Male Atrial Fibrillation Research Articles

Gender-specific relationship between abdominal obesity and prevalence of new-onset atrial fibrillation in the general Japanese population

Abstract Background The number of incidences of atrial fibrillation (AF) is expected to rise rapidly in the near future because of the increased number of geriatric patients in Japanese society. In addition, obesity is increasing in the general Japanese population. Although a higher body mass index is associated with a higher risk of AF, the relationship between abdominal obesity (large waist circumference) and new-onset AF is unclear. Methods and results We performed a longitudinal retrospective observational study from January 2007 to October 2018 using the annual health checkup data. Data from 58,844 adults (29,572 males, age 54±13 years) without baseline AF, who underwent routine health checkups, were analyzed. We performed logistic regression analyses to determine the strength of the association between abdominal obesity and new-onset AF. We also examined the effect of abdominal obesity on the incidences of AF stratified by gender. During a median follow-up of 4 years, we recorded new cases of AF in 322 (0.5%) individuals. In univariate analysis, a large waist circumference was significantly associated with new-onset AF, both in males [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.02 to 1.05, p<0.001] and in females (HR 1.04, 95% CI 1.01 to 1.06, p=0.002), respectively. In multivariate analysis adjusted for clinical variables (age, hypertension, dyslipidemia, estimated glomerular filtration rate, habitual drinking and diabetes), a large waist circumference was significantly and independently associated with new-onset AF in males (HR 1.04, 95% CI 1.03 to 1.06, p<0.001), but not in females (HR 1.01, 95% CI 0.99 to 1.04, p=0.269). Conclusion Abdominal obesity is independently associated with an increased risk of new-onset AF in males. This association in males might imply some sex-specific mechanisms. There might be a gender difference in the effectiveness of interventions to decrease abdominal obesity to prevent AF. Funding Acknowledgement Type of funding source: None

Sex differences in the predictors of recurrent atrial fibrillation after catheter ablation: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry

Abstract Background The impact of sex differences on the clinical outcomes of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is controversial. We previously reported that females experienced more frequent AF recurrences than males after the index and last RFCA procedures. Purpose To identify the risk factors associated with recurrent AF in females and males after RFCA of AF. Methods We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centers (64±10 years; 1369 [27.3%] females; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. Results The incidence of AF recurrences after a single procedure was 43.3% in females and 39.0% in males. After a multivariate adjustment at baseline, the significant predictors of AF recurrence in females after the index RFCA were non-paroxysmal AF (hazard ration [HR],1.59; 95% confidence interval [CI],1.31–1.93, p<0.0001), a history of AF ≥2 years (HR,1.47; 95% CI,1.24–1.74, p<0.0001), coronary artery disease (HR,1.43; 95% CI,1.03–1.98, p=0.0035), and an estimated glomerular filtration rate (eGFR)<60 mL/min/1.73m2 (HR,1.46; 95% CI,1.10–1.95, p=0.0086). On the other hand, significant predictors of AF recurrence in males after the index RFCA were non-paroxysmal AF (HR,1.54; 95% CI,1.37–1.73, p<0.0001), a history of AF ≥2 years (HR,1.40; 95% CI,1.26–1.56, p<0.0001), the number of antiarrhythmic drugs (HR,1.06; 95% CI,1.003–1.13, p=0.040), a left atrial diameter≥40mm (HR,1.13; 95% CI,1.007–1.27, p=0.038), and dilated cardiomyopathy (HR,1.55; 95% CI,1.07–2.26, p=0.021), however, an eGFR<60 mL/min/1.73m2 was not associated with AF recurrence in males (HR, 1.00; 95% CI, 0.88–1.13, p=0.97). Conclusion The Kansai Plus Atrial Fibrillation Registry revealed a distinct sex difference in terms of the predictors of recurrent AF after RFCA. Non-Paroxysmal AF and a long history of AF were common risk factors both in females and males. However, renal dysfunction was a significant predictor of AF recurrence in females, while it was not a risk of recurrence in males. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Research Institute for Production Development in Kyoto, Japan.

