Migotanie przedsionków typu trzepotanie

Migotanie przedsionków typu trzepotanie
Epidemiologia

Trzepotanie przedsionków stanowi około 10% wszystkich nadkomorowych tachyarytmii, z roczną zapadalnością w USA na poziomie około 200 000 nowych przypadków oraz ogólną zapadalnością 88/100 000 osobolat, która wzrasta do 587/100 000 u osób powyżej 80. roku życia. Choroba występuje znacznie częściej u mężczyzn (stosunek 2,5:1) i jest silnie związana z wiekiem (mediana diagnozy 62-72 lata). Izolowane trzepotanie przedsionków stanowi jedynie 2% przypadków, najczęściej współistnieje z chorobami układu sercowo-naczyniowego i oddechowego, takimi jak POChP (ryzyko 1,9x), niewydolność serca (ryzyko 3,5x), nadciśnienie tętnicze, cukrzyca oraz historia nadużywania alkoholu. Epidemiologia wskazuje na częste współwystępowanie trzepotania i migotania przedsionków, z około 50-58% pacjentów doświadczających obu arytmii, co ma istotne znaczenie dla strategii leczenia i profilaktyki powikłań zakrzepowo-zatorowych.

Epidemiologia trzepotania przedsionków

Migotanie przedsionków typu trzepotanie jest drugą najczęstszą arytmią serca po migotaniu przedsionków. Mimo to, epidemiologia trzepotania przedsionków jest znacznie mniej zbadana w porównaniu z migotaniem przedsionków.¹² Szacuje się, że trzepotanie przedsionków stanowi około 10% przypadków wszystkich nadkomorowych tachyarytmii, podczas gdy migotanie przedsionków odpowiada za około 77% przypadków.¹

Częstotliwość występowania i zapadalność

Badania epidemiologiczne wskazują, że roczna zapadalność na trzepotanie przedsionków w Stanach Zjednoczonych wynosi około 200 000 nowych przypadków rocznie.¹² W badaniu populacyjnym stwierdzono, że ogólna zapadalność wynosi 88/100 000 osobolat.¹ Wskaźniki zapadalności wahają się od 5/100 000 u osób w wieku poniżej 50 lat do 587/100 000 u osób powyżej 80. roku życia, co pokazuje wyraźny wzrost występowania tej arytmii wraz z wiekiem.¹

Częstość występowania trzepotania przedsionków na świecie szacuje się na około 36 na 100 000 osób.¹ Niektóre źródła podają, że częstość występowania wynosi od 37 do 134 nowych przypadków na 1000 osobolat u mężczyzn i od 25 do 86 nowych przypadków na 1000 osobolat u kobiet.¹ W populacji ogólnej szacuje się częstość występowania na poziomie 0,41%, co przekłada się na około 2,7 miliona pacjentów w Stanach Zjednoczonych.¹

Różnice związane z płcią i wiekiem

Trzepotanie przedsionków występuje znacznie częściej u mężczyzn niż u kobiet, z przewagą mężczyzn wynoszącą około 2,5:1.¹²³ W niektórych badaniach mężczyźni stanowili nawet 75-80% wszystkich przypadków trzepotania przedsionków.¹²

Wiek jest kluczowym czynnikiem ryzyka rozwoju trzepotania przedsionków. Częstość występowania tej arytmii znacząco wzrasta wraz z wiekiem.¹ Mediana wieku w momencie diagnozy wynosi 62-72 lata.¹ W badaniach epidemiologicznych wykazano, że trzepotanie przedsionków dotyka głównie osoby starsze, a średni wiek pacjentów wynosi około 64 lata.¹ U osób powyżej 80. roku życia częstość występowania trzepotania przedsionków może sięgać nawet 8%.¹

Czynniki ryzyka i choroby współistniejące

Trzepotanie przedsionków rzadko występuje jako izolowany problem u osób bez chorób współistniejących. Tylko około 2% przypadków trzepotania przedsionków to tzw. izolowane trzepotanie (lone atrial flutter), występujące bez rozpoznawalnej choroby podstawowej.¹ Najczęściej trzepotanie przedsionków rozwija się w kontekście istniejących chorób układu sercowo-naczyniowego lub oddechowego.

Główne czynniki ryzyka i choroby współistniejące związane z trzepotaniem przedsionków obejmują:¹²

Przewlekła obturacyjna choroba płuc (POChP) – zwiększa ryzyko rozwoju trzepotania przedsionków 1,9 razy; około 12% przypadków trzepotania przedsionków przypisuje się POChP¹
Niewydolność serca – zwiększa ryzyko 3,5 razy; około 16% przypadków trzepotania przedsionków jest przypisywanych niewydolności serca¹
Nadciśnienie płucne¹
Nadciśnienie tętnicze¹
Cukrzyca¹
Historia nadużywania alkoholu¹

W badaniu porównującym czynniki ryzyka u pacjentów z trzepotaniem przedsionków i migotaniem przedsionków wykazano, że osoby z trzepotaniem przedsionków częściej miały w wywiadzie POChP (25% vs. 12%), niewydolność serca (28% vs. 17%) oraz palenie tytoniu (49% vs. 37%). Z kolei nadciśnienie tętnicze było częstsze u osób z migotaniem przedsionków (63% vs. 47%).¹

Około 60% pierwszych epizodów trzepotania przedsionków jest związanych z konkretnym ostrym czynnikiem wywołującym, takim jak poważna operacja, zapalenie płuc czy zawał mięśnia sercowego. Natomiast 38% przypadków jest związanych z przewlekłymi chorobami, takimi jak niewydolność serca, choroby płuc czy nadciśnienie tętnicze.¹

Epidemiologia w różnych populacjach

Różnice etniczne i geograficzne

Trzepotanie przedsionków częściej dotyka osoby rasy kaukaskiej. Osoby pochodzenia afroamerykańskiego mają mniejsze prawdopodobieństwo rozwoju trzepotania przedsionków.¹ Podobnie jak w przypadku migotania przedsionków, występują różnice geograficzne w rozpowszechnieniu trzepotania przedsionków, z wyższymi wskaźnikami w krajach o wysokim dochodzie w porównaniu do krajów o niskim dochodzie.¹

Trzepotanie przedsionków u dzieci i młodzieży

Trzepotanie przedsionków u dzieci i młodzieży występuje najczęściej w kontekście wrodzonych wad serca, szczególnie po zabiegach kardiochirurgicznych:¹

