rhythm-control group but could be stopped at the physician 's discretion if sinus rhythm had been maintained for at least 4 , and preferably 12 , consecutive weeks with antiarrhythmic therapy . The prevalence of sinus rhythm in the rhythm-control group was 82 % , 73 % , and 63 % at 1 , 3 , and 5 years , respectively . The prevalence of sinus rhythm in the rate-control group was 34.6 % at 5 years . The primary end point in the AFFIRM trial , overall mortality , was not statistically significantly different between the groups . However , the rhythm-control strategy was associated with a higher risk for death than the rate-control strategy among older patients , those without congestive heart failure , and those with coronary disease .  Rates of stroke also did not differ between groups ; 70 % of all strokes occurred in patients who had stopped receiving anticoagulation or who had subtherapeutic international normalized ratios ( < 2.0 ) . More hospitalizations were reported in the rhythm-control group ( P < 0.001 ) . Another recent study , the RAte Control versus Electrical cardioversion for persistent atrial fibrillation ( RACE ) study , r and omly assigned patients to receive aggressive rhythm control or rate control ( 7 ) . This was a smaller study , involving 522 patients ( mean age , 68 years ) . Sixty-four percent of patients were men , 49 % had hypertension , and 27 % had coronary artery disease . All patients had persistent atrial fibrillation lasting less than 1 year and had had at least 1 previous electrical cardioversion ( a maximum of 2 previous cardioversions was permitted for study inclusion ) . The primary end point was a composite of cardiovascular mortality , heart failure , thromboembolic complications , bleeding , pacemaker implantation , and severe side effects of antiarrhythmic drugs . Again , no difference was seen between groups in the primary composite end point . As in the AFFIRM study , most of the strokes occurred in patients whose anticoagulation had been halted or patients whose international normalized ratio was subtherapeutic ( < 2.0 ) . In post hoc analysis , a benefit for rate control over rhythm control was seen in patients with hypertension and in women . Since this was a post hoc analysis , these results will need to be confirmed by further studies . Of note , despite an aggressive treatment protocol , at the end of follow-up only 39 % of the patients in the rhythm-control group were in sinus rhythm . The Pharmacological Intervention in Atrial Fibrillation ( PIAF ) trial r and omly assigned 252 patients 18 to 75 years of age with new-onset or permanent symptomatic atrial fibrillation ( mean duration of atrial fibrillation , approximately 4 months ) to rate control with diltiazem or aggressive conversion ( many times if necessary ) and maintenance therapy with amiodarone ( 8) . The primary end point of the study was improvement in symptoms related to atrial fibrillation . After 1 year of follow-up , relief of symptoms was similar in both groups , as were quality -of-life measures . Walking distance was improved in the rhythm-control group , but hospital admissions were more frequent in this group . Although final results are not yet available , preliminary reports of the Strategies of Treatment of Atrial Fibrillation ( STAF ) trial have been presented ( 9 ) . Patients were r and omly assigned to receive anticoagulation for 3 weeks before conversion and for 4 weeks after attempted conversion , with antiarrhythmic therapy to maintain sinus rhythm , or to long-term anticoagulation and rate control . ( Patients included in this study had at least 1 previous conversion attempt . ) After more than 1.5 years of follow-up , no difference was seen between the groups in rates of the primary end points of death , stroke , transient ischemic attacks , cardiopulmonary resuscitation , or thromboembolism . Of interest , only 40 % of patients in the rhythm-control group were still in sinus rhythm at 1 year , and all primary end points occurred in patients in atrial fibrillation , even in the rhythm-control group . This result has created speculation about whether fewer events would have occurred if anticoagulation had been continued indefinitely in the conversion group . It also suggests that despite aggressive rhythm management , a substantial number of patients can not maintain sinus rhythm . In general , the trial sample s were older and male and had risk factors for stroke , such as hypertension , congestive heart failure , and coronary disease . Certain subgroups of patients with atrial fibrillation , such as younger patients with healthy hearts or paroxysmal atrial fibrillation , were not well represented in the trials . Therefore , it is not certain whether these subgroups of patients may benefit from more aggressive rhythm control or rate control . Recommendation 1 : Rate control with chronic anticoagulation is the recommended strategy for the majority of patients with atrial fibrillation . Rhythm control has not been shown to be superior to rate control ( with chronic anticoagulation ) in reducing morbidity and mortality and may be inferior in some patient subgroups to rate control . Rhythm Background — Atrial fibrillation is common among older persons .  