Abstract WP379: Sex-specific Effects of Comorbid Diabetes and Depression on Post-stroke Mortality in Individuals With Atrial Fibrillation

Background: Comorbid diabetes and depression are highly prevalent in atrial fibrillation (AF) and increase the risk of stroke. Women with AF show higher mortality rates and have worse functional outcomes post-stroke. However, the sex-specific effects of comorbid diabetes and depression on mortality and other adverse outcomes in stroke patients with a history of AF is unclear. Methods: Prospectively collected consecutive patients with ischemic stroke and known AF presenting to designated stroke centres in Ontario (2003-2013). Multinomial regression was used to determine sex-specific associations between diabetes and depression and in-hospital mortality post-stroke in individuals with AF. Cox proportional hazards regression was used to estimate the adjusted hazard of long-term mortality post-stroke and competing risks models to estimate hazards of recurrent stroke/TIA, admission to long-term care, and incident dementia post-discharge. Results: Among 5082 stroke patients with known AF (median age=80, IQR:73-85), female patients were more likely to have comorbid depression than males (63.5% vs. 36.5%) and those with comorbid diabetes and depression were younger (77 yrs) and had more vascular history (HTN, CAD, hyperlipidemia) than those with AF only. For males, comorbid diabetes increased the likelihood of in-hospital mortality post-stroke by 53% (OR=1.53, 95% CI=1.16-2.02), after adjustment for stroke severity, demographic and clinical factors, while comorbid depression did not significantly impact in-hospital mortality and neither diabetes or depression affected in-hospital mortality post-stroke for females. However, diabetes was independently associated with increased hazard of long-term mortality for both female (HR=1.15, 95%CI=1.02-1.29) and male AF stroke patients (HR=1.35, 95%CI=1.19-1.53). No associations with recurrent stroke/TIA, institutionalization or dementia post-stroke were observed for either females or males. Conclusion: In stroke patients with known AF, comorbid diabetes but not depression was independently associated with increased in-hospital mortality for males and increased long-term mortality post-stroke for both females and males.

P5661Validation of CHA2DS2-VA score (excluding female sex) in non-valvular atrial fibrillation patients: a nationwide population-based study

Abstract Background Sex category (Sc, ie, female sex) confers 1 point on CHA2DS2-VASc score. So, no woman with atrial fibrillation (AF) can have a CHA2DS2-VASc score of 0. This study aimed to compare CHA2DS2-VA (excluding female sex) and CHA2DS2-VASc score in Korean AF patients. Methods Using the Korean National Health Insurance Service database, we analyzed the risk of ischemic stroke in non-valvular AF patients between 2013 and 2017. The predictive value of the CHA2DS2-VA and CHA2DS2-VASc scores for ischemic stroke was evaluated by c-statistic difference and net reclassification improvement (NRI). The propensity score matching method was used to balance covariates across male and female AF patients. Results A total of 182,133 patients with AF (49.2% women) were included to this study. The adjusted incidence rate (IR) of ischemic stroke was not significantly different between males and females (0.89%/y and 0.90%/y, respectively, p=0.411) in low-risk patients without risk factor. Also, no sex difference was found in high-risk patients with above 2 risk factors for ischemic stroke (4.46%/y for male and 4.49%/y for male, p=0.498). In c-statistic analysis for ischemic stroke, there was no significant difference between the CHA2DS2-VA and CHA2DS2-VASc scores (AUC 0.662 vs. 0.664, z=1.572, p=0.116). When compared with CHA2DS2-VASc score, CHA2DS2-VA score was not significantly inferior in net reclassification improvement (NRI 0.031, 95% CI 0.002–0.037, p=0.118) for ischemic stroke. C-statistics Conclusions In Korean AF patients, the CHA2DS2-VA score excluding female sex is a useful risk scoring system for ischemic stroke.