U 57% pacjentów z pojedynczą lewą komorą, którzy przeszli operację Fontana, można spodziewać się trzepotania lub migotania przedsionków w ciągu 20 lat po zabiegu¹
Średnia roczna częstość występowania nowych zaburzeń rytmu (głównie trzepotania przedsionków) po operacji Fontana wynosi 5%¹
W długoterminowej obserwacji pacjentów po zabiegach metodą Mustarda lub Senninga z powodu przełożenia wielkich pni tętniczych, tachyarytmie nadkomorowe stwierdzono u 48% pacjentów, z czego trzepotanie przedsionków było najczęstszym typem (73%)¹

Trzepotanie przedsionków może również występować u płodów i noworodków. W międzynarodowym przeglądzie przypadków trzepotanie przedsionków stanowiło 26,2% wszystkich tachyarytmii płodowych, podczas gdy tachykardia nadkomorowa stanowiła 73,2%.¹ Rzeczywista częstość występowania trzepotania przedsionków u płodów jest prawdopodobnie niedoszacowana, ponieważ często dochodzi do spontanicznej konwersji do rytmu zatokowego podczas porodu, a późniejsze nawroty są rzadkie.¹

Trzepotanie przedsionków u kobiet w ciąży

Badania wykazały, że wskaźnik nawrotów trzepotania i migotania przedsionków u kobiet z wcześniej istniejącymi zaburzeniami rytmu serca podczas ciąży był najwyższy spośród wszystkich badanych arytmii, osiągając 52%.¹

Współwystępowanie z migotaniem przedsionków

Trzepotanie przedsionków często współwystępuje z migotaniem przedsionków.¹ Około 50-58% pacjentów z trzepotaniem przedsionków ma również w wywiadzie epizody migotania przedsionków.¹² W badaniu populacyjnym pacjentów z pierwszym rozpoznaniem trzepotania przedsionków, u 69% wcześniej zdiagnozowano migotanie przedsionków, a wśród pozostałych pacjentów u 40% rozwinęło się migotanie przedsionków w ciągu następnych 3 lat.¹

Około jednej trzeciej osób z trzepotaniem przedsionków ma również migotanie przedsionków.¹ W momencie wystąpienia arytmii te dwa stany często się na przemian zmieniają. Szacuje się, że około 50% osób, u których początkowo występuje samo trzepotanie przedsionków, rozwinie migotanie przedsionków w ciągu ośmiu lat.¹

Trzepotanie przedsionków jest często stanem przejściowym, który albo przechodzi w migotanie przedsionków, albo powraca do rytmu zatokowego.¹ Jest to istotne z punktu widzenia leczenia, ponieważ wpływa na wybór strategii kontroli rytmu lub częstości.

Globalne obciążenie chorobowe

Trendy czasowe w epidemiologii trzepotania przedsionków

Badania wskazują na rosnącą częstość występowania trzepotania przedsionków na całym świecie. Według danych z badania Global Burden of Disease (GBD) z 2019 roku, liczba osób z migotaniem lub trzepotaniem przedsionków na świecie wzrosła z 19,1 miliona w 1990 roku do 37,6 miliona w 2017 roku i przewiduje się dalszy wzrost w przyszłości.¹ W 2019 roku na całym świecie było 59,70 miliona pacjentów z migotaniem lub trzepotaniem przedsionków, z 4,72 milionami nowych przypadków, 0,315 miliona zgonów i 8,39 miliona lat życia skorygowanych niepełnosprawnością (DALYs).¹

Chociaż standaryzowane względem wieku wskaźniki częstości występowania, zapadalności i DALY wykazywały tendencję spadkową w skali światowej od 1990 do 2019 roku, liczba bezwzględna pacjentów rośnie z powodu starzenia się populacji i wzrostu populacji ogólnej.¹² Ponadto obciążenie trzepotaniem przedsionków rośnie w różnym stopniu we wszystkich regionach, ale ogólne wskaźniki zgonów i DALY mają tendencję do zmniejszania się w regionach rozwiniętych.¹

Prognozy na przyszłość

Badania prognostyczne przewidują znaczący wzrost obciążenia trzepotaniem przedsionków w przyszłości. Na przykład w Iranie szacuje się, że liczba pacjentów z migotaniem lub trzepotaniem przedsionków wzrośnie z 339,1 tysięcy w 2019 roku do 1,1 miliona w 2050 roku. Liczba nowych przypadków wzrośnie z 30,2 tysięcy do 91 tysięcy, a liczba zgonów związanych z migotaniem lub trzepotaniem przedsionków wzrośnie z 1,7 tysiąca do 7,2 tysiąca (wzrost o 375,4%). Liczba DALY wzrośnie z 48 tysięcy do 170,8 tysiąca (wzrost o 248,2%).¹²

W Unii Europejskiej szacuje się, że liczba osób powyżej 65. roku życia z migotaniem przedsionków (w tym trzepotaniem) wzrośnie o 90%, z około 7,5 miliona w 2016 roku do około 14,5 miliona w 2060 roku.¹

Trzepotanie przedsionków w kontekście innych chorób

Trzepotanie przedsionków w intensywnej terapii

Nowo powstałe migotanie i trzepotanie przedsionków stanowią częsty problem u pacjentów w stanie krytycznym. Badania wykazują, że częstość występowania nowo powstałego migotania przedsionków u pacjentów niekardiologicznych na oddziałach intensywnej terapii waha się od 4,5% do 15,0%, z wyjątkiem szczególnych przypadków, takich jak wstrząs septyczny, gdzie częstość ta może być znacznie wyższa.¹

Ciężkość choroby (mierzona skalami APACHE II, SAPS II), ogólnoustrojowa reakcja zapalna (SIRS), wstrząs i posocznica są czynnikami ryzyka rozwoju migotania i trzepotania przedsionków u pacjentów w stanie krytycznym. W podgrupie pacjentów we wstrząsie septycznym częstość występowania nowo powstałego migotania przedsionków była wyjątkowo wysoka i wynosiła 46%.¹

Trzepotanie przedsionków u pacjentów z COVID-19

COVID-19 jest związany z różnymi powikłaniami sercowo-naczyniowymi, w tym arytmiami. W jednym z badań stwierdzono, że 69 pacjentów (10,66%) z COVID-19 rozwinęło migotanie lub trzepotanie przedsionków, z czego 41 pacjentów (6,34%) doświadczyło nowo powstałych arytmii. Częstość występowania nowo powstałego migotania przedsionków wynosiła 5,4%, a trzepotania przedsionków 0,9%.¹

Starszy wiek (≥65 lat) był istotnie związany z nowo powstałym migotaniem lub trzepotaniem przedsionków (OR: 5,43; 95% CI: 2,31-12,77; p < 0,001), podobnie jak rozwój sepsy (OR: 2,73; 95% CI: 1,31-5,70; p = 0,008).¹ Te wyniki są zgodne z wytycznymi ACC/AHA/ACCP/HRS z 2023 roku, które uznają sepsę i zaawansowany wiek za czynniki ryzyka migotania przedsionków.¹

