心房細動の臨床知見補遺 : 心房細動患者の豫後について

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Statistical analyses of 113 patients with auricular fibrillation, who had been followed up for from one to nine years subsequent to the first medical examination, were made with particular emphasis on prognosis, the relationship between therapy and prognosis and several other factors which affect the prognosis.1) Of the 113 cases 45 cases (39.8 per cent) died; the death rate per, year of the first five years was between 10.7 and 19.0 per cent.The number of deaths in the first year was 15 (33.3 per cent of the total deceased); 31 (68.9 per cent) were dead by the end of the third year; 42 (93.3 per cent), by the end of the fifth year.Congestive heart failure constituted 42.2 per cent of all the immediate causes of death; cerebral vascular accidents, 17.8 per cent; sudden death, 15.6 per cent; cardiac death, 11.1 per cent; other causes not related to the cardiovascular system, 13.3 per cent.The average life expectancy was two years and one month; in the two cases, where auricular fibrillation was found before the age of 20 and was fatal, the life expectancy was 11 months for both.2) The degree of working ability of the patients, who survived more than one year after the first medical examination, was graded in four classes.The percentage of each group was as follows : (I) 32.4,(II) 36.8,(III) 25.0,(IV) 5.9. Thus, in a greater part of the patients, working ability was relatively good.3) According to etiological classification, 45 cases (39.8 per cent) were of valvular type; their average age at the first medical examination was 40 years. There were 20 deaths (44.4 per cent) and the death rate per year was between 16.7 and 23.1 per cent for one of the initial five years. There were 8 deaths (20.0 per cent of the total deceased) within the first year; 16 (80.0 per cent), by the end of the third year; 20 (100.0 per cent), by the end of the fifth year. The average life expectancy was one and half years and the average age at death was 41 years.Causes of death were congestive heart failure for 40.0 per cent; sudden death, 25.0 per cent; cardiac death, 15.0 per cent; cerebral vascular accinents, 10.0 per cent; other causes not related to the cardiovascular system, 10.0 per cent.4) There were 31 cases (27.4 per cent) of hypertensive type; their average age at the first examination was 55 years. There were 14 deaths (45.2 per cent); the death rate per year was between 15.0 and 16.1 per cent for one of the initial three years. The percentage of deaths in the fourth year was 42.9. No deaths were found in the fifth year. There were 5 deaths (35.7 per cent of the total deceased) within the first year; 8 (71.4 per cent) by the end of the third year; 12 (92.9 per cent) by the end of the fifth year. The average life expectancy was two years and five months, and the average age at death was 58 years.In 35.7 per cent of the total deceased, the death was due to congestive heart failure; in 28.6 per cent, cerebral vascular accidents; in 14.3 per cent, cardiac death; in 14.3 per cent, other causes not related to the cardiovascular system; in 7.1 per cent, sudden death.5) Among the patients with auricular fibrillation due to other etiology, one patient died out of the 4 patients with syphilitic heart disease; 3 out of 4 with infectious heart disease; 4 out of 5 with other diseases; 3 out of 13 of unknown etiology. There were no deaths among the 3 patients with thyrotoxicosis and 8 patients without evidence of other causes than auricular fibrillation.6) Of the 68 patients of non-valvular type of auricular fibrillation, 25 patients died. The death rate per year was between 7.4 per cent and 17.2 per cent for one of the initial five years. Compared to the valvular type, the death rate of the non-valvular type seemed somewhat lower, though no significant difference appeared to exist.7) There were 12 cases (10.6 per cent) of paroxysmal type. Only one death was encountered, indicating that the prognosis of this type is favorable.8) Exlcuding the cases which died of non-cardiac causes, the relationship between prognosis and the degree of ECG changes was examined.9) There were 19 cases who survived more than 5 years after the first medical examination.10) In the cases of valvular type, the cases in which the cardio-thoratic ratio of chest roentgenogram was greater than the normal had not always unfavorable prognosis as expected; in cases of non-valvular type, the cases in which the cardiothoracic ratio was smaller than 0.59 had good prognosis and the ones with more than 0.6,unfavorable.11) Of the 34 cases who received the quinidine therapy, 20 cases (58.8 per cent) converted to the sinus rhythm. There were 7 deaths (35.0 per cent) among them. The average life expectancy was 2 years.There were 14 cases in which the sinus rhythm was not restored. Four patients (28.6 per cent) died out of them. The average life expectancy was 2 years.The two patients who regained sinus rhythm with procaine amide are living at the present time after 4 years and 3 months and 6 years and 5 months respectively since the time of their initial examinations.
社団法人日本循環器学会の論文
1959-06-20

心房細動の臨床知見補遺 : 心房細動患者の豫後について

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