atrial fibrillation

Atrial fibrillation: description

Atrial fibrillation is the most common form of cardiac arrhythmia. Mostly older people are affected. Ten percent of over-70s suffer from atrial fibrillation.

Normally, an electrical signal is generated in the sinus node in the right atrium, which is conducted via a conduction system into the heart chambers. There it triggers a muscle contraction and thus the heartbeat. In atrial fibrillation, many circulating electrical excitations arise in the atria, some of which are also conducted via the conduction system to the chambers. This results in an irregular heart rhythm (arrhythmia). He is usually too fast (tachyarrhythmia). If a so-called lead block is added, it sometimes becomes too slow (bradyarrhythmia).

Most often, atrial fibrillation develops in the course of life. In many cases, it first appears as an attack (medically: paroxysmal) and then stops for minutes, hours or even days. Eventually, chronic (permanent) atrial fibrillation develops, which can persist stubbornly even under drug treatment.

The circling electrical signals do not allow the atria to fill up completely with blood. Therefore, the amount of blood ejected from the heart is also reduced. If the heart is already weakened, less blood will be pumped. The blood pressure drops.

What is atrial flutter?

Another form of arrhythmia also originates from the atria and is treated similarly, but has a different cause. Read more in the article Atrial Fluttering.

Atrial fibrillation: symptoms

Atrial fibrillation is often symptomless. Many of those affected feel nothing or only a small performance kink from a seizure-like atrial fibrillation. The rest, however, suffers from unpleasant symptoms such as palpitations, dizziness, shortness of breath, pain in the chest or feelings of anxiety.

The symptoms depend on the speed of the heartbeat. If the heart beats normally fast despite the atrial fibrillation, those affected may feel only tiredness and dizziness. If the heart beats too fast (often over 100 beats per minute), those affected usually feel an unpleasant palpitation, often chest pains and shortness of breath. If the heart beats too slowly, they are dizzy or even faint.

If the atrial fibrillation becomes chronic, the organism can “get used to” the arrhythmia and sufferers no longer have any pronounced symptoms.

Atrial fibrillation: cause and risk factors

Atrial fibrillation usually develops in old age. However, why it arises is not fully understood. Since the heart structure changes in age and the heart tissue increasingly scarred, electrical signals in the forecourt are incorrectly forwarded. As a result, the signals circulate through the atrial tissue and interfere with normal cardiac activity.

There are several risk factors that can promote atrial fibrillation. Many chronic diseases are included. Long-standing hypertension, heart disease, diabetes mellitus, thyroid and lung diseases, sleep apnea syndrome or kidney disease can lead to long-term atrial fibrillation. Researchers found that the risk of atrial fibrillation also has a genetic component. Sometimes, however, the arrhythmia develops without any apparent cause.

Atrial fibrillation: diagnosis and examination

The specialist for atrial fibrillation is a cardiologist. First, the doctor will ask about the medical history. Of importance are the following questions:

• How often and how long do you feel tachycardia?
• Do certain factors such as alcohol consumption, sleep deficit or surgery trigger the tachycardia?
• Do you suffer from a heart or thyroid disease?
• Do you have more discomfort during the heart’s ailment?
• Is there atrial fibrillation in your family?

This is followed by a physical examination and a pulse and blood pressure control.

Electrocardiogram (ECG)

The most important examination to diagnose atrial fibrillation is the electrocardiogram (ECG). Here, the electrical heart currents are measured via electrodes that are glued to the chest. Sometimes an ECG needs to be written over several days. For this purpose, small ECG devices are available, which are hung around the neck. The ECG can also be recorded during physical activity. The patients have to burden themselves on a kind of exercise bike.

echocardiography

By an ultrasound examination of the heart (echocardiography) its structure and pumping behavior can be examined. Especially if atrial fibrillation has been diagnosed, it is important to look for blood clots in the heart.

In order to examine the atria in more detail and to detect any blood clots, the ultrasound head is introduced with a tube into the esophagus like a gastroscopy. Approximately in the middle of the esophagus, the right atrium is very close to the ultrasound head. He can be judged very well from this position. This study is called transesophageal echocardiography. It is usually performed under a light anesthetic.