Monitorowanie i nadzór epidemiologiczny

Metody monitorowania

Diagnoza i monitorowanie trzepotania przedsionków opiera się na różnych technikach elektrokardiograficznych. W przypadku pacjentów z okresowymi i nieprzewidywalnymi epizodami arytmii zaleca się stosowanie urządzeń monitorujących, takich jak:¹

Holter EKG – małe, przenośne urządzenie wielkości smartfona, które monitoruje aktywność elektryczną serca przez określony czas (zwykle 24-48 godzin)¹
Ambulatoryjne urządzenie telemetryczne – lekkie, przenośne urządzenie do monitorowania serca, które jest noszone przez okres do dwóch tygodni w celu pomiaru aktywności elektrycznej serca w poszukiwaniu oznak zaburzeń rytmu serca¹
Wszczepialny rejestrator pętlowy – małe urządzenie umieszczane pod skórą klatki piersiowej, które ciągle monitoruje i rejestruje rytm serca przez okres do dwóch lat¹

Bardziej systematyczne monitorowanie przyczyniło się do lepszego wykrywania „cichego” trzepotania przedsionków, co częściowo wyjaśnia obserwowany wzrost częstości występowania tej arytmii.¹

Znaczenie nadzoru epidemiologicznego

Systematyczny nadzór epidemiologiczny nad trzepotaniem przedsionków jest istotny z kilku powodów:

Migotanie i trzepotanie przedsionków zwiększają ryzyko udaru mózgu prawie pięciokrotnie, a około 20% wszystkich udarów może być spowodowanych migotaniem przedsionków¹
Migotanie i trzepotanie przedsionków mają znaczący wpływ na koszty opieki zdrowotnej, stanowiąc około 1% budżetu Narodowej Służby Zdrowia w Wielkiej Brytanii i około 26 miliardów dolarów rocznych wydatków w Stanach Zjednoczonych¹
Ryzyko powikłań zakrzepowo-zatorowych w izolowanym trzepotaniu przedsionków jest szacowane na około połowę tego, co w migotaniu przedsionków. Jednakże, ponieważ wielu pacjentów z trzepotaniem przedsionków ma również (lub rozwinie) migotanie przedsionków, wytyczne dotyczące antykoagulacji nie rozróżniają między pacjentami z trzepotaniem przedsionków a tymi z migotaniem przedsionków¹

Amerykańskie Towarzystwo Kardiologiczne (ACC) i Amerykańskie Towarzystwo Serca (AHA) opracowały wytyczne dla postępowania w przypadku trzepotania przedsionków, które są regularnie aktualizowane na podstawie najnowszych danych epidemiologicznych i klinicznych.¹

Implikacje dla zdrowia publicznego

Trendy epidemiologiczne w trzepotaniu przedsionków mają istotne implikacje dla zdrowia publicznego i systemów opieki zdrowotnej:

W wielu krajach obserwuje się wzrost liczby hospitalizacji z powodu trzepotania przedsionków.¹ Rosnąca częstość występowania trzepotania przedsionków wpływa na zwiększenie kosztów opieki zdrowotnej i obciążenia systemów opieki zdrowotnej.¹

Głównym czynnikiem ryzyka wpływającym na obciążenie chorobowe związane z trzepotaniem przedsionków jest wysokie ciśnienie skurczowe.¹²³ Skuteczne strategie zdrowia publicznego powinny zatem skupiać się na profilaktyce i leczeniu nadciśnienia tętniczego.

Pomimo postępów w profilaktyce i leczeniu, trzepotanie przedsionków pozostaje poważnym problemem zdrowia publicznego.¹ Konieczne są efektywne kosztowo i ogólnokrajowe interwencje mające na celu ograniczenie przyszłego obciążenia tą chorobą.¹

Proaktywna interwencja jest niezbędna, aby przeciwdziałać rosnącej liczbie osób żyjących z trzepotaniem przedsionków i zmniejszyć związane z tym powikłania.¹ Wczesna diagnoza, edukacja i poprawa opieki medycznej przyczyniły się do stabilizacji standaryzowanych względem wieku wskaźników DALY i zgonów związanych z trzepotaniem przedsionków w niektórych krajach.¹

Obciążenie trzepotaniem przedsionków różni się w regionach o różnym poziomie rozwoju społeczno-ekonomicznego. Obciążenie to stopniowo rośnie w regionach o niskim i średnim wskaźniku SDI (Sociodemographic Index).¹ Szybki rozwój gospodarczy w niektórych regionach, taki jak na Bliskim Wschodzie, nie był dostosowany do wolniejszego rozwoju edukacji i opieki medycznej, co sugeruje potrzebę zwiększenia wydatków na edukację i opiekę medyczną oraz połączenia niektórych podejść do zdrowia publicznego z krajów europejskich w celu poprawy polityki profilaktyki i leczenia.¹