P4776Age-dependent anti-thrombotic therapy for atrial fibrillation patients with intermediate risk (CHA2DS2-VASc Score of 1 or 2) of ischemic stroke

Abstract Background Although older age is one of the most important risk factor for stroke in atrial fibrillation (AF), it is unclear whether oral anticoagulants are beneficial for AF patients with intermediate CHA2DS2-VASc score (1 for male or 2 for female) according to age threshold. We sought to investigate the effect of age-dependent antithrombotic therapy for ischemic stroke in Korean intermediate risk AF patients. Methods We enrolled 29,592 patients (males with CHA2DS2-VASc score of 1 and females with CHA2DS2-VASc score of 2) using the Korean National Health Insurance Service database. The clinical endpoint was the occurrence of ischemic stroke. The propensity score matching method was used to balance covariates across treated and untreated patients. Results Treated male AF patients were 6,570 (67.1%) with age <55 years, 7,115 (70.9%) with 55–64 years and 6,470 (68.3%) with 65–74 years in each age risk criterion. Also, treated female AF patients were 3,156 (71.3%) with age <55 years, 2,838 (71.0%) with 55–64 years and 3,440 (72.6%) with 65–74 years in each age risk criterion. Among male and female patients (age <55 years and 55–64 years) with 1 risk factor, an annual ischemic stroke rate was not significantly different between treated and untreated patients at full follow-up. However, treated AF patients who are in age 65–74 year without other risk factor had a much lower annual risk of ischemic stroke [(1.05%/year (male) and 1.04%/year (female)] compared with untreated patients [(1.77%/year (male) (p<0.026) and 1.86%/year (female) (p<0.041). Conclusions Age is an important predictor in determining the risk of ischemic stroke in AF patients with intermediate CHA2DS2-VASc scores (1 for male or 2 for female). We suggest that the benefit of anti-thrombotic therapy for intermediate risk AF patients depends on age threshold.

Sex Differences in Quality of Life in Patients With Atrial Fibrillation: A Systematic Review.

BackgroundThe goal of this literature review was to assess sex differences in the quality of life (QoL) in patients with atrial fibrillation (AF) and, if possible, to determine if these are due to AF.Methods and ResultsThe electronic database PubMed was searched on January 23, 2018, using the search terms “QoL”, gender differences, “AF” female, and gender to find potential articles that assessed sex differences in QoL in AF patients. In all, 851 articles were identified, from which 25 original studies were eligible for this systematic review. Female AF patients were found to have poorer QoL and more symptoms than male AF patients. They scored lower, predominantly on the physical component score of the Medical Outcomes Study Short‐Form 36 Health Survey.ConclusionsThe available literature consistently describes poorer QoL in female AF patients but does not clearly address whether this is a reflection of sex differences seen in the general population or is related to AF per se. It is also questionable whether the relatively poorer QoL in women is large enough to be of clinical importance.

CHA2DS2-VASc scores and Intermountain Mortality Risk Scores for the joint risk stratification of dementia among patients with atrial fibrillation

High CHA2DS2-VASc scores in atrial fibrillation (AF) patients are generally associated with increased risks of stroke and dementia. At lower CHA2DS2-VASc scores, there remains an unquantifiable cranial injury risk, necessitating an improved risk assessment method within these lower-risk groups. The purpose of this study was to determine whether sex-specific Intermountain Mortality Risk Scores (IMRS), a dynamic measures of systemic health that comprises commonly performed blood tests, can stratify dementia risk overall and among CHA2DS2-VASc score strata in AF patients. Female (n = 34,083) and male (n = 39,998) AF patients with no history of dementia were studied. CHA2DS2-VASc scores were assessed at the time of AF diagnosis and were stratified into scores of 0-1, 2, and ≥3. Within each CHA2DS2-VASc score stratum, patients were further stratified by IMRS categories of low, moderate, and high. Multivariable Cox hazard regression was used to determine dementia risk. High-risk IMRS patients were generally older and had higher rates of hypertension, diabetes, heart failure, and prior stroke. Higher CHA2DS2-VASc score strata (≥3 vs ≤1: women, hazard ratio [HR] 7.77, 95% confidence interval [CI] 5.94-10.17, P<.001; men: HR 4.75, 95% CI 4.15-5.44, P < .001) and IMRS categories (high vs low: women, HR 3.09, 95% CI 2.71-3.51, P<.001; men, HR 2.70, 95% CI 2.39-3.06, P < .001) were predictive of dementia. When stratified by CHA2DS2-VASc scores, IMRS further identified risk in each stratum. Both CHA2DS2-VASc scores and IMRS were independently associated with dementia incidence among AF patients. IMRS further stratified dementia risk among CHA2DS2-VASc score strata, particularly among those with lower CHA2DS2-VASc scores.

