Atrial fibrillation

Atrial fibrillation (AF) is defined as an irregular and accelerated heartbeat that results in reduced blood flow to the body.

The disturbance of the heart rhythm causes a cardiac arrhythmia at the level of the sinus node.
In atrial fibrillation, the atria lose their physiological rhythm.
The atria pump with an abnormal rhythm and thus also cause an irregularity of the heart chambers (ventricles). The abnormal heart rhythm is called arrhythmia.
Treatment of this condition depends on the patient’s state of health and other underlying causes.
The heart begins to pump a small amount of blood faster.
This leads to arterial hypertension.
AF can also occur with cardiac ischemia such as angina pectoris or myocardial infarction.

There are similar cardiac disorders, for example:

1. Atrial flutter, which is similar to atrial fibrillation and also causes irregular heartbeats and tachycardia, but is less serious.
2. Extrasystoles are premature heart contractions that alter the heart rhythm.

Classification

There are three types of atrial fibrillation:

►Chronic or permanent atrial fibrillation: it is always present.
►Persistent atrial fibrillation: The normal heart rhythm lasts only a short time. ►Paroxysmal atrial fibrillation: The heart rhythm is normal, but there are occasional fibrillation episodes.

Valvular fibrillation is caused by a rheumatic disease of the heart valve (for example, mitral valve stenosis) or by a valve prosthesis.
In the other cases, atrial fibrillation is called non-valvular.

Neurogenic atrial fibrillation can:

1. be of vagal origin if it occurs at night, at rest, after eating, etc.; this type of AF is preceded by bradycardia (slow heartbeat);
2. be of adrenergic origin if it occurs during the day after severe emotional stress.

Some people with atrial fibrillation have no defects or damage to the heart: it is a condition called lone atrial fibrillation or idiopathic fibrillation. With Lone Atrial Fibrillation, the cause is unclear and serious complications are rare.

One speaks of isolated atrial fibrillation when there is no heart disease that causes this disorder.

Symptoms of atrial fibrillation

Often atrial fibrillation is asymptomatic or silent; If symptoms occur, you may feel the following symptoms:

1. Weakness
2. Palpitation
3. Shortness of breath
4. Chest pain
5. Vertigo
6. Fainting (syncope)

The main symptoms are palpitations. There are cases when the person feels energetic, very strong heartbeats. This feeling of “strength or energy” during the heartbeat is called palpitation.

The normal heart rate is 60-70 heartbeats per minute. If the person has persistent atrial fibrillation, the pulse beats can be up to 175 beats per minute.

Causes of atrial fibrillation

Abnormalities or damage to the heart structure are the most common causes of atrial fibrillation.
Other possible causes include:

• High blood pressure
• Heart attack
• Abnormal heart valves
• Congenital heart defects
• Overactive thyroid gland (hyperthyroidism) or other metabolic imbalance
• Sinus node syndrome: malfunction of the natural pacemaker
• Dilated cardiomyopathy
• Hypertrophic cardiomyopathy
• Emphysema or other lung diseases
• Pulmonary embolism
• Cardiac surgery

Scientific studies show that middle-aged people who exercise intensively and for long periods of time are at greater risk for AF than other people with a sedentary lifestyle.

Risk factors

• Viral infections
• Anxiety and stress
• Infection with Helicobacter pylori
• Hiatal hernia (diaphragmatic hernia)
• Some medications, caffeine, smoking, or alcohol are the most common causes of atrial fibrillation
• Overweight
• Sleep apnea

The risk factors for atrial fibrillation include:

1. Age: The higher the age, the greater the risk of atrial fibrillation.
2. Heart disease: Valvular problems, infarction or heart surgery are examples of diseases that increase the risk of atrial fibrillation.
3. Hypertension: High arterial blood pressure increases the likelihood.
4. Other chronic conditions: Thyroid problems, sleep apnea, and other medical problems are an indication of the more likely development of AF.
5. Alcohol consumption: Alcohol can lead to an episode of atrial fibrillation. Excessive drinking (five cocktails in two hours for men or four drinks for women) can trigger flicker.
6. Family disposition: Atrial fibrillation has a strong genetic component.

Atrial fibrillation – examinations and tests

The electrocardiogram (ECG) is the best way to diagnose atrial fibrillation. In most cases, the anamnesis and the physical examination take place at the same time.
If the doctor suspects atrial fibrillation that occasionally occurs, he can use a device to record the heart rhythm over a longer period of time. This examination has various names, including ambulatory electrocardiogram, outpatient ECG, Holter ECG, 24-hour ECG and monitoring of cardiac events.
Also, to check the effectiveness of a drug, the doctor could use such a device.