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Materiały źródłowe

#1 Atrial Flutter (AFL): Abnormal Heart Rhythm | Doctor
https://patient.info/doctor/atrial-flutter
Atrial flutter is less common than atrial fibrillation, but epidemiology is less well studied. It is one tenth as common as atrial fibrillation. […] It is the second most common arrhythmia after atrial fibrillation. […] Atrial flutter is commonly associated with atrial fibrillation. On presentation the two often alternate. Around 50% of those presenting with atrial flutter alone are said to develop atrial fibrillation within the next eight years. […] The prevalence increases with age. With an ageing population, it is becoming increasingly common. […] Atrial flutter is more common in men, with males accounting for 80% of cases. […] Systemic embolism is less common than it is in atrial fibrillation (occurring about 30% as frequently). There is no difference if there is associated atrial fibrillation.
#1 Atrial Flutter: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/151210-overview
Atrial flutter is much less common than atrial fibrillation. Of the patients admitted to US hospitals with a diagnosis of supraventricular tachycardia between 1985 and 1990, 77% had atrial fibrillation and 10% had atrial flutter. On the basis of a study of patients referred to tertiary care centers, the incidence of atrial flutter in the United States is estimated to be approximately 200,000 new cases per year. […] In a study of 100 patients with atrial flutter, 75% were men. In another study performed at a tertiary care study, atrial flutter was 2.5 times more common in men. […] Patients with atrial flutter, as with atrial fibrillation, tend to be older adults. In one study, the average age was 64 years. The prevalence of atrial fibrillation increases with age, as follows: 25-35 years: 2-3 cases per 1000 population; 55-64 years: 30-90 cases per 1000 population; 65-90 years: 50-90 cases per 1000 population.
#1 Incidence and predictors of atrial flutter in the general population – PubMed
https://pubmed.ncbi.nlm.nih.gov/11127467/
Objectives: The goal of our study was to determine the incidence and predictors of atrial flutter in the general population. […] Although atrial flutter can now be cured, there are no reports on its epidemiology in unselected patients. […] A total of 181 new cases of atrial flutter were diagnosed for an overall incidence of 88/100,000 person-years. Incidence rates ranged from 5/100,000 in those 50 years old to 587/100,000 in subjects older than 80. Atrial flutter was 2.5 times more common in men (p 0.001). The risk of developing atrial flutter increased 3.5 times (p 0.001) in subjects with heart failure and 1.9 times (p 0.001) for subjects with chronic obstructive pulmonary disease. Among those with atrial flutter 16% were attributable to heart failure and 12% to chronic obstructive lung disease.
#1 Atrial flutter epidemiology and demographics – wikidoc
https://www.wikidoc.org/index.php/Atrial_flutter_epidemiology_and_demographics
Atrial flutter is more common in elderly males. Men are affected 2.5 times more than women. The incidence of new cases every year in the USA is 200,000. […] The incidence of atrial flutter is approximately 36 per 100,000 individuals worldwide. […] The prevalence of atrial flutter is approximately 37 to 134 new cases per 1000 person-years in men and from 25 to 86 new cases per 1000 person-years in women. […] Patients of all age groups may develop atrial flutter. The incidence of atrial flutter increases with age; the median age at diagnosis is 62-72 years. […] Atrial flutter usually affects individuals of the Caucasians race. African-American individuals are less likely to develop atrial flutter. […] Atrial flutter affects men and women equally.
#1 Atrial Fibrillation and Atrial Flutter | 5-Minute Clinical Consult
https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/117475/all/Atrial_Fibrillation_and_Atrial_Flutter?q=Chronic+Failure%2C+Heart
Incidence/prevalence increases significantly with age. […] Young patients with AFib, particularly lone AFib, are most commonly males. […] AFib: from 0.1%/year 40 years to 1.5%/year 80 years. […] Lifetime risk: 25% for those aged 40 years. […] AFlut is less common. […] Estimated at 0.41% in general population, with 2.7 million patients in America. […] Increases with age, up to 8% in those 80 years.
#1 Atrial Flutter | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/17963
Atrial flutter is the second most common cardiac arrhythmia after atrial fibrillation. […] It is commonly associated with atrial fibrillation, but the incidence and the prevalence of the atrial flutter are less known when compared with atrial fibrillation. […] Atrial flutter is more frequent in males than in females. Aging is a significant risk factor as other associated disorders in patients with atrial fibrillation include systemic hypertension, diabetes mellitus, and a history of alcohol abuse. Older age is associated with an increased risk of atrial fibrillation and atrial flutter.
#1 Atrial flutter: RF, differential diagnosis, management strategies
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-6/Atrial-flutter-RF-differential-diagnosis-management-strategies-Title-Atria
The overall incidence of atrial flutter is 0,09%, 58% of patients also have atrial fibrillation in their history. Atrial flutter represents 0,1% of hospital discharges in the US, with the mean age at 67 years and male predominance cca 2:1. Case fatality is 1%, mostly related to underlying disease. […] A first occurrence of atrial flutter is in 60% of cases associated with a specific acute precipitating event (major surgery, pneumonia, myocardial infarction). In 38% of cases, atrial flutter is associated with chronic illness (heart failure, lung disease, hypertension). Lone atrial flutter (without any recognisable underlying disease) is rare only 2% of atrial flutter patients.
#1 Atrial Flutter – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK540985/
Atrial flutter is the second most common cardiac arrhythmia after atrial fibrillation. It is commonly associated with atrial fibrillation, but the incidence and the prevalence of the atrial flutter are less known when compared with atrial fibrillation. Atrial flutter in common in patients with underlying diseases such as chronic obstructive pulmonary disease, pulmonary hypertension, and heart failure. Isolated atrial flutter in the absence of abnormal heart anatomy is rare and usually occurs when atrial size abnormalities have developed. Atrial flutter is more frequent in males than in females. Aging is a significant risk factor as other associated disorders in patients with atrial fibrillation include systemic hypertension, diabetes mellitus, and a history of alcohol abuse. Older age is associated with an increased risk of atrial fibrillation and atrial flutter.
#1 Clinical Medicine & Research
https://www.clinmedres.org/content/8/1/1.short?related-urls=yes&legid=clinmedres;8/1/1
Objective: Determine and compare the prevalence of known risk factors for cardiovascular disease among unselected individuals presenting with their first ever episode of atrial flutter (AFL) and atrial fibrillation (AF). […] Results: Among the 472 incident cases, 76 (16.1%) had AFL and 396 (83.9%) had AF. Compared to those with AF, subjects with AFL were more likely to have had a history of chronic obstructive pulmonary disease (25% vs. 12%, P = 0.006), heart failure (28% vs. 17%, P = 0.05), and smoking (49% vs. 37%, P = 0.06). Hypertension, on the other hand, was more common among individuals with AF (63% vs. 47%, P = 0.01). […] This study represents the first report to evaluate potential differences in the conditions associated with the development of AFL versus AF. Research into the mechanisms of atrial arrhythmogenesis may lead to improved preventive and therapeutic interventions.
