Atrial Fibrillation

Atrial Fibrillation

Atrial fibrillation is probably the most common cardiac arrhythmia, which increases significantly with age. Ten percent of people over the age of 70 have this “supraventricular tachyarrhythmia”.

What is atrial fibrillation?

That is, there is an irregular and rapid heartbeat that originates in the left atrium. Comparatively, only 1% of those over 50 have this cardiac arrhythmia. Furthermore, the causes, examination methods, treatment and course options as well as preventive measures are discussed. For short rib polydactyly syndrome (srps), please visit nonprofitdictionary.com.

The heart has its own stimulus generation and conduction system. In the case of atrial fibrillation, there are areas in the atrium that are also electrically excited.

This leads to very rapid movements of the heart walls with an atrial fibrillation rate between 350-600/min. As a result, there is no haemodynamically effective atrial contraction, which reduces the total cardiac output (volume of blood pumped from the heart into the circulatory system within one minute). Due to the AV node, only a small part of the atrial actions is transferred to the ventricles.

Causes

Approximately 15% of atrial fibrillation patients have primary atrial fibrillation with heart health. The most common causes are cardiac.

These include coronary artery disease, myocardial infarction, heart failure and mitral valve disease in 50% of cases. Other heart diseases that can cause atrial fibrillation are cardiomyopathy, heart muscle inflammation, heart surgery. Extracardiac causes are also known, such as thyroid disorders, high blood pressure, pulmonary embolism and certain medications.

Those affected complain of palpitations with dizziness, brief loss of consciousness ( syncope ) and shortness of breath with decreasing cardiac output.

Symptoms, Ailments & Signs

Many patients hardly notice the atrial fibrillation, others react with considerable symptoms. The first group mainly includes people who have become accustomed to the disease. In them, the atrial fibrillation has usually developed chronically unnoticed. They are often afflicted by dizziness and tiredness.

Reduced performance is then attributed to other factors such as stress or private problems. Atrial fibrillation itself is not initially life-threatening. However, it can lead to serious consequential damage if left untreated. Distinct symptoms involve the heart, which beats irregularly.

Sick people consciously perceive the beating of their heart. This suddenly hits extremely fast. This perception is often accompanied by chest pain. Sometimes shortness of breath sets in, which is immediately assessed as threatening. The signs described have an impact on the psyche. A sudden, incomprehensible fear arises.

Atrial fibrillation can lead to further late effects if it is not treated professionally. These mainly affect older people. Statistically, people over the age of 70 are affected. It is not uncommon for them to suffer a stroke. Even embolisms in the legs or in the cerebral vessels are possible.

Diagnosis & History

Atrial fibrillation is diagnosed after recording atrial fibrillation using a resting ECG or during the recording of a long-term ECG. Depending on the course or duration of the atrial fibrillation, a further classification is made.

There is:

1.) A newly diagnosed atrial fibrillation.

2.) Paroxysmal atrial fibrillation, which usually self-limits within 48 hours to a maximum of 7 days.

3.) Persistent or persistent atrial fibrillation, which is to be converted back into sinus rhythm.

4.) A long-lasting atrial fibrillation for more than 1 year, which should be converted to sinus rhythm.

5.) A permanent atrial fibrillation in which atrial fibrillation has been accepted and is being rate controlled.

The most common complication of atrial fibrillation is the formation of blood clots, which can cause an embolism. 20% of all strokes are due to atrial fibrillation. The longer the atrial fibrillation lasts, the greater the risk.

Complications

Untreated atrial fibrillation leads to various symptoms and health complications as it progresses. When the condition is associated with a drop in heart rate, possible consequences include dizziness, weakness, and syncope, a brief loss of consciousness. Symptoms such as tachycardia and shortness of breath can accompany this.

Too little pumping capacity can cause pulmonary congestion, which can lead to the development of life-threatening pulmonary edema. In the long term, acute atrial fibrillation turns into permanent atrial fibrillation. Such a severe course increases the risk of consequential damage considerably: it can lead to embolism and thus also to strokes and cardiovascular comorbidities.

In the worst case, a heart attack occurs and the patient dies as a result. People with coronary artery disease may experience an angina attack or an acute myocardial infarction. There are also risks in the treatment of atrial fibrillation. Implanting a defibrillator can result in injury or infection, and device rejection is a possibility.

Electrical cardioversion can cause abnormal heart rhythms or a heart attack in the event of an undetected valvular defect or an underactive thyroid. Additional risks come from the anesthetics, which can cause side effects in some patients.

When should you go to the doctor?

Arrhythmias of the heart, which also include auricular fibrillation, should be diagnosed and treated as early as possible. Atrial fibrillation is usually frightening for those affected, because the heart races and suddenly gets out of rhythm. This cardiac arrhythmia often lasts no longer than a few minutes, rarely hours or days.

The greatest danger lies in initially ignoring the symptoms and thus postponing a visit to the doctor. However, atrial fibrillation can cause serious, even life-threatening health problems. If timely treatment has not been initiated due to late diagnosis, atrial fibrillation can also take a chronic course. Then the chances of recovery decrease considerably, because the heart rhythm can then only be brought back to normal with difficulty.