Atrial fibrillation: treatment

If the atrial fibrillation has developed as a result of another disease such as hyperthyroidism, it must first be treated. In many cases, the arrhythmia then improves by itself.

If the atrial fibrillation has occurred seizure, it often disappears by itself in a few hours or days. Patients who have already been diagnosed with atrial fibrillation are usually prescribed a drug by the doctor, which they must take as soon as the atrial fibrillation recurs. Through this drug, the heart rhythm usually “jumps” back into normal rhythm.

The so-called antiarrhythmic drugs are indeed very effective, but often have not insignificant side effects. When overdosed, the heart sometimes beats so slowly that patients experience severe dizziness or tiredness.

If the tachycardic attacks are very common or very uncomfortable, you can take other medicines to prevent it from the outset. Again, dizziness, but also depression can occur as side effects.

Since the risk of stroke is increased by very frequent or persistent atrial fibrillation, in many cases a concomitant medication must be taken, which dilutes the blood.

cardioversion

Sometimes the atrial fibrillation is very persistent and does not pass either by itself or under medical therapy. The heart rhythm can then be normalized by electrical currents from the outside. This therapeutic measure is called cardioversion.

Electrocardioversion works in a similar way to a resuscitation defibrillation. First, the patient is connected to various monitoring devices to monitor blood pressure and oxygenation. Thereafter, the patient is anesthetized for a short time and conducts current into his heart via two electrodes for a fraction of a second. The pulse often causes the heart to fall back into its normal rhythm. Patients who have paroxysmal atrial fibrillation can be treated with electrical cardioversion instead of medication.

pulmonary vein isolation

By a so-called Pulmonalvenenisolation many patients can be cured of atrial fibrillation. In the process, the regions of the heart that trigger the atrial fibrillation become desolate. First, a wire (catheter) is guided via the inguinal veins into the heart. Since the atrial fibrillation often arises in the area in which the pulmonary veins (pulmonary veins) flow into the heart, the tissue is deserted there. The chance of recovery in this procedure is 60 to 80 percent.

Pacemaker implantation

Patients who experience a slow heartbeat sometimes need to be treated with pacemaker implantation. The pacemaker makes for a faster and more stable heartbeat.

Protection against stroke

If people suffer from paroxysmal or chronic atrial fibrillation, there is a risk of blood clots forming in the atrium that can trigger a stroke. Since the blood in the atrium due to the arrhythmia no longer circulates properly, it can “clump”. The blood clots can pass through the heart into the bloodstream and from there into the cerebral vessels.

When a cerebral vasculature is blocked, it is called a stroke. Taking blood-thinning medications can reduce the risk of stroke. However, bleeding complications may occur.

A newer method of protection against stroke is the occlusion of the so-called atrial appendage. The atrial appendage is an auricular outgrowth in which the clots are particularly common.

Atrial fibrillation: disease course and prognosis

Even after a successful therapy, it is always possible that atrial fibrillation occurs again. Relapses are common, especially in people with heart disease.

Paroxysmal atrial fibrillation may develop into a permanent atrial fibrillation untreated over time. The longer the arrhythmia, the more difficult it is to treat it. However, if it has been caused by other illnesses, such as hyperthyroidism, the arrhythmia after treatment often disappears on its own.

The prognosis of atrial fibrillation is determined especially by concomitant heart disease. If the heart is already weakened, the atrial fibrillation can significantly increase mortality. The increased risk of stroke can be well controlled with anticoagulant drugs. Especially in old people, the risk of overdose is high, since their liver is not working so well, they sometimes have to take many other drugs, drink too little or fall more frequently. In these cases, one sometimes has to discourage anticoagulant medication.

Although it is not possible to prevent the atrial fibrillation itself, it does prevent the diseases that cause it. Eating a healthy diet, exercising regularly and abstaining from luxury foods reduces the risk of coronary heart disease – the main cause of atrial fibrillation.