#1 13: Atrial/Flutter Fibrillation | Thoracic Key
https://thoracickey.com/13-atrialflutter-fibrillation-2/
The epidemiology of AFib is summarized in Figure 13.1. As with most heart-related diseases, the incidence and prevalence of AFib are increasing globally. According to the available epidemiological data, between 1990 and 2010, there was a modest increase in the prevalence and a major increase in the incidence of AFib. In 2010, the prevalence rates per 100,000 population were 596.2 (95% uncertainty intervals [UI]: 558.4 to 636.7) in men (5% increase since 1990) and 373.1 (95% UI: 347.9 to 402.2) in women (4% increase since 1990), while AFib incidence per 100,000 population was 77.5 (95% UI: 65.2 to 95.4) in men (28% increase from 1990) and 59.5 (95% UI: 49.9 to 74.9) in women (35% increase from 1990). The estimated number of individuals with AFib globally in 2010 was 33.5 million (20.9 million men [95% UI: 19.5-22.2 million] and 12.6 million women [95% UI: 12.0-13.7 million]). Burden associated with AFib, measured as disability-adjusted life-years, increased by 18.8% (95% UI: 15.8-19.3) in men and 18.9% (95% UI: 15.8-23.5) in women from 1990 to 2010. For both men and women, the prevalence and incidence of AFib are disproportionately higher in high-income nations compared with low-income nations (Chugh et al., 2014).
#1 Pediatric Atrial Flutter: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/894226-overview
Atrial flutter is most commonly seen in young adults with repaired congenital heart disease, such as after the Senning or Mustard surgical procedures for transposition of the great arteries (used in the past) and after Fontan repair. According to a United States study, 57% of patients with double-inlet left ventricle who undergo the Fontan operation may be expected to present with atrial flutter or fibrillation by 20 years after surgery. […] The mean annual incidence of new dysrhythmias (predominantly atrial flutter) after the Fontan operation is 5%. According to a multicenter study, tachyarrhythmia prevalence over time was similar between the intracardiac lateral tunnel and the extracardiac conduit Fontan operations. […] A long-term follow-up study into adulthood of patients undergoing the Mustard or Senning procedure for correction of D-transposition of the great arteries demonstrated SVT in 48%, of which atrial flutter was the most common type (73%).
#1 Pediatric Atrial Flutter: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/894226-overview
On the other end of the age spectrum, in an international review, atrial flutter accounted for 26.2% of all cases of fetal tachyarrhythmias, and supraventricular tachycardia (SVT) accounted for 73.2%. […] In an earlier population study of 3383 English newborns by Southall and colleagues, only 1 newborn had atrial flutter. This likely underestimated the incidence of atrial flutter in utero because spontaneous conversion often occurs during birth and subsequent recurrence is uncommon. […] Predictors of late postoperative atrial flutter after surgical closure of atrial septal defect in adults seem to include age 40 years at the time of surgery and presence of preoperative or immediate postoperative atrial flutter. […] One study reported that the recurrence rate of atrial flutter and fibrillation in women with preexisting cardiac rhythm disorders during pregnancy was the highest of all the studied arrhythmias, reaching 52%.
#1 Atrial Flutter – Cardiovascular Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/atrial-flutter
Atrial flutter is much less common than atrial fibrillation, but its causes and hemodynamic consequences are similar. Many patients with atrial flutter also have periods of atrial fibrillation. In a population-based study of patients with a first diagnosis of atrial flutter, 69% were already known to have atrial fibrillation and, of those not known to have had atrial fibrillation, 40% were found to have atrial fibrillation over the next 3 years. […] The probability of a thromboembolic event in isolated atrial flutter is thought to be about half of that in atrial fibrillation. However, many patients with atrial flutter also have (or will develop) atrial fibrillation. Accordingly, guidelines for anticoagulation make no distinction between patients with atrial flutter and those with atrial fibrillation.
#1 The difference between atrial flutter and atrial fibrillation – BHF
https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/ask-the-experts/atrial-flutter
Atrial flutter is less common than atrial fibrillation. […] Atrial flutter is less common, but has similar symptoms (feeling faint, tiredness, palpitations, shortness of breath or dizziness). […] About a third of people with atrial flutter also have atrial fibrillation. […] Both conditions carry increased risk of stroke, usually managed by drugs (such as warfarin or a newer anticoagulant). […] This is why, whether you have atrial fibrillation or atrial flutter, it is vital to be diagnosed early so you can get the right treatment and reduce your stroke risk. […] Catheter ablation is usually considered the best treatment for atrial flutter.
#1 Atrial Fibrillation (AF) & Flutter complicating critical illness – EMCrit Project
https://emcrit.org/ibcc/af/
Atrial flutter is usually a short-lived transitional state, which either degenerates into atrial fibrillation or converts to sinus rhythm. As a transitional state, atrial flutter often resembles new-onset atrial fibrillation (NOAF). […] The management of atrial flutter is similar to that of AF, but a rhythm control strategy is more effective for the following reasons: (1) Rate control in atrial flutter is often difficult (the heart rate tends to get stuck at ~150 b/m). (2) Atrial flutter is often a transient state that is relatively easy to cardiovert into normal sinus rhythm. […] Atrial flutter is often difficult to treat using rate control, since the rate tends to be stubbornly stuck at around 150.
#1 Global, regional, and national burden of disease study of atrial fibrillation/flutter, 1990â2019: results from a global burden of disease study, 2019 | BMC Public Health | Full Text
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14403-2
The number of people with atrial fibrillation worldwide increased rapidly between 1990 and 2017, rising from 19.1 million to 37.6 million, and is expected to increase further in the future. […] The study showed that the burden of AF/AFL is increasing in varying degrees in all regions, but the overall deaths and DALYs ratios tend to decrease in developed regions. […] The burden of AF/AFL varies in different regions of economic and social development. […] High systolic blood pressure has the most significant impact on the disease burden of AF/AFL. […] The burden is progressively increasing in regions with low and middle SDI. […] The rapid economic development in the Middle East in recent years has not been matched by the slow development of education and medical care, so we can target increased spending on education and medical care and combine some of the public health approaches of European countries to improve prevention and treatment policies.
#1 Global, regional, and national burden of disease study of atrial fibrillation/flutter, 1990â2019: results from a global burden of disease study, 2019 | BMC Public Health | Full Text
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14403-2
