Brief overview
- Symptoms: Racing heart, irregular pulse, dizziness, shortness of breath, chest pain, anxiety
- Therapy: drug frequency or rhythm control, catheter ablation of abnormally altered heart muscle cells, anticoagulation for stroke prophylaxis
- Causes and risk factors: Frequently other heart disease and physical illness (for example, thyroid or kidney disease), obesity, alcohol consumption, stress
- Course of disease: Atrial fibrillation is not acutely life-threatening, but may lead to complications such as strokes or heart failure.
- Prognosis: The prognosis depends mainly on the underlying diseases and the success of the treatment.
What is atrial fibrillation?
Atrial fibrillation is the most common form of cardiac arrhythmia. It usually affects older people. Up to 15 percent of people over 70 suffer from atrial fibrillation.
This results in an irregular heart rhythm (arrhythmia). If the heart activity is completely irregular and no regularity can be detected in the ECG, it is an absolute arrhythmia (arrhythmia absoluta).
Due to the circling electrical signals, the atria do not manage to fill completely with blood. Therefore, the amount of blood ejected by the heart is reduced. If the heart is already weakened, it pumps even less blood. Blood pressure drops.
Atrial fibrillation: Forms
Doctors distinguish between three different forms of atrial fibrillation:
- Persistent atrial fibrillation: The heartbeat does not find its way back to its usual rhythm on its own; atrial fibrillation ends only with cardioversion.
- Permanent atrial fibrillation: Chronic atrial fibrillation, should or cannot be restored to a stable sinus rhythm.
In addition to the three forms of atrial fibrillation, medical experts distinguish two types:
- In the vagotonic type, the heart rate decreases. This type of atrial flutter usually occurs at night or at rest.
- In the sympathicotonic type, the heart rate increases. It often occurs in the morning or during the day after stress or physical exertion.
Valvular and non-valvular atrial fibrillation
It is characterized primarily by an increased risk of blood clot formation – compared to other forms of atrial fibrillation. The term non-valvular atrial fibrillation includes all other forms independent of the mitral valve.
Atrial fibrillation or atrial flutter?
Another form of arrhythmia also originates from the atria and is treated similarly, but has a different cause. Read more about this in the article Atrial Flutter.
Atrial fibrillation is often asymptomatic. About two-thirds of those affected feel nothing or only a slight drop in performance from a seizure-like atrial fibrillation. In others, the symptoms are so pronounced that normal, daily activities are impaired.
Typical symptoms of atrial fibrillation include:
- Tachycardia, palpitations
- Irregular pulse
- Dizziness
- Shortness of breath
- Chest pain or pressure
- Anxiety
- frequent urination
When atrial fibrillation becomes chronic, the organism sometimes becomes accustomed to the arrhythmia and those affected no longer have any pronounced symptoms.
How is atrial fibrillation treated?
If atrial fibrillation has developed due to another condition such as hyperthyroidism, it is important to treat this condition first. In many cases, the arrhythmia will then improve on its own.
Frequency control
In most cases, the heartbeat in atrial fibrillation is too fast. Depending on the cause of the atrial fibrillation and concomitant diseases, various agents are used to lower the heart rate, in particular beta-blockers, calcium channel blockers (calcium antagonists) and digitalis. Guidelines recommend aiming for a resting heart rate of less than 80 beats per minute.
Medicinal rhythm control
For example, the following active ingredients are used:
- Vernakalant (antiarrhythmic agent)
- Flecainide (antiarrhythmic agent)
- Propafenone (antiarrhythmic agent)
- Amiodarone (potassium channel blocker)
In some cases, a single dose is sufficient to bring the heart rhythm back under control. If the affected person is appropriately trained, a visit to the doctor is not always necessary: in this case, he or she carries the medication with him or her and takes it when an episode of atrial fibrillation occurs.
Electrocardioversion
Sometimes atrial fibrillation is very persistent and does not pass on its own or with drug therapy. The doctor then tries to normalize the heart rhythm by applying electrical currents from outside. Doctors refer to this therapeutic measure as electrocardioversion.
Electrocardioversion works in a similar way to defibrillation during resuscitation. During the procedure, the patient is connected to various monitoring devices that control blood pressure and oxygen supply. Under a brief anesthetic, the doctor directs electricity into the heart through two electrodes for a fraction of a second. The heart often returns to its normal rhythm as a result of the electric shock.
Catheter ablation
Catheter ablation makes it possible to cure many sufferers of atrial fibrillation in the long term. In certain circumstances, current guidelines even recommend considering ablation as the first treatment option for rhythm control.
Pacemaker implantation
Patients with a heartbeat that is too slow sometimes need a pacemaker. This ensures a faster and stable heartbeat.
Protection against stroke
If there is an increased risk of stroke, this can be reduced by taking blood-thinning and anticoagulant drugs. In addition to the vitamin K antagonists (e.g. warfarin and phenprocoumon), the new oral anticoagulants (NOAK) with the active ingredients apixaban, dabigatran, edoxaban and rivaroxaban are among the drugs available.
The benefit of such therapy compared to drug therapy cannot be conclusively assessed at present, as too few study data are available so far.