Other tests
Other tests the doctor may recommend include:

• Electrophysiological study (EP study). This examination helps the doctor diagnose arrhythmias of the heart and draw up a treatment plan.
• Load EKG. This examination shows the doctor whether coronary heart disease is present.
• Echocardiogram (UKG). This examination shows whether the heart valves are damaged and whether the patient suffers from heart failure or has had a heart attack.
• Blood test in case of hyperthyroidism (hyperthyroidism).
  If an anticoagulant such as warfarin (for example, Coumadin) is taken, a regular blood test must be done to check the clotting time.
  Oral anticoagulants are contraindicated during the first trimester of pregnancy because they have a teratogenic effect, i.e. can lead to malformations in the child.

Therapy for atrial fibrillation (AF)

Guidelines

Sometimes patients show no symptoms or complications due to AF. This is the case in very old people who are less active, so atrial fibrillation is also called benign.
Treatment for atrial fibrillation is necessary because it can lead to blood clots.
These blood clots lead to complications such as stroke, cardiomyopathy, pulmonary embolism and heart failure.

Drug therapy
The doctor prescribes blood thinners to prevent the formation of blood clots.
Along with these medications, the doctor may recommend a medicine for atrial fibrillation. These drugs prevent atrial fibrillation and help control heart rate during an attack. Antiarrhythmics such as propafenone, sotalol, amiodarone (Cornaron), and flecainide are used to prevent AF.
Beta-blockers such as propranolol, atenolol, metoprolol and verapamil control the heartbeat during an attack.
It should not be forgotten that these drugs have side effects and that the listed active ingredients only help to control the symptoms and not to treat the condition. If the patient stops taking the medication, atrial fibrillation may recur.

When to use anticoagulants?
The risk of stroke is increased in patients over 75 years of age and associated with other conditions, including:

1. Diabetes
2. Hypertension
3. Valvular heart disease
4. Previous infarction or stroke
5. Decreased ventricular performance
6. Other vascular diseases

In these cases, the doctor prescribes therapy with anticoagulants.

There are scientific studies on the use of magnesium for atrial fibrillation that show no improvement.

Electrical cardioversion
The procedure consists of sending an electric shock to the chest wall. This shock serves to resume normal heart rhythm.

This procedure is used if the patient has been affected by this disease for several months.
The person must be on anticoagulant therapy in order for electrical cardioversion to be performed.
If blood clots have formed, they can detach and flow with the bloodstream.
The coaguls can be carried to the brain, in which case the result would be a stroke.
Before cardioversion, the doctor can wait up to 4 weeks after the prescription for warfarin (Coumadin) is issued.

Ablation of the atrioventricular node (AV node)
A solution to the problem is ablation of the atrioventricular node, when the patient complains of the following symptoms:

1. Shortness
2. Vertigo
3. Stress intolerance

This procedure is necessary in patients who have not shown improvement under medication. A catheter is inserted into an inguinal vein up to the level of the AV node in the heart.
A high-frequency current is passed through the catheter, which serves to destroy the AV node.
The irregular heartbeats are now completely switched off.
This procedure causes heart pulsations that drop up to 30 beats per minute. The patient is then given a heart stimulator (pacemaker) to maintain the normal heart rhythm.

Pacemaker
An electronic device is implanted under the skin on the upper thorax: the pacemaker. This device is connected with two wires that are inserted into a vein. The device is positioned directly above the heart and sends electrical impulses to the heart from time to time. The pacemaker works with a battery that has a lifespan of about 6 years. The success rate of a pacemaker is 99%.
This application is very helpful in reducing the symptoms of chronic atrial fibrillation with decreased ventricular frequency (i.e. bradycardia).

Open-heart
surgery Open-heart surgery may be needed to treat atrial fibrillation.
The surgeon makes a breast incision and reaches the heart through the lower end of the sternum.
After creating an operating field through various incisions, tissue icing and cauterization, the doctor “fixes” the atrial fibrillation. This procedure leads to the cure of the patients in 90% of cases.

Nutrition and diet

It is recommended to avoid salted foods, as they are contraindicated in case of hypertension (high blood pressure) or cardiac decompensation.
Anticoagulants, which the patient usually takes, may interfere with some foods and drinks:

1. Lettuce
2. Broccoli
3. Asparagus
4. Cooked ham
5. Pumpkin seed oil
6. Black tea

Prognosis and life expectancy

The Framingham Heart Study has shown that people with atrial fibrillation have a 1.5 to 1.9 times higher risk of death than people without atrial fibrillation.

The risk of ischemic stroke (due to a clot) is 5 times greater in individuals with atrial fibrillation and represents 15% of all strokes in the United States.
More than 2.3 million people in the U.S. suffer from atrial fibrillation, half of whom are older than 80. Only 0.1% of people under the age of 50 have atrial fibrillation.
The risk of sudden death from heart disease is three times higher in people with atrial fibrillation.

• Extrasystoles
• Lumba: causes, symptoms and therapy
• Arrhythmia