Influence of abdominal obesity and habitual behaviors on incident atrial fibrillation in Japanese

BackgroundAs atrial fibrillation (AF) increases with the aging of the population, it is urgently required to clarify modifiable factors to prevent AF. However, evidence regarding the independent influence of abdominal-obesity and habitual behaviors on incident AF is limited among Japanese. Methods and ResultsThose aged 40–79 years undergoing periodic health checkups during 2008–2014 were followed-up in 2015 (n=96,841) and the independent risk of incident AF was estimated using multivariate Cox proportional hazards regression models after adjustment for potential covariates. Participants were classified into four groups according to the baseline body mass index (BMI: kg/m2) (normal-BMI or overweight: < or ≥25) and waist circumference (WC: cm) (normal-WC or abdominal-obesity: < or ≥85 for male, ≥90 for female). Baseline habitual behaviors, smoking status, alcohol intake, and physical activity, were also included as modifiable factors. Among 65,984 eligible participants, 349 developed AF over mean follow-up of 5.5±1.6 years. Increase of both BMI and WC significantly elevated the risk of AF. Compared to the normal-BMI and normal-WC group, the normal-BMI but abdominal-obesity and the overweight and abdominal-obesity groups in males and the overweight and abdominal-obesity group in females had significantly elevated risk of AF. Among modifiable behavioral factors including abdominal-obesity, alcohol intake (≥40g/day) and abdominal-obesity significantly elevated the risk of AF in males, and abdominal-obesity was the strongest risk factor in both sexes, but smoking and physical activity were not significant. However, an aggregation of these four behavioral factors increased the risk of AF more than 2.5 times in both sexes. ConclusionsAbdominal-obesity could be a crucial risk factor in prediction of AF in Japanese, and an aggregation of four behavioral factors increased the risk of AF almost three times. To prevent incident AF, practicing healthy habitual behaviors is recommended.

Stroke Prevention in Atrial Fibrillation

It is important to evaluate the risks of stroke and bleeding when screening patients with atrial fibrillation (AF), in whom anticoagulation therapy is indicated. Oral anticoagulation therapy is recommended in male AF patients with CHA2 DS2-VASc score ≥1 and female AF patients with CHA2 DS2-VASc score ≥2. Non-vitamin K oral anticoagulants (NOACs) are preferred over vitamin K anticoagulants in eligible patients. NOACs are contraindicated in patients with mechanical heart valves or moderate-to-severe mitral stenosis. Key words: Atrial Fibrillation; Stroke; Anticoagulation

Should Atrial Fibrillation Patients With 1 Additional Risk Factor of the CHA2DS2-VASc Score (Beyond Sex) Receive Oral Anticoagulation?

BackgroundAlthough the CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score is recommended by both American and European guidelines for stroke risk stratification in atrial fibrillation (AF), the treatment recommendations for a CHA2DS2-VASc score of 1 are less clear. ObjectivesThis study aimed to investigate the risk of ischemic stroke in patients with a single additional stroke risk factor (i.e., CHA2DS2-VASc score = 1 [males] or 2 [females]) and the impact of different component risk factors. MethodsWe used the National Health Insurance Research Database in Taiwan. Among 186,570 AF patients not on antiplatelet or anticoagulant therapy, we evaluated males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2. The clinical endpoint was the occurrence of ischemic stroke. ResultsAmong 12,935 male AF patients with a CHA2DS2-VASc score of 1, 1,858 patients (14.4%) experienced ischemic stroke during follow-up (5.2 ± 4.3 years), with an annual stroke rate of 2.75%. Ischemic stroke risk ranged from 1.96%/year for men with vascular disease to 3.50%/year for those 65 to 74 years of age. For 7,900 females with AF and a CHA2DS2-VASc score of 2, 14.9% experienced ischemic stroke for an annual stroke rate of 2.55%. Ischemic stroke risk increased from 1.91%/year for women with hypertension to 3.34%/year for those 65 to 74 years of age. ConclusionsNot all risk factors in CHA2DS2-VASc score carry an equal risk, with age 65 to 74 years associated with the highest stroke rate. Oral anticoagulation should be considered for AF patients with 1 additional stroke risk factor given their high risk of ischemic stroke.