Data from the Global Burden of Disease, Injury, and Risk Factor Study 2019 (GBD 2019) was used to assess the burden and change in prevalence, incidence, deaths, disability-adjusted life years, and risk factors for atrial fibrillation/flutter in 204 countries and territories between 1990 and 2019. […] There are 59.70 million (95% uncertainty interval (UI) 45.7375.29 million) AF/AFL patients worldwide in 2019, with 4.72 million (95% uncertainty interval (UI) 3.645.96 million) new cases and 0.315 million deaths (95% uncertainty interval (UI) 0.2680.361 million) and 8.39 million disability-adjusted years (95% uncertainty interval (UI) 6.6910.54 million). […] AF/AFL remains a major global public health problem, although the ASR of prevalence, incidence, and DALY at the worldwide level showed a decreasing trend from 1990 to 2019 (the ASR of deaths increased slightly). However, the unfavorable trend observed in this study in countries with lower SDI suggests that current prevention and treatment strategies should be reoriented.
#1 Estimating the burden of atrial fibrillation and atrial flutter with projection to 2050 in Iran | Scientific Reports
https://www.nature.com/articles/s41598-024-71296-4
Atrial fibrillation (AF)/atrial flutter (AFL) is the most common cardiac tachyarrhythmia, with an increasing trend in its burden in recent years. […] The burden of AF/AFL in Iran remains unclear. […] In 2019, there were 339.1 (259.4-433.7) thousand AF/AFL patients in Iran, with 30.2 (23.2-38.5) thousand new cases, 1.7 (1.5-2) thousand deaths and 48 (37.7-60.5) thousand DALYs. […] High systolic blood pressure and elevated body mass index (BMI) were the predominant attributable risk factors for AF/AFL-related deaths and DALYs. […] It is estimated that in 2050, the number of AF/AFL patients will increase to 1.1 million people, the incidence of AF/AFL will increase to 91 thousand patients, and the number of AF/AFL-related deaths and DALYs will surge to 7.2 and 170.8 thousand, respectively.
#1 13: Atrial/Flutter Fibrillation | Thoracic Key
https://thoracickey.com/13-atrialflutter-fibrillation-2/
In the European Union, it is estimated that ~7.5 million people over 65 years old had AFib in 2016, and this number is expected to increase by 90%, i.e., to ~14.5 million, by 2060 (Di Carlo et al., 2019). Based on data from the Framingham heart study, the prevalence of AFib increased 3-fold over the last 50 years in the USA. The lifetime risk of AFib was estimated at about 1 in 4 in white men and women older than 40 years in 2004, while a decade later, lifetime risk estimates reached about 1 in 3 for white individuals and 1 in 5 for black individuals. In the USA, at least 3 to 6 million people have AFib, and the numbers are projected to reach 6 to 16 million by 2050 (Kornej, Borschel, Benjamin, Schnabel, 2020). In addition, there are more than 450,000 hospitalizations with AFib as the primary diagnosis each year in the USA, which leads to approximately 158,000 deaths (Benjamin et al., 2019). Based on Centers for Disease Control and Prevention data, white people are more likely to have AFib than African Americans. With regards to gender, AFib incidence is generally lower in women than men, however, women have a higher prevalence of AFib at older ages, a fact that can be attributed to women’s higher life expectancy and a more severe disease clinical presentation and symptomatology compared to men (Mohanty, Trivedi, Gianni, Natale, 2018).
#1 Epidemiology, prevention, and treatment of new-onset atrial fibrillation in critically ill: a systematic review | Journal of Intensive Care | Full Text
https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-015-0085-4
Atrial fibrillation (AF) is a common arrhythmia in the ICU. The aim of this review is to summarize relevant information on new-onset AF in non-cardiac critical illness with respect to epidemiology, prevention, and treatment. […] The incidence of new-onset AF varied from 4.5% to 15.0%, excluding exceptional cases (e.g., septic shock). […] New-onset AF occurred in 5%15% of the non-cardiac critically ill patients. Patients with new-onset AF had poor outcomes compared with those without AF. Despite the high incidence of new-onset AF in the general ICU population, currently available information for AF, especially for management (prevention, treatment, and anticoagulation), is quite limited. Further research is needed to improve our understanding of new-onset AF in critically ill patients. […] Compared with the amount of knowledge for cardiac diseases, however, information on AF occurring in general critically ill populations is limited.
#1 Epidemiology, prevention, and treatment of new-onset atrial fibrillation in critically ill: a systematic review | Journal of Intensive Care | Full Text
https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-015-0085-4
The goal of treatment for AF and atrial flutter might be rhythm conversion to improve cardiac output and preventing thromboembolic events. […] Severity of illness (APACHE II, SAPS II, SIRS, shock), organ failures, and sepsis were all reported as risk factors of AF in multiple studies. A subgroup of septic shock patients also had a markedly high incidence of new-onset AF (46%). […] Although studies in cardiac surgery patients showed that -blockers had a prophylactic effect for postoperative AF, none of the studies in this review showed a significant relationship between -blockers and occurrence of new-onset AF. […] As for AF prevention, we excluded two RCTs because of focusing on patients after lung resection, although they were conducted in the ICU. […] This review has several limitations. First, we included only 12 studies and their quality of evidence was generally low.
#1 Emergence of Atrial Fibrillation and Flutter in COVID-19 Patients: A Retrospective Cohort Study
https://www.mdpi.com/2227-9032/12/17/1682
COVID-19 is associated with various cardiovascular complications, including arrhythmias. This study investigated the incidence of new-onset atrial fibrillation (AFB) and atrial flutter (AFL) in COVID-19 patients and identified potential risk factors. We found that 69 patients (10.66%) developed AFB or AFL, with 41 patients (6.34%) experiencing new-onset arrhythmias. The incidence rates for new-onset AFB and AFL were 5.4% and 0.9%, respectively. Older age (â¥65 years) was significantly associated with new-onset AFB/AFL (OR: 5.43; 95% CI: 2.31â12.77; p < 0.001), as was the development of sepsis (OR: 2.73; 95% CI: 1.31â5.70; p = 0.008). Our findings indicate that new-onset atrial arrhythmias are a significant complication in COVID-19 patients, particularly among the elderly and those with sepsis. This highlights the need for targeted monitoring and management strategies to mitigate the burden of atrial arrhythmias in high-risk populations during COVID-19 infection.
#1 Emergence of Atrial Fibrillation and Flutter in COVID-19 Patients: A Retrospective Cohort Study
https://www.mdpi.com/2227-9032/12/17/1682
Our results showing age and sepsis as risk factors for arrhythmia are in line with the results found in other studies. The 2023 ACC/AHA/ACCP/HRS guideline recognizes sepsis and advancing age as risk factors for atrial fibrillation. With every five-year increase in age, the risk of incident AF increases (HR of 1.43â1.66). Severe sepsis increases the risk of atrial fibrillation (OR of 6.82). […] Our study highlights the burden of atrial arrhythmias, specifically atrial fibrillation and atrial flutter, as a consequence of COVID-19 infection. Our results are consistent with other studies in highlighting sepsis and advanced age as risk factors for developing arrhythmias secondary to COVID-19. Our findings highlight the critical need for vigilant monitoring of at-risk patients to safeguard this already vulnerable population from the onset of atrial arrhythmias.
#1 Diagnosing Atrial Fibrillation & Atrial Flutter | NYU Langone Health
https://nyulangone.org/conditions/atrial-fibrillation-atrial-flutter/diagnosis
