Atrial fibrillation in numbers

Atrial fibrillation is a heart rhythm disorder that affects approximately 750,000 French people. In a decade, knowledge about this disease has evolved in a major way. These advances have given rise to a new vision of this rhythm disorder and new therapeutic approaches.

A new vision of the FA

It is known today that atrial fibrillation (AF) is one of the major disorders of cardiology. A new concept leads to consider the AF no longer as an isolated disease but as a marker of cardiovascular risk. Significant therapeutic advances have already taken place and others are expected.

Atrial fibrillation: great therapeutic advances

Auricular Fibrillation is a disorder of the heart rhythm which consists of an anarchic activation of the atria. This leads to an almost complete absence of the auricular contractions and, as a corollary, an irregular contraction of the ventricles (the heart is composed of 4 cavities, 2 atria and 2 ventricles.) The atria receive blood from the veins and the ventricles eject the blood by The arteries). Patients who suffer from this condition, often referred to as arrhythmia, usually come for symptoms such as palpitations or shortness of breath. An electrocardiogram (ECG) and sometimes a 24-hour ECG record can be used to diagnose this disorder. A few years ago, the extent of the problems posed by FMD was poorly measured. It is now known to be the most common of all heart rhythm disorders. The AF currently affects about 750,000 people in the United States. The prevalence increases over the years, with progressive growth from quarantine, then an acceleration from 60 years. The average age of patients is around 70. The aging of the population and the increase in prevalence with age suggest a rapid growth in the number of patients in the years to come. It is estimated that nearly 2 million French will be affected in 2050.

A very important concept has recently led to considering Auricular Fibrillation no longer as an isolated disease but as a marker of cardiovascular risk. In most cases, AF occurs as part of an underlying cardiovascular disease: heart failure, diabetes, high blood pressure (hypertension), coronary disease ... Patients who suffer from this rhythm disorder are Of subjects at high cardiovascular risk, whose mortality is increased compared to subjects of the same age group. In general, all cardiovascular diseases can be complicated with Auricular Fibrillation. However, recent studies highlight the role of arterial hypertension. In patients with this rhythm disorder, almost 75% of subjects have hypertension. Auricular Fibrillation is also the cause of major thromboembolic risks, which result from the formation of clots due to atrial dilation and blood stagnation. The most important risk? Embolism at the level of a cerebral artery, responsible for cerebrovascular accidents (strokes). 15% of strokes are thus due to an Auricular Fibrillation, evident or passed unnoticed. AF may also be responsible for heart failure. "This new concept encourages a rigorous cardiovascular assessment when AF is discovered. It also requires comprehensive management, including not only the treatment of the rhythm disorder but also that of all cardiovascular diseases, in order to reduce the risk to normal.

Patients have an increased risk of mortality in the absence of treatment. This risk can be corrected by adequate care. The treatment aims to avoid or reduce the number of seizures and to prevent the occurrence of a stroke. The strategy is often complex. When it is a first episode, the doctor can take time for reflection. However, a treatment is prescribed as soon as the FA is less well supported .; Effective treatments are now available, coming from two therapeutic families: antiarrhythmics to maintain the sinus rhythm and anticoagulants to oppose the formation of clots Treatment of Auricular Fibrillation has also grown significantly in recent years through the use of ablation techniques. This therapeutic approach - which consists in suppressing the focus at the origin of the constitution of the arrhythmia by mounting a probe at the level of the heart by the vessels - is aimed at avoiding the occurrence of the rhythm disorder. The techniques of ablation have been subjected to a succession of improvement to become a very spectacular technique.

To date, significant progress is expected in the drug approach. An antiarrhythmic drug is on hold. While no drug has been developed in this indication for 20 years, a new molecule is announced and should be marketed in 2009: dronedarone. This medication which preserves patients from seizures and improves symptoms has the advantage of not containing iodine, which avoids the problems of allergy and the problems of modification of the thyroid physiology Five anticoagulant molecules are in development. These drugs are not antivitamins K, whose handling is always difficult for patients. They are designed to have the same anticoagulant efficacy, without imposing the same monitoring difficulties. The first of them should arrive at the end of 2009.

Press kit, XIX European Days of the French Society of Cardiology, January 2009