Catheter ablation is increasingly used in patients for whom medical therapy has failed . Methods and Results — We conducted a retrospective cohort study of all fee-for-service Medicare beneficiaries ≥65 years of age who underwent catheter ablation for atrial fibrillation between July 1 , 2007 , and December 31 , 2009 . The main outcome measures were major complications within 30 days and mortality , heart failure , stroke , hospitalization , and repeat ablation within 1 year . A total of 15 423 patients underwent catheter ablation for atrial fibrillation . Mean age was 72 years ; 41 % were women ; and > 95 % were white . For every 1000 procedures , there were 17 cases of hemopericardium requiring intervention , 8 cases of stroke , and 8 deaths within 30 days . More than 40 % of patients required hospitalization within 1 year ; however , atrial fibrillation or flutter was the primary discharge diagnosis in only 38.4 % of cases . Eleven percent of patients underwent repeat ablation within 1 year . Renal impairment ( hazard ratio , 2.07 ; 95 % confidence interval , 1.66–2.58 ) , age ≥80 years ( hazard ratio , 3.09 ; 95 % confidence interval , 2.32–4.11 ) , and heart failure ( hazard ratio , 2.54 ; 95 % confidence interval , 2.07–3.13 ) were major risk factors for 1-year mortality . Advanced age was a major risk factor for all adverse outcomes . Conclusions — Major complications after catheter ablation for atrial fibrillation were associated with advanced age but were fairly infrequent . Few patients underwent repeat ablation . R and omized trials are needed to inform risk-benefit calculations for older persons with drug-refractory , symptomatic atrial fibrillation Objectives Atrial fibrillation ( AF ) is the most common sustained arrhythmia encountered in clinical practice with major public health impact mainly due to the increased risk of stroke . The recent Global Burden of Disease Study reported a lack of prevalence data from India . Our goal was to conduct a pilot study to evaluate the feasibility of assessing AF prevalence and stroke prophylaxis in an urban Indian community . Methods A screening camp was conducted in Nagpur , India , that evaluated adults aged ≥18 years . We collected  demographics , recorded blood pressure , height , weight and the 12-lead electrocardiogram ( ECG ) .  The presence of diabetes and hypertension was recorded by self-reported history . Patients diagnosed with AF were evaluated further to assess aetiology and management . Results Of the total 4077 r and omly selected , community-dwelling adults studied , 0.196 % ( eight patients ) were found to have AF . Mean age of the population was 43.9±14.8 , and 44.5 % were female . The mean age of the patients with AF was 60.5±15.8 years ( five females )  . Rheumatic heart disease was found in five patients with AF . Three patients had history of stroke ( 37.5 % ) and one had peripheral arterial thrombosis . Three patients were on warfarin , but without routine international normalised ratio ( INR ) monitoring . One patient was on aspirin . Five patients were on β-blockers and one on both β-blocker and digoxin . Conclusions The prevalence of AF was low compared with other regions of the world and stroke prophylaxis was underused . A larger study is needed to confirm these findings . This study demonstrates that larger evaluations would be feasible using the community-based techniques employed here OBJECTIVE To correlate atrial fibrillation with the incidence of new thromboembolic ( TE ) stroke  in older patients with and without prior TE stroke . DESIGN In a prospect i ve study of 2101 older patients ,  electrocardiograms  showed that atrial fibrillation was present in 283 patients ( 13 % ) . At 42-month mean follow-up , atrial fibrillation was associated with the incidence of new TE stroke in patients with and without prior TE stroke . SETTING A large long-term health care facility