Prevent relapses
Sport with atrial fibrillation
Many people with heart disease ask themselves whether they should continue to exercise. In fact, the health-promoting effect of moderate endurance sports in cardiac arrhythmias has been scientifically proven. Exercise even reduces the risk of recurrent attacks of atrial fibrillation. With the right training and weight reduction, the frequency of atrial fibrillation episodes can be reduced, sometimes noticeably.
Start of training in atrial fibrillation
In addition, it is recommended that patients with atrial fibrillation always discuss the appropriate training dose (intensity and duration) with their attending physician before starting training. He or she will determine the performance capacity of the patient using various tests and will then make an individual recommendation for the training based on this.
Which sport for cardiac arrhythmia?
If a person increases his or her exercise tolerance by more than 50 watts, which corresponds to walking faster, the risk of recurrent atrial fibrillation is reduced by more than one-third over a period of five years. If the patient also loses a few extra pounds, the risk of recurrent atrial fibrillation attacks is reduced by as much as three quarters. Sport and weight loss have a comparable effect to medication.
The following endurance sports are good for atrial fibrillation:
- Jogging
- Walking/Nordic Walking
- Rowing
- Cycling or ergometer training
- Dancing
Strength training prevents falls
In addition to endurance training, heart patients benefit from low-dose strength training. This is because older people in particular are affected by cardiac arrhythmias such as atrial fibrillation. Strength training gives them more confidence in everyday life and may help prevent falls.
The following exercises are particularly gentle on the leg:
- Strengthening the adductors (flexors): Sit upright on a chair with your hands between your knees. Now press outward with the hands. The legs work against the hands. Maintain the tension for a few seconds and then relax completely.
Since muscle mass consumes more energy than fat, muscles increase the basal metabolic rate and help with weight loss. That’s why cardiac patients benefit doubly from light strength exercises: Muscles become stronger, gait becomes more secure, and fat deposits disappear more quickly.
These sports are not suitable in atrial fibrillation
Climbing or mountain hiking or other sports with an acute risk of falling are also not suitable for people with atrial fibrillation.
For patients taking anticoagulants for stroke prophylaxis, sports with a low risk of injury are recommended. Injuries cause internal or external bleeding, which is difficult to stop by the medication taken.
Unsuitable sports for cardiac arrhythmias such as atrial fibrillation are therefore:
- Mountain biking
- Alpine skiing
- Boxing
- Karate
- Full contact sports (for example handball, soccer, ice hockey)
Self-help for atrial fibrillation
The most effective self-help for atrial fibrillation is to reliably take the prescribed medication, to attend regular check-ups with your doctor and to adjust your lifestyle if necessary. Since stress is a possible trigger for atrial fibrillation, it is advisable to reduce constant time pressure and mental stress wherever possible.
Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.
Cause and risk factors
However, there are some risk factors that promote atrial fibrillation. Such risk factors are found in about 85 percent of those affected. In addition to certain medications that trigger atrial fibrillation, many chronic diseases are among them, such as:
- High blood pressure
- Heart disease (for example, valvular heart disease, myocardial insufficiency, coronary artery disease)
- Heart surgery
- Diabetes mellitus
- Thyroid diseases
- Lung diseases
- Sleep apnea
- Kidney disease
- Significant alcohol consumption
- Obesity
- Stress and other psychological strains
Researchers found that the risk for atrial fibrillation also has a genetic component.
Diagnosis and examination
The specialist for atrial fibrillation is a cardiologist. First, the doctor asks about the history of the disease. Of importance, for example, is:
- How often the heart palpitations occur and for how long
- Whether certain factors, such as alcohol consumption or a sleep deficit, trigger the palpitations
- Whether the affected person suffers from heart disease or another physical illness
- Whether other complaints occur during the heart racing
This is followed by a physical examination and a pulse and blood pressure check.
Electrocardiogram (ECG)
The most important examination to diagnose atrial fibrillation is the electrocardiogram (ECG). Here, the doctor measures the electrical heart currents via electrodes that are stuck to the chest.
Echocardiography
An ultrasound examination of the heart (echocardiography) can be used to examine its structure and pumping behavior. Especially if the doctor has already diagnosed atrial fibrillation, it is important to look for blood clots in the heart.
Laboratory values
To track down the cause of atrial fibrillation, the doctor may perform some blood tests. These include, for example, the determination of:
- Blood salts (electrolytes), especially potassium and magnesium
- Thyroid values
- Coagulation values
- Infection parameters (under certain circumstances)
Living with atrial fibrillation
Atrial fibrillation can be treated in a variety of ways, but it is always possible for atrial fibrillation to recur even after successful therapy. Relapses are particularly common in people with heart disease.
The prognosis of atrial fibrillation depends particularly on concomitant heart disease. If the heart is already weakened, atrial fibrillation may significantly increase mortality and reduce life expectancy. However, there is no general answer to how long life expectancy is with atrial fibrillation.
While it is not possible to prevent atrial fibrillation, it is possible to prevent the diseases that cause it. A healthy diet, regular exercise and avoiding stimulants reduce the risk of coronary heart disease – the main cause of atrial fibrillation.
Sexuality in atrial fibrillation?
In case of doubt, consult a physician. This person is able to assess or check the physical resilience.