Cardiac electrophysiologists at NYU Langones Heart Rhythm Center treat people who have atrial fibrillation (AFib) and atrial flutter. […] Atrial flutter causes a fast but regular heartbeatsometimes as rapid as 350 beats per minute. […] Like AFib, this rapid heartbeat also increases the risk of developing blood clots and stroke. […] A surveillance monitor, including a Holter device, ambulatory telemetry device, or implantable cardiac loop recorder, may be recommended if you have intermittent and unpredictable episodes of arrhythmia. […] A Holter device is a small, wearable surveillance device that is the size of a smartphone. […] An ambulatory telemetry device is a lightweight, portable heart monitor that is worn for up to two weeks to measure your hearts electrical activity for signs of a heart rhythm disorder. […] An implantable cardiac loop recorder is a small device thats placed under the skin of the chest to continuously monitor and record your heart rhythm for up to two years.
#1 Atrial fibrillation – Wikipedia
https://en.wikipedia.org/wiki/Atrial_fibrillation
Atrial fibrillation is the most common arrhythmia and affects more than 33 million people worldwide. In Europe and North America, as of 2014, it affects about 2% to 3% of the population. In the developing world, rates are about 0.6% for males and 0.4% for females. The number of people diagnosed with AF has increased due to better detection of silent AF, increasing age and increase of conditions that predispose to it such as obesity and increasing survival from other forms of cardiovascular disease. […] The rate of hospital admissions for AF has risen. AF is the cause for 20% of all ischemic strokes. After a transient ischemic attack or stroke, about 11% are found to have a new diagnosis of atrial fibrillation. 3% to 11% of patients with AF have structurally normal hearts. […] The number of new cases each year of AF increases with age. In younger people the prevalence is estimated to be 0.05% and is associated with congenital heart disease or structural heart disease in this demographic. As of 2001, it was anticipated that in developed countries, the number of people with atrial fibrillation was likely to increase during the following 50 years, due to the growing proportion of elderly people.
#1 Digoxin for atrial fibrillation and atrial flutter: A systematic review with meta-analysis and trial sequential analysis of randomised clinical trials | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193924
Atrial fibrillation is the most common arrhythmia of the heart with a prevalence of approximately 2% in the western world. Atrial fibrillation and atrial flutter are both associated with an increased risk of morbidity and death. The risks of both cerebral stroke and heart failure are increased nearly fivefold in patients with atrial fibrillation and atrial flutter, and about 20% of every stroke may be due to atrial fibrillation. Atrial fibrillation and atrial flutter also have a significant impact on healthcare costs and account for approximately 1% of the National Health Service budget in the United Kingdom and approximately 26 billion dollars of annual expenses in the United States. […] During recent years, systematic reviews of observational studies have compared digoxin to no digoxin in patients with atrial fibrillation or atrial flutter, and these reviews suggested that digoxin seems to increase the risk of all-cause mortality regardless of concomitant heart failure.
#1 Estimating the burden of atrial fibrillation and atrial flutter with projection to 2050 in Iran | Scientific Reports
https://www.nature.com/articles/s41598-024-71296-4
Despite advancements in prevention and treatment, AF/AFL remains a major public health problem in Iran. […] The burden of AF/AFL in Iran, however, remains unclear. […] The findings are in line with previous studies demonstrating that the increase in AF/AFL incidence and prevalence are higher in the Middle East region, which can attributed to many factors, including population aging, rapid economic developments in recent years, and the shift toward westernized diets, despite the slower progress in education and medical care. […] Our analyses showed that AF/AFL burden is progressively rising, with a 375.4% increase in AF/AFL-related deaths and a 248.2% increase in DALYs. […] Projections suggest that by 2050, AF/AFL-related deaths and DALYs could reach about 7 and 170 thousand annually.
#1 Three decades of atrial fibrillation and flutter epidemiology and risk factors in Iran with a focus on the impact of COVID-19 | Scientific Reports
https://www.nature.com/articles/s41598-025-91737-y
Atrial fibrillation/flutter (AF/AFL) is one of the most common sustained heart rhythm disorders in clinical practice and a major public health concern. This study aimed to evaluate the disease burden of AF/AFL in Iran and analyze trends using the Global Burden of Disease (GBD) 2021 data, by age, sex, location, risk factor, and socio-demographic index (SDI), considering the impacts of COVID-19. Data on the prevalence, incidence, disability-adjusted life years (DALYs), deaths, and six attributable risk factors related to AF/AFL in Iran and its 31 provinces from 1990 to 2021 was collected from the GBD 2021 study. In Iran, in 2021, the AF/AFL age-standardized incidence rate (ASIR) was 40.6 (30.0 to 54.4), the age-standardized prevalence rate (ASPR) was 425.4 (327.2 to 559.2), the age-standardized DALY rate was 72.4 (57.4 to 88.3), and the age-standardized death rate (ASDR) was 3.3 (2.5 to 3.8) per 100,000 population. The national incidence, prevalence, DALYs, and death rates of AF/AFL showed an overall increasing trend with age. Males experienced higher rates of incidence and prevalence compared to females. In contrast, females had higher rates of DALYs and deaths compared to males. The burden of AF/AFL increased with advancing age. The risk factor with the highest DALYs and deaths attributable to AF/AFL was high systolic blood pressure. Notably, no remarkable association was found between SDI and the burden of AF/AFL in Iran. The incidence and prevalence of AF/AFL in Iran have significantly increased, highlighting the critical need for cost-effective and nationwide interventions.
#1 Three decades of atrial fibrillation and flutter epidemiology and risk factors in Iran with a focus on the impact of COVID-19 | Scientific Reports
https://www.nature.com/articles/s41598-025-91737-y
The study found no significant changes in the age-standardized DALY and death rates of AF/AFL in Iran from 1990 to 2021. […] The observed trends likely reflect advancements in medical management, early diagnosis, and improvements in education over the past three decades. However, the rising incidence and prevalence of AF/AFL indicate a growing public health challenge. It is crucial to prioritize and promote preventive measures, such as the management of hypertension and other modifiable risk factors, to mitigate the future burden of AF/AFL. Proactive intervention is essential to address the growing number of individuals living with AF/AFL and to reduce associated complications. […] Our study found higher AF/AFL ASIR and ASPR in males compared to females in 2021 in Iran, consistent with the GBD 2021 of AF/AFL on the global scale. However, the prior GBD 2019 studies in Iran and the MENA region found incompatible results, indicating higher ASIR and ASPR of AF/AFL in females. […] The main risk factor contributing to DALYs and deaths from AF/AFL was high SBP, in line with prior GBD analyses of AF/AFL.
#2 Atrial Flutter | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/17963
