Atrial fibrillation is probably the most common arrhythmia of the heart, and it increases significantly with age. Ten percent of people over age 70 have this “supraventricular tachyarrhythmia.”
What is atrial fibrillation?
This means there is an irregular and rapid heartbeat that originates in the left atrium. Comparatively, only 1% of people over 50 years old have this cardiac arrhythmia. In the following, the causes, examination methods, treatment and progression possibilities as well as preventive measures will be discussed. The heart has its own stimulus generation and conduction system. In atrial fibrillation, there are areas in the atrium that are additionally electrically excited. This leads to very fast movements of the heart walls with an atrial fibrillation frequency between 350 – 600/min. As a result, there is a lack of hemodynamically effective atrial contraction, which lowers the overall cardiac output (blood volume pumped from the heart into the circulation within one minute). Because of the AV node, only a small fraction of atrial actions are transmitted to the ventricles.
Causes
Primary atrial fibrillation is present in approximately 15% of atrial fibrillation patients in cardiac health. The most common causes are cardiac related. 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 include cardiomyopathy, myocarditis, heart surgery. Extracardiac causes are also known, such as thyroid disease, hypertension, pulmonary embolism, and certain medications. Affected individuals complain of palpitations with dizziness, brief loss of consciousness (syncope), and shortness of breath as cardiac output decreases.
Symptoms, complaints, and signs
Many patients barely notice atrial fibrillation, while others react with significant discomfort. In particular, individuals who have become accustomed to the condition belong to the first group. In them, atrial fibrillation has developed chronically, usually unnoticed. Not infrequently, they are afflicted by dizziness and fatigue. However, reduced performance is then attributed to other circumstances such as stress or private problems. At first, atrial fibrillation itself is not life-threatening. However, it can lead to serious consequential damage if it is not treated. Clear symptoms concern the heart, which beats irregularly. Sufferers are consciously aware of the beating of their heart. It suddenly beats at a rapid pace. This perception is often accompanied by chest pain. Sometimes the patient experiences shortness of breath, which is immediately perceived as threatening. The signs described above have an impact on the psyche. A sudden, incomprehensible anxiety occurs. Atrial fibrillation can lead to further late effects if it is not treated professionally. These mainly affect older seniors. Statistically, it is people over the age of 70 who 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 and progression
Defibrillation is a treatment method for cardiac arrhythmias such as ventricular fibrillation or palpitations, atrial fibrillation, and atrial flutter in which strong electrical shocks are used to restore healthy heart activity. The diagnosis of atrial fibrillation is made after recording atrial fibrillation by means of a resting ECG or during the recording of a long-term ECG. Depending on the course or duration of atrial fibrillation, a further classification is made. There are:
1.) A first-time diagnosed atrial fibrillation. 2.) A paroxysmal atrial fibrillation, which usually self-limits within 48 hours to a maximum of 7 days. 3.) A persistent or sustained atrial fibrillation that should be restored to sinus rhythm. 4.) A prolonged atrial fibrillation over 1 year, but which should be converted to sinus rhythm. 5.) A permanent atrial fibrillation in which atrial fibrillation has been accepted and is frequency controlled. The most common complication of atrial fibrillation is the formation of blood clots that can cause embolism. 20% of all strokes are due to atrial fibrillation. The risk is greater the longer the atrial fibrillation persists.
Complications
Untreated atrial fibrillation leads to various symptoms and health complications as it progresses.If the disease is associated with a drop in heart rate, possible consequences include dizziness, weakness and syncope, a brief loss of consciousness. Accompanying symptoms may include palpitations and shortness of breath. Insufficient pumping action can cause pulmonary congestion, which can lead to the development of life-threatening pulmonary edema. In the long term, acute atrial fibrillation progresses to permanent atrial fibrillation. Such a severe course significantly increases the risk of secondary damage: embolisms may occur, leading to strokes and concomitant cardiovascular diseases. In the most severe case, a heart attack occurs and the patient dies as a result. Individuals with coronary artery disease may suffer an angina pectoris attack or acute myocardial infarction. There are also risks associated with the treatment of atrial fibrillation. Defibrillator implantation may be associated with injury or infection, and device rejection cannot be ruled out. Electrical cardioversion can cause arrhythmias or cause a heart attack in the case of an undetected valvular defect or hypothyroidism. Other risks come from the anesthetics, which can cause side effects in some patients.
When should you see a doctor?
