Diagnosis | Atrial fibrillation

Diagnosis

The most important diagnostic method for atrial fibrillation is the ECG (electrocardiogram), since the disease shows typical patterns of change in the examination. A conventional, short recording is often sufficient. However, in some patients, despite a high degree of suspicion, the ECG does not initially show any abnormalities.

In such cases, a long-term ECG may be suitable, which usually records the heart activity over 24 hours. With increasing age, more and more people suffer from atrial fibrillation. In the over-80s, the figure is already almost 10%!

As “silent” heart rhythm disturbances often lead to strokes, especially in this group, it is recommended to occasionally feel the pulse from the age of 65 onwards in order to quickly detect any irregularities.If your doctor suspects that you have atrial fibrillation, he will pay particular attention to the following special features when evaluating the ECG: The R-wave is the most conspicuous wave of the electrocardiogram and is part of the QRS complex, which represents the propagation of excitation within the heart chambers. The distances between the individual R-peaks can provide information about heart rate and regularity of the heartbeat. In the case of atrial fibrillation, the distances vary, sometimes considerably, so that a rhythm disturbance can be inferred.

In the ECG of a healthy person, the P-wave is the first small, positive wave after the zero line. It represents the electrical excitation of the atria. Since this process is disrupted in atrial fibrillation, there is no P-wave in the affected person.

Instead of the regular P-waves, so-called “flicker waves” are very often found. They are an expression of the circling excitation of the atria and are characterized by very fast (>350/min), small deflections. Behind this complicated term is a Greek term for the word “seizure-like”.

It occurs spontaneously and without recognizable triggers and usually ends after a maximum of 48 hours. Although paroxysmal atrial fibrillation can also last up to seven days, the 48-hour period is significant. After this time it is unlikely that our heart will “jump” into the correct sinus rhythm on its own.

If atrial fibrillation lasts longer than seven days and only disappears after the start of therapy (e.g. medication), this is called persistent atrial fibrillation. By definition, persistent atrial fibrillation exists when neither electrical cardioversion nor medication that can correct the cardiac dysrhythmia is available. Both doctor and patient then accept this condition and refrain from further electronic cardioversion attempts.