Less Known but Clinically Relevant Comorbidities of Atrial Fibrillation: A Narrative Review.

BACKGROUND: The important risk factors for atrial fibrillation (AF) in the general population are not always equally important in specific and relatively prevalent diseases. OBJECTIVE: The main goal of this narrative review is to focus attention on the presence and the relationship of AF with several important diseases, such as cancer or sepsis, in order to: 1) stimulate further research in the field, and 2) draw attention to this relationship and search for AF in clinical practice. METHODS: We searched PubMed, SCOPUS, Elsevier, Wiley, Springer, Oxford Journals, Cambridge, SAGE, and Google Scholar for less-known comorbidities of AF. The search was limited to publications in English. No time limits were applied. RESULTS: AF is widely represented in cardiovascular and other important diseases, even in those in which AF is rarely mentioned. In some specific clinical subsets of AF patients (e.g., patients with sepsis or cancer), the general risk factors for AF may not be so important. Patients with new-onset AF have a several-fold increase in relative risk of cancer, deep vein thrombosis, and pulmonary thromboembolism (PTE) during the follow-up. CONCLUSION: AF presence, prognosis, and optimal therapeutic approach are insufficiently recognised in several prevalent diseases, including life-threatening ones. There is a need for a better search for AF in PTE, pulmonary oedema, aortic dissection, sepsis, cancer and several gastrointestinal diseases. Improved AF detection would influence treatment and improve outcomes.

[Ebstein's anomaly as a cause of paroxysmal atrial fibrillation].

BACKGROUND: Ebstein's anomaly is characterized by a displacement of the tricuspid valve toward apex, because of anomalous attachment of the tricuspid leaflets. There are type B of Wolff-Parkinson-White (WPW) syndrome and paroxysmal arrhythmias in more than a half of all patients. CASE REPORT: We presented a female, 32-year old, with frequent paroxysms of atrial fibrillation. After conversion of rhythm an ECG showed WPW syndrome. Echocardiographic examination discovered normal size of the left cardiac chambers with paradoxical ventricular septal motion. The right ventricle was very small because of its atrialization. The origin of the tricuspid valve was 20 mm closer to apex of the right ventricle than the origin of the mitral valve. Electrophysiological examination showed a posterolateral right accesorial pathway. Atrial fibrillation was induced very easily in electrophysiological laboratory and a successful ablation of accessorial pathway was made. There were no WPW syndrome and paroxysms of atrial fibrillation after that. CONCLUSION: Ebstein's anomaly is one of the reasons of paroxysmal atrial fibrillation, especially in young persons with WPW syndrome.

[Cardiac rhabdomyosarcoma].

BACKGROUND: Primary malignant cardiac tumors are rare entities and rhabdomyosarcoma accounts 20% of these lesions. CASE REPORT: We presented a female patient with loss of appetite and loss of weight. She also had symptoms of heart failure and bilateral pleural effusions. A mobile tumor in the left heart with the entrance from the left atrium to left ventricle during diastole was seen by transthoracic echocardiography. The tumor was extirpated in total, histologic diagnosis was rhabdomyosarcoma, and the patient died after 6 months. CONCLUSION: Primary malignant cardiac tumors can simulate heart failure or systemic disorders. Cardiac rhabdomyosarcomas have a poor prognosis with the average survival of 6 months after the occurrence of symptoms and making a diagnosis. In cardiac insufficiency, differential diagnostics should be used to consider cardiac tumors that could be with certainty confirmed or excluded by echocardiography.