Emboli and strokes caused by atrial fibrillation can often be prevented by seeing a cardiologist in good time. Because even with a simple ECG or long-term ECG, atrial fibrillation can be diagnosed well and reliably. Certain previous illnesses such as obesity, diabetes, heart failure or hypertension considerably increase the risk of suffering from atrial fibrillation.

That is why patients with these additional risk factors should take even the smallest cardiac arrhythmia seriously and see a doctor immediately to avoid serious damage. Since atrial fibrillation as a special arrhythmia of the heart occurs more frequently with increasing age, older people should be examined by a cardiologist at regular intervals. Atrial fibrillation can then also be an incidental finding, because it is not always noticed by those affected.

Treatment & Therapy

Therapeutically, there is frequency control on the one hand and rhythm control on the other, which are prognostically equivalent.

The frequency control is drug-based with beta- blockers, verapamil (rarely) or digitalis preparations. The aim is to lower the heart rate. There are forms of atrial fibrillation with a very low heart rate, which then increases only slightly under stress. This is often an indication for pacemaker implantation.

Rhythm control of atrial fibrillation involves converting the heart’s rhythm to a sinus rhythm. This can also be done with medication or with ECG-triggered electrocardioversion. When it comes to drug therapy, a distinction must be made between patients with and without heart disease. Patients without heart disease can be controlled on class I antiarrhythmics such as flecainide or propafenone.

In paroxysmal atrial fibrillation, a pill-in-the-pocket approach with a single dose of antiarrhythmic drugs can be tried. Patients with heart disease are placed on amiodarone under inpatient conditions. Amiodarone is the most effective antiarrhythmic drug, but it also has many side effects.

Furthermore, an ECG-triggered electrical cardioversion can be performed under short-term anesthesia. An electric shock is emitted from the outside. Previously, the duration of the atrial fibrillation must be considered. If this persists for more than 48 hours, thrombi in the heart must be ruled out using transesophageal echocardiography (swallowing ultrasound of the heart). Or you can take blood-thinning agents (anicoagulants) for at least four weeks and then perform electrical cardioversion.

Prevention

Depending on the risk of thromboembolism, blood-thinning therapy is also given temporarily or for life. This reduces the risk of a stroke. Marcumar or Falithrom and, for some time now, dabigatran and rivaroxaban have also been available for this purpose.

There is a high rate of atrial fibrillation recurrence of 30% within one week and 75% at one year in patients undergoing electrical cardioversion. Therefore, long-term antiarrhythmic drugs are often prescribed to prevent atrial fibrillation. In addition, there are catheter ablation procedures in the form of high-frequency current or cold, in which the sites of excitation formation of atrial fibrillation are sought out and sclerosed.

Aftercare

Regular follow-up examinations are extremely important for patients with atrial fibrillation. All patients with atrial fibrillation and after ablation are treated and cared for. If an ablation is performed, the patient should see the treating physician every three months for the first year after treatment. The examinations will then be carried out once every six months.

In the event of deterioration and symptoms, the patient should consult a doctor immediately. Depending on the evaluation of the examination results, the doctor will advise the patient on how to proceed. In the further course, ECG control examinations are necessary in order to be able to check the long-term success of the therapy. Patients often need to continue taking medication after the ablation.

Anticoagulants are often used over a certain period of time, the mode of action of which must be monitored regularly by blood tests. If there is improvement, a slow discontinuation, monitored by the doctor, can then take place if necessary. In some cases, however, the ablation has to be repeated.

Long-term atrial fibrillation is usually treated entirely with anticoagulants to prevent the patient from having a stroke. This is monitored and assessed as part of the aftercare. In the case of atrial fibrillation, the goal of treatment in the secured follow-up care is to restore a normal rhythm. This can often be achieved with medication.

You can do that yourself

If the heart is beating abnormally fast or irregularly, a visit to the cardiologist is recommended. Atrial fibrillation must first be clarified and treated with medication or electrical cardioversion. The therapy can be supported by self-measures.

First of all, physical activity is recommended. It is best to start with light exercise and gradually increase the intensity. The increasing fitness avoids accompanying symptoms of atrial fibrillation such as high blood pressure or diabetes. Interval training, sport with alternating stress and recovery phases, is particularly effective. Endurance training, on the other hand, should be avoided. Patients first discuss the sporting measures with the responsible doctor in order to avoid complications.

In the case of atrial fibrillation, the heart rate must be monitored and, if necessary, adjusted with medication. Patients use an appropriate measuring device to check heart rate. If there are deviations below or above, the doctor must be informed. The causes of atrial fibrillation must be identified and eliminated. In addition to treatment of the underlying disease, general measures such as a healthy lifestyle, avoidance of stress and a balanced diet apply to this. The attending doctor suggests suitable measures with regard to the intensity and cause of the atrial fibrillation.

Atrial Fibrillation