Arrhythmias of the heart, which include atrial fibrillation, should be diagnosed and treated as early as possible. Atrial fibrillation is usually frightening for those affected, as the heart races and abruptly goes out of rhythm. This cardiac arrhythmia often lasts no longer than a few minutes, rarely hours or days. The greatest danger, therefore, 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 is not initiated due to delayed diagnosis, atrial fibrillation can also take a chronic course. In this case, the chances of recovery are considerably reduced, because the heart rhythm is then difficult to return to normal. Embolisms and strokes caused by atrial fibrillation can often be prevented by timely consultation with a cardiologist. This is because atrial fibrillation can already be diagnosed well and reliably with a simple ECG or long-term ECG. Certain pre-existing conditions such as obesity, diabetes, heart failure or hypertension increase the risk of atrial fibrillation considerably. For this reason, patients with these additional risk factors in particular should take even the slightest cardiac arrhythmia seriously and see a doctor immediately to avoid worse damage. Since atrial fibrillation as a special rhythm disturbance of the heart occurs more frequently with increasing age, older people should have themselves 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 and therapy
Therapeutically, there is frequency control on the one hand and rhythm control on the other, which are prognostically equivalent. Rate control is achieved medicinally by beta-blockers, verapamil (less commonly), or digitalis preparations. The goal 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 rhythm to a sinus rhythm. This can also be done with medication or ECG-triggered electrocardioversion. In drug therapy, a distinction must be made between patients with and without heart disease. Patients without cardiac disease can be adjusted to class I antiarrhythmic drugs such as flecainide or propafenone. For paroxysmal atrial fibrillation, a pill-in-the-pocket approach with a single dose of antiarrhythmic drugs can be tried. Patients with cardiac disease are adjusted to amiodarone under steady-state conditions. Amiodarone is the most effective antiarrhythmic drug, but it also has many side effects. Furthermore, ECG-triggered electrical cardioversion can be performed under short anesthesia. In this procedure, an electric shock is delivered externally. Before this, the duration of the atrial fibrillation must be taken into account. If this persists for longer than 48 hours, it is essential to exclude thrombi in the heart by means of transesophageal echocardiography (swallowing ultrasound of the heart).Or 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 stroke. Marcumar or falithrom and, more recently, dabigatran and rivaroxaban are available for this purpose. There is a high atrial fibrillation recurrence rate of 30% within one week and 75% after one year in patients after electrical cardioversion. Therefore, antiarrhythmic drugs are often prescribed for the longer term to prevent atrial fibrillation. In addition, there are catheter ablation procedures in the form of radiofrequency current or cold, in which the sites of excitation of atrial fibrillation are visited and obliterated.
Follow-up
For patients with atrial fibrillation, regular follow-up visits are extremely important. This involves the treatment and care of all patients with atrial fibrillation and after ablation. If ablation is performed, the patient should present to the treating physician every three months for the first year after treatment. Subsequent examinations will then be once every six months. In case of deterioration and complaints, the patient should consult a physician immediately. Depending on the evaluation of the examination results, the physician will give the patient appropriate advice on the further course of action. In the further course, ECG control examinations are necessary in order to be able to check the lasting success of the therapy. Patients often need to continue taking medication after ablation. Frequently, anticoagulants are used for a certain period of time, and their mode of action must be monitored regularly by blood tests. If there is improvement, they can then be slowly discontinued if necessary, monitored by the physician. In some cases, however, ablation must be repeated. Long-term atrial fibrillation is usually treated entirely with anticoagulants to prevent strokes in the patient. This is monitored and assessed during follow-up. In atrial fibrillation, the treatment goal in confirmed follow-up is to restore a normal rhythm. This can often be achieved with medication.
Here’s what you can do yourself
If the heart beats unusually fast or irregularly, a visit to a cardiologist is recommended. Atrial fibrillation must first be clarified and treated with medication or electrical cardioversion. The therapy can be supported by personal measures. Physical activity is recommended. It is best to start with light exercise and gradually increase the intensity. Increasing fitness helps avoid accompanying symptoms of atrial fibrillation such as high blood pressure or diabetes. Interval training, i.e. sport with alternating periods of exertion and recovery, is particularly effective. Endurance training, on the other hand, should be avoided. Patients should first discuss sporting measures with their 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 a suitable measuring device to check their heart rate. If any downward or upward deviations occur, the physician must be informed. The causes of atrial fibrillation must be identified and eliminated. For this, in addition to treatment of the underlying disease, general measures such as a healthy lifestyle, avoidance of stress and a balanced diet apply. The attending physician suggests appropriate measures with regard to the intensity and cause of atrial fibrillation.