Polymorphisms of angiotensin-converting enzyme 2 gene confer a risk to lone atrial fibrillation in Chinese male patients.

Growing epidemiologic evidence has indicated that genetics can predispose individuals to the occurrence of lone atrial fibrillation (AF). The angiotensin-converting enzyme 2 (ACE2) gene has been established to be associated with hypertension and left ventricular hypertrophy. The objective of our study was to investigate the association of ACE2 gene polymorphisms with lone AF. A total of 265 consecutive lone AF patients and 289 healthy controls were successfully investigated. The polymorphisms rs2106809 and rs2285666 were genotyped by polymerase chain reaction (PCR) and direct sequencing. A Logistic regression model was used to determine the odds ratio (OR) and 95% confidence intervals (CI) of variations of ACE2 for lone AF. The T allele of rs2106809 conferred an increased risk for lone AF (OR 1.24, 95% CI 1.01-1.52, P = 0.03) in males after adjustment for conventional risk factors. SNP at rs2285666 in males was not significantly different between AF patients and controls. No association was found between the two polymorphisms in the female population with lone AF. After (36.3 ± 4.5) months of follow-up, the end point data were obtained: death (cardiac and noncardiac), ischemic stroke, and heart failure. In the male subgroup, the associations between rs2106809 T male carriers and combined end points including ischemic stroke, heart failure, and death in our study were of significance (OR 3.6, 95% CI 1.0-13.1, P = 0.04). The results indicate that polymorphism at ACE2 gene is associated with male lone AF in a Chinese Han population. Lone AF males who carry the rs2106809 T allele are associated with adverse cardiac events.

Clinical significance of ST depression in patients with atrial fibrillation: from the Fushimi AF registry

Purpose: Atrial fibrillation (AF) increases the risks of stroke and death, and the prevalence of AF is increasing significantly (reportedly, 0.6% of total population in Japan). ST depression is a common feature of electrocardiogram in AF patients, but its clinical significance is not well characterized. Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients living in Fushimi-ku, Kyoto, which is a typical urban district of Japan with a population of 283,000. At present, we have enrolled 3,379 Japanese AF patients (1.2% of total population) from March 2011 to December 2012. We analyzed 12-lead electrocardiograms during AF in 2,017 registered patients. After the exclusion of ventricular pacing, bundle branch block and digitalis use, 1,398 patients (males 58.8%; 73.9±11.2 years; mean heart rate 93.3±26.1 bpm; paroxysmal in 39.6%, persistent in 7.8%, and permanent in 52.6%) underwent ST depression analysis. ST depression was defined as the depression of the ST segment level >0.1 mV from the baseline. Results: ST depression was found in 350 patients (25.1% of total, 20.2% in male, 31.9% in female); which was much more prevalent than general elderly (≥70) population in Japan (6.8% in male and 9.8% in female, reportedly). CHADS2 score was greater in AF patients with ST depression compared with those without ST depression (2.27 vs. 2.06; p=0.02). AF patients with ST depression were faster in heart rate (107.9 vs. 88.5 bpm; p<0.01) and higher in blood pressure (126.2 vs. 123.5 mmHg; p=0.02). They were more likely to have heart failure (33.7 vs. 25.4%; p<0.01), valvular heart disease (22.1 vs. 15.7%; p<0.01), cardiomyopathy (4.9 vs. 1.8%; p<0.01) and coronary artery disease (21.1 vs. 12.1%; p<0.01). Furthermore, there was a striking difference in clinical backgrounds between male and female. Male AF patients with ST depression had more heart failure (36.4 vs. 20.7%; p<0.01), valvular heart disease (22.0 vs. 11.7%; p<0.01), cardiomyopathy (9.1 vs. 2.3%; p<0.01) and coronary artery disease (25.5 vs. 11.0%; p<0.01), whereas female AF patients were associated with none of them; heart failure (31.4 vs. 33.2%; p=0.66), valvular heart disease (22.3 vs. 22.3%; p=0.99), cardiomyopathy (1.1 vs. 1.0%; p=0.93) and coronary artery disease (17.3 vs. 13.9%; p=0.29). Conclusion: ST depression was more prevalent in patients with AF than general population. The presence of ST depression in male AF patients was associated with various organic heart diseases, but not in female AF patients.