where 2101 older patients were studied . PATIENTS The 2101 patients included 1451 women and 650 men , mean age 81 + /- 8 years ( range 60 to 103 ) . MEASUREMENTS AND MAIN RESULTS Atrial fibrillation was present in 283 of 2101 patients ( 13 % ) . The mean age was 84 + /- 7 years in patients with atrial fibrillation and 81 + /- 8 years in patients with sinus rhythm ( P = .0001 ) . The prevalence of atrial fibrillation was 5 % in patients aged 60 to 70 years , 14 % in patients aged 71 to 80 years , 13 % in patients aged 81 to 90 years , and 22 % in patients aged 91 to 103 years ( P < .0001 ) . Mean follow-up was 31 + /- 18 months in patients with atrial fibrillation and 44 + /- 27 months in patients with sinus rhythm ( P = .0001 ) . Previous TE stroke occurred in 123 of 283 patients ( 43 % ) with atrial fibrillation and in 431 of 1818 patients ( 24 % ) with sinus rhythm ( P < .0001 ) . New TE stroke occurred in 131 of 283 patients ( 46 % ) with atrial fibrillation and in 303 of 1818 patients ( 17 % ) with sinus rhythm ( P < .0001 ) . The log-rank test showed that patients with atrial fibrillation had a significantly higher probability of developing new TE stroke than those with sinus rhythm ( P < .0001 ) . The multivariate Cox regression model showed that independent risk factors for new TE stroke were male sex ( relative risk = 1.3 ) , prior TE stroke ( relative risk = 3.1 ) , and atrial fibrillation ( relative risk = 3.3 ) . CONCLUSIONS Atrial fibrillation , prior TE stroke , and male sex are independent risk factors for the development of new TE stroke in older patients Purpose Ischemic stroke is a frequent pathology with high rate of recurrence and significant morbidity and mortality . There are several causes of stroke , affecting prognosis , outcomes , and management , but in many cases , the etiology remains undetermined . We hypothesized that atrial fibrillation was involved in this pathology but underdiagnosed by st and ard methods . The aim of the study was to determine the incidence of atrial fibrillation in cryptogenic ischemic stroke by using continuous monitoring of the heart rate over several months . The secondary objective was to test the value of atrial vulnerability assessment in predicting spontaneous atrial fibrillation . Methods and results We prospect ively enrolled 24 patients under 75 years of age , 15 men and 9 women of mean age 49 years , who within the last 4 months had experienced cryptogenic stroke diagnosed by clinical presentation and brain imaging and presumed to be of cardioembolic mechanism . All causes of stroke were excluded by normal 12-lead ECG , 24-h Holter monitoring , echocardiography , cervical Doppler , hematological , and inflammatory tests . All patients underwent electrophysiological study . Of the patients , 37.5 % had latent atrial vulnerability , and 33.3 % had inducible sustained arrhythmia . Patients were secondarily implanted with an implantable loop recorder to look for spontaneous atrial fibrillation over a mean follow-up interval of 14.5 months . No sustained arrhythmia was found . Only one patient had non-significant episodes of atrial fibrillation . Conclusion In this study , symptomatic atrial fibrillation or AF with fast ventricular rate has not been demonstrated by the implantable loop recorder  in patients under 75 years with unexplained cerebral ischemia . The use of this device should not be generalized in the systematic evaluation of these patients . In addition , this study attests that the assessment of atrial vulnerability is poor at predicting spontaneous arrhythmia in such patients BACKGROUND Catheter ablation procedures for treating atrial fibrillation ( AF ) have dramatically increased since triggers of AF were first described in 1998 . OBJECTIVE We explored changes in patient characteristics in patients referred for catheter ablation of AF over a seven-year period from 1999 through 2005 . METHODS Patient characteristics were examined for all patients undergoing AF ablation from 1999 through 2005 at the University of Pennsylvania Health System ( UPHS ) . The gender of patients undergoing ablation was also compared with out patients seen at UPHS with a primary diagnosis of AF . RESULTS From 1999 to 2005 the number of patients undergoing ablation  has increased steadily , from 29 patients in 1999 to 265 patients in 2005 ( P < 0.01 ) . Patients have become older ( 47 to 56 years ; P < 0.01 ) , with more persistent or permanent AF ( 17 % to 45 % ; P < 0.01 ) , larger left atrial size ( 4.0 to 4.4 cm ; P < 0.01 ) , and fewer antiarrhythmic drugs used prior