Atrial flutter is the second most common cardiac arrhythmia after atrial fibrillation. […] It is commonly associated with atrial fibrillation, but the incidence and the prevalence of the atrial flutter are less known when compared with atrial fibrillation. […] Atrial flutter is more frequent in males than in females. Aging is a significant risk factor as other associated disorders in patients with atrial fibrillation include systemic hypertension, diabetes mellitus, and a history of alcohol abuse. Older age is associated with an increased risk of atrial fibrillation and atrial flutter.
#2 Incidence and predictors of atrial flutter in the general population – PubMed
https://pubmed.ncbi.nlm.nih.gov/11127467/
This study, the first population-based investigation of atrial flutter, suggests this curable condition is much more common than previously appreciated. If our findings were applicable to the entire U.S. population, we estimate 200,000 new cases of atrial flutter in this country annually. At highest risk of developing atrial flutter are men, the elderly and individuals with preexisting heart failure or chronic obstructive lung disease.
#2 Incidence and predictors of atrial flutter in the general population – PubMed
https://pubmed.ncbi.nlm.nih.gov/11127467/
Objectives: The goal of our study was to determine the incidence and predictors of atrial flutter in the general population. […] Although atrial flutter can now be cured, there are no reports on its epidemiology in unselected patients. […] A total of 181 new cases of atrial flutter were diagnosed for an overall incidence of 88/100,000 person-years. Incidence rates ranged from 5/100,000 in those 50 years old to 587/100,000 in subjects older than 80. Atrial flutter was 2.5 times more common in men (p 0.001). The risk of developing atrial flutter increased 3.5 times (p 0.001) in subjects with heart failure and 1.9 times (p 0.001) for subjects with chronic obstructive pulmonary disease. Among those with atrial flutter 16% were attributable to heart failure and 12% to chronic obstructive lung disease.
#2 Atrial Flutter (AFL): Abnormal Heart Rhythm | Doctor
https://patient.info/doctor/atrial-flutter
Atrial flutter is less common than atrial fibrillation, but epidemiology is less well studied. It is one tenth as common as atrial fibrillation. […] It is the second most common arrhythmia after atrial fibrillation. […] Atrial flutter is commonly associated with atrial fibrillation. On presentation the two often alternate. Around 50% of those presenting with atrial flutter alone are said to develop atrial fibrillation within the next eight years. […] The prevalence increases with age. With an ageing population, it is becoming increasingly common. […] Atrial flutter is more common in men, with males accounting for 80% of cases. […] Systemic embolism is less common than it is in atrial fibrillation (occurring about 30% as frequently). There is no difference if there is associated atrial fibrillation.
#2 Atrial flutter: RF, differential diagnosis, management strategies
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-6/Atrial-flutter-RF-differential-diagnosis-management-strategies-Title-Atria
The overall incidence of atrial flutter is 0,09%, 58% of patients also have atrial fibrillation in their history. Atrial flutter represents 0,1% of hospital discharges in the US, with the mean age at 67 years and male predominance cca 2:1. Case fatality is 1%, mostly related to underlying disease. […] A first occurrence of atrial flutter is in 60% of cases associated with a specific acute precipitating event (major surgery, pneumonia, myocardial infarction). In 38% of cases, atrial flutter is associated with chronic illness (heart failure, lung disease, hypertension). Lone atrial flutter (without any recognisable underlying disease) is rare only 2% of atrial flutter patients.
#2 Estimating the burden of atrial fibrillation and atrial flutter with projection to 2050 in Iran | Scientific Reports
https://www.nature.com/articles/s41598-024-71296-4
The higher incidence and prevalence in females can be explained through two hypotheses. […] Our study showed that despite noticeable advancements, AF/AFL remains a major public health problem in Iran. Over the past 30 years, the epidemiological and burden metrics of AF/AFL have increased significantly, mostly due to population aging and population growth.
#2 Estimating the burden of atrial fibrillation and atrial flutter with projection to 2050 in Iran | Scientific Reports
https://www.nature.com/articles/s41598-024-71296-4
Despite advancements in prevention and treatment, AF/AFL remains a major public health problem in Iran. […] The burden of AF/AFL in Iran, however, remains unclear. […] The findings are in line with previous studies demonstrating that the increase in AF/AFL incidence and prevalence are higher in the Middle East region, which can attributed to many factors, including population aging, rapid economic developments in recent years, and the shift toward westernized diets, despite the slower progress in education and medical care. […] Our analyses showed that AF/AFL burden is progressively rising, with a 375.4% increase in AF/AFL-related deaths and a 248.2% increase in DALYs. […] Projections suggest that by 2050, AF/AFL-related deaths and DALYs could reach about 7 and 170 thousand annually.
#2 Estimating the burden of atrial fibrillation and atrial flutter with projection to 2050 in Iran | Scientific Reports
https://www.nature.com/articles/s41598-024-71296-4
Atrial fibrillation (AF)/atrial flutter (AFL) is the most common cardiac tachyarrhythmia, with an increasing trend in its burden in recent years. […] The burden of AF/AFL in Iran remains unclear. […] In 2019, there were 339.1 (259.4-433.7) thousand AF/AFL patients in Iran, with 30.2 (23.2-38.5) thousand new cases, 1.7 (1.5-2) thousand deaths and 48 (37.7-60.5) thousand DALYs. […] High systolic blood pressure and elevated body mass index (BMI) were the predominant attributable risk factors for AF/AFL-related deaths and DALYs. […] It is estimated that in 2050, the number of AF/AFL patients will increase to 1.1 million people, the incidence of AF/AFL will increase to 91 thousand patients, and the number of AF/AFL-related deaths and DALYs will surge to 7.2 and 170.8 thousand, respectively.
#3 Atrial Flutter | Concise Medical Knowledge
https://www.lecturio.com/concepts/atrial-flutter/
More common in the elderly […] Uncommon in patients without underlying structural heart disease […] Less common than atrial fibrillation […] 2.5 times more prevalent in men than in women.
#3 Three decades of atrial fibrillation and flutter epidemiology and risk factors in Iran with a focus on the impact of COVID-19 | Scientific Reports
https://www.nature.com/articles/s41598-025-91737-y
The study found no significant changes in the age-standardized DALY and death rates of AF/AFL in Iran from 1990 to 2021. […] The observed trends likely reflect advancements in medical management, early diagnosis, and improvements in education over the past three decades. However, the rising incidence and prevalence of AF/AFL indicate a growing public health challenge. It is crucial to prioritize and promote preventive measures, such as the management of hypertension and other modifiable risk factors, to mitigate the future burden of AF/AFL. Proactive intervention is essential to address the growing number of individuals living with AF/AFL and to reduce associated complications. […] Our study found higher AF/AFL ASIR and ASPR in males compared to females in 2021 in Iran, consistent with the GBD 2021 of AF/AFL on the global scale. However, the prior GBD 2019 studies in Iran and the MENA region found incompatible results, indicating higher ASIR and ASPR of AF/AFL in females. […] The main risk factor contributing to DALYs and deaths from AF/AFL was high SBP, in line with prior GBD analyses of AF/AFL.