PULMONARY VEIN SPONTANEOUS ACTIVITIES: INFLUENCE FACTORS AND IMPACT ON PULMONARY VEIN RECONNECTION

ObjectivesIn this study, we sought to evaluate the influence factors of pulmonary vein (PV) spontaneous activities (SAs) and the impact of SAs on the PV reconnection (PVR) in atrial fibrillation...

Atrial fibrillation in elderly patients after coronary artery bypass grafting; gender differences in outcome

Objectives. To evaluate gender-related differences in preoperative risk factors, hospital events, especially atrial fibrillation (AF), and length of stay in elderly patients undergoing isolated coronary artery bypass grafting (CABG). Design. Prospectively collected data from consecutive patients undergoing isolated CABG in Tampere University Hospital between May 1999 and November 2000, in total 1 131 patients. Result. We analysed 621 patients 65 years and older of whom 401 (65%) were male. When evaluating gender differences we found that the women were older (73 vs. 71 yrs, p<0.001) and significantly more often had hypertension (66% vs. 49%, p<0.001) and chronic heart insufficiency (11% vs. 4%, p=0.001). The NYHA classification of the women was worse (3.4 vs. 3.1, p<0.001) and in the angiografic data they had left main stenosis more often (31% vs. 21%, p=0.005) than the men. The women needed longer hospitalisation (19 vs. 15 days, p<0.001). There was no difference in the prevalence of postoperative AF between the genders, but in spite of that women had more postoperative strokes (6% vs. 3%, p=0.028) and also other major complications (29% vs. 19%, p=0.004) than the men. The 30-day mortality was higher in the female group (8% vs. 5%, p=0.06). We analysed preoperative risk factors and found that the females had a 1.6-fold risk for postoperative major complication after adjustment for age and other risk factors. In a logistic regression analysis age and the number of anastomoses emerged as independent predictors of AF in males, but in females we could not find any predictor for postoperative AF. Conclusions. The women are older and have more comorbidities and risk factors at the time of CABG. They also have more postoperative complications, but not a significantly higher mortality. Importantly, the excess of morbidity remains after adjustment for age and underlying risk factors. There is no gender difference in the incidence of postoperative AF in the elderly population. However, it seems to occur independent of age in the women only.

Cardiovascular risk factors, ECG abnormalities and quality of life in subjects with atrial fibrillation.

In Central European regions epidemiologic findings for atrial fibrillation (AF) in a randomly selected population are not available. Therefore, information obtained by a standardized examination procedure including resting 12 lead ECG of 4003 participants (2014 men, 1989 women), aged 25 to 64 years, of the MONICA-Augsburg Survey 1984/85 were analysed. Reexamination of 3753 subjects took place three years later (Follow-up Study 1987/88). Persons with AF in the baseline survey (n = 13) were compared with an age-and sex-matched control group (n = 156) without AF, chosen from the same population sample, with regard to cardiovascular risk factors, associated disease and disturbances in the subjects' general well-being. In 1984/85 thirteen cases with AF (6 males, 7 females) were observed, giving an age-standardized prevalence of AF in males of 0.22% and in females of 0.34%. The age of men with AF ranged between 50 and 63 years and of women between 61 and 64 years. No significant differences were observed in persons with AF compared to the control group in risk factor levels and alcohol consumption; however, significant differences could be seen concerning disturbances in quality of life like self-reported health status (p < 0.001), sleep disturbances (p < 0.05), antihypertensive medication (p < 0.001). AF cases were found to have further ECG abnormalities significantly more often (left anterior hemiblock: p < 0.05; ventricular premature beats: p < 0.05). In all subjects with AF in the initial examination 1984/85 AF was found three years later (chronic AF). Overall 13 new cases (7 men, 6 women) were identified in the 1987/88 follow-up. The prevalence of AF in a South German population is comparable with AF prevalences reported from studies in other populations (e.g.) Framingham 1950, Reykjavik 1967/70). Associated ECG abnormalities were found more frequently in subjects with AF. Cases with AF have considerable disturbances in their general well-being.