to ablation ( 3.9 to 2.0 drugs ; P < 0.01 ) . Patients undergoing ablation have been predominantly male , with a significantly higher male prevalence than patients seen in the UPHS outpatient primary care clinic with AF ( 77 % vs 59 % male ; P < 0.001 ) . CONCLUSIONS Patients undergoing AF ablation from 1999 to 2005 are older , with larger left atrial size , more persistent/permanent AF , and fewer prior antiarrhythmic agents used . Compared with the gender-specific rates of AF in the population , the majority of patients referred for ablation are men , suggesting a referral bias against this invasive procedure for women . These findings are important for interpreting the outcome of ablation in the current era , and for design ing prospect i ve r and omized trials Atrial fibrillation ( AF ) is the most frequently encountered cardiac arrhythmia . It is a risk factor for stroke and premature death . We studied the temporal changes in the prevalence of  AF  from 1976 to 1994 in a r and om population aged 50 to 89 years . The prevalence of AF , diagnosed from electrocardiograms ( ECGs ) , was determined in 8,606 patients examined in 1976 to 1978 , in 8,943 patients examined in 1981 to 1983 , and in 6,733 subjects examined in 1991 to 1994 . Changes in prevalence of AF were estimated by logistic regression analysis . In men , the age-st and ardized prevalence of AF increased from 1.4 % in 1976 to 1978 ( odds ratio [ OR ] 1.0 , reference ) to 1.9 % in 1981 to 1983 ( OR 1.6 , 95 % confidence interval [ CI ] 1.1 to 2.1 ) , and to 3.3 % in 1991 to 1994 ( OR 2.3 , 95 % CI 1.6 to 3.4 , p<0.001 , adjusted for age ) . In women , the prevalence of AF decreased from 1.5 % in 1976 to 1978 ( OR 1.0 , reference ) to 1.0 % in 1981 to 1983 ( OR 0.7 , 95 % CI 0.5 to 1.0 ) , and to 1.1 % in 1991 to 1994 ( OR 0.7 , 95 % CI 0.5 to 1.0 ) , although the overall decrease was not significant ( p=0.11 , adjusted for age ) . After adjusting for changes in comorbidity , body weight , and height , the increase in the prevalence of AF in men from 1976 to 1978 and from 1991 to 1994 remained significant ( OR 1.9 , 95 % CI 1.3 to 2.8 , p=0.002 ) . Although unchanged in women , the prevalence of AF in men more than doubled from the 1970s to the 1990s . The factors responsible for this gender-specific increase in the prevalence of this common arrhythmia have yet to be identified Background — Information on comparative outcome between radiofrequency catheter ablation ( RFA ) and antiarrhythmic drugs ( AADs ) > 1 year after r and omization is important for clinical decision-making . Methods and Results — A total of 198 patients ( age , 56±10 years ) with paroxysmal atrial fibrillation were r and omly assigned to RFA ( 99 patients ) or to AADs ( 99 patients ) . We evaluated efficacy of RFA or AADs in a comparable 48-month follow-up period according to intention-to-treat analysis . Cardiac rhythm was assessed with daily transtelephonic transmissions . Quality of life was also analyzed . At 4 years , among the 99 patients first assigned to RFA , the procedure was repeated because of recurrent atrial fibrillation/atrial tachycardia in 27 patients ( 27.3 % ) . Among the 99 patients r and omly assigned to AADs , 87 ( 87.9 % ) crossed over to undergo RFA and 4 years after r and om assignment only 12 ( 12.1 % ) were in sinus rhythm with AAD alone without ablation . Despite the high level of crossovers , at 4 years the intention-to-treat analysis showed that 72.7 % of patients in the ablation arm and 56.5 % of those initially r and omly assigned to AADs were free of recurrent atrial fibrillation/atrial tachycardia ( P=0.017 ) . During the follow-up , 19.2 % of AAD patients progressed to persistent atrial fibrillation before switching to RFA . RFA significantly improved quality of life ( P<0.001 ) , whereas before crossing over to RFA , patients receiving AADs showed poorer quality of life . Except for new left atrial tachycardia , there were no serious complications caused by RFA . Conclusions — With follow-up extended to 4 years after r and omly assigned , ablation remains superior to antiarrhythmic drug in these patients with paroxysmal atrial fibrillation . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00340314 OBJECTIVE The goal of this study was to assess the effectiveness of opportunistic screening through pulse palpation in the early detection of  atrial fibrillation in subjects aged≥65 years versus detection through an active search for patients with symptoms and /or complications and sequelae associated . MATERIAL AND METHODS This was a cluster r and omized controlled trial performed in 48 primary care centers of the Spanish National Healthcare System . A total of 368 physicians and nurses were r and omized . The research ers in the experimental group ( EG ) performed opportunistic screening for auricular fibrillation , whereas the research ers in the control group ( CG ) actively search ed for symptomatic patients . An  ECG  was performed on patients found to have an irregular heartbeat to confirm the diagnosis of auricular fibrillation . RESULTS A total of 5,465 patients with a mean age of 75.61 years were recruited for the EG , and 1,525 patients with a mean age of 74.07 years were recruited for the CG . Of these , 58.6 % were female , without significant differences between groups . Pulse was irregular in 4.3 and 15.0 % of the patients in the EG and the CG , respectively ( P<.001 ) . A total of 164 new cases of atrial fibrillation were detected ( 2.3 % ) , 1.1 % in the EG and 6.7 % in the CG ( adjusted OR : 0.29 ; 95 % CI 0.18 - 0.45 ) . CONCLUSIONS Case finding for atrial fibrillation in patients aged≥65 years with symptoms or signs suggestive of atrial fibrillation is a more effective strategy than opportunistic screening through pulse palpation in asymptomatic patients . TRIAL REGISTRATION The trial is registered in Clinical Trials.gov ( NCT01291953 ; February 8 , 2011 ) Background — Atrial arrhythmias are common early after atrial fibrillation ( AF ) ablation . We hypothesized that empirical antiarrhythmic drug ( AAD ) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias . Methods and Results — We r and omized consecutive patients with paroxysmal AF undergoing ablation to empirical antiarrhythmic therapy ( AAD group ) or no antiarrhythmic therapy ( no-AAD group ) for the first 6 weeks after ablation . In the no-AAD group , only atrioventricular nodal blocking agents were prescribed . All patients wore a transtelephonic monitor for 4 weeks after discharge and were reevaluated at 6 weeks . The primary end point of the study was a composite of ( 1 ) atrial arrhythmias lasting more than 24 hours ; ( 2 ) atrial arrhythmias associated with severe symptoms requiring hospital admission , cardioversion , or initiation/change of antiarrhythmic drug therapy ; and ( 3 ) intolerance to antiarrhythmic agent requiring drug cessation .  Of 110 enrolled patients ( age 55±9 years , 71 % male ) , 53 were r and omized to AAD and 57 to no-AAD . There was no difference in baseline characteristics between groups . During the 6 weeks after ablation , fewer patients reached the primary end point in the AAD compared with the no-AAD group ( 19 % versus 42 % ; P=0.005 ) . There remained fewer events in the AAD group ( 13 % versus 28 % ; P=0.05 ) when only end points of AF > 24 hours , arrhythmia-related hospitalization , or electrical cardioversion were compared . Conclusions — AAD treatment during the first 6 weeks after AF ablation is well tolerated and reduces the incidence of clinical ly significant atrial arrhythmias and need for cardioversion/hospitalization for arrhythmia management
In brief , female atrial fibrillation patients more commonly present comorbidities , leading to a higher prevalence of persistent atrial fibrillation ; moreover , they refer to hospital care later and with a longer disease history .
Atrial fibrillation symptoms relate to low quality of life in female patients ; in fact , atrial fibrillation paroxysm usually presents higher heart rate , leading to preferentially adopt a rate rather than a rhythm-control strategy .
Female atrial fibrillation patients present an increased risk of stroke , worsened by the lower  oral anticoagulant prescription rate related to the concomitant higher haemorrhagic risk profile .
Trans-catheter ablation is under-used in female patients and , on the contrary , they are more commonly affected by anti-arrhythmic drug side effects
Atrial fibrillation is the most common supraventricular arrhythmia .
Its prevalence increases with age and preferentially affects male patients .
Over 75 years of age , however , female patients being more prevalent , the absolute number of patients affected is similar between sexes .
Despite this , few data are available in the literature concerning sex-related differences in atrial fibrillation patients .
The present systematic review therefore considers comorbidities , referring symptoms , quality of life , pharmacological approaches  and  trans-catheter ablation  in female rather than in male atrial fibrillation patients in search of parameters that may have an impact on the treatment outcome .