Atrial fibrillation - Causes, symptoms and treatment. MF.

Fibrillation is a rapid irregular atrial contraction, in which the frequency of their contractions exceeds 350 per minute. The appearance of fibrillation is characterized by irregular contraction of the ventricles. Atrial fibrillation is one of the types of supraventricular tachyarrhythmia( atrial fibrillation).If the contraction of myocardial fibers occurs at a slower rate of 200-400 bpm, this type of atrial fibrillation is called atrial flutter.

Atrial fibrillation is one of the complications of coronary heart disease( CHD) along with other disorders of the heart rhythm. This is one of the most common heart rhythm disturbances. In addition to IHD, the cause of atrial fibrillation may be thyroid disease, accompanied by its increased function and rheumatism( not to be confused with lower back pain - this is not rheumatism).

Atrial fibrillation occurs in two main forms. This is a temporary or paroxysmal and permanent or chronic form.

Symptoms of atrial fibrillation are the same as in other arrhythmias:

• a feeling of heart failure;
• sensation of "bubbling" in the chest;
• syncope possible;
• darkening in the eyes.

Of the complications of fibrillation, strokes and gangrene can be identified as a result of thrombosis of the arteries. Most people with atrial fibrillation( especially if the duration of atrial fibrillation exceeds 48 hours) have an increased risk of developing blood clots, which, due to their mobility, can contribute to the development of a stroke. Blood clots form because the blood "whips" like in a mixer because of a chaotic contraction of the atrium walls. Then the thrombus sticks to the inner wall of the atria.

If you take the appropriate drugs, the risk of thrombosis decreases dramatically. Therefore, regular intake of drugs prescribed by a doctor will help prevent complications, improve the quality and duration of your life.

Transition of the paroxysmal form of atrial fibrillation into a permanent form can promote the development or progression of chronic heart failure.

Symptoms of Atrial Fibrillation

Atrial fibrillation is the most common form of supraventricular arrhythmia, in which the atria contract chaotically at a frequency of usually 400-600 per minute without coordination with the ventricles of the heart. The role of the frequency filter performed to the ventricles of the pulses is performed by the AV node( normally the atrioventricular node is able to hold up to 140-200 pulses per minute).Therefore, with atrial fibrillation, only a fraction of the impulses reach the ventricles, while their contraction occurs irregularly, resembling fibrillation( hence the name atrial fibrillation).The sinus node at the same time loses its function as a pacemaker.

The appearance of fibrillation is accompanied by a sharp increase in the heart rate, which can be accompanied by a sudden palpitation, cardiac disruptions, general weakness, lack of air, shortness of breath, a sense of fear, and chest pains. Sometimes this attack passes quickly( within a few seconds or minutes), without taking medication or other medical measures. However, very often heart palpitations do not pass by themselves, can last long enough( hours, days) and require treatment for medical help.

Risk of development of atrial fibrillation

• Age. With age, electrical and structural changes in the atria can occur, which contributes to the development of atrial fibrillation.
• Organic heart disease, including heart disease, surgery on the open heart, increases the risk of developing atrial fibrillation.
• Other chronic diseases. Diseases of the thyroid gland, arterial hypertension and other pathologies can promote atrial fibrillation.
• Alcohol is a known "starter" of attacks of atrial fibrillation.

Diagnosis of atrial fibrillation

1. Registration of an electrocardiogram.
2. Holter monitoring is a round-the-clock recording of an electrocardiogram in the usual mode of the patient's life.
3. Recording of paroxysms of atrial fibrillation in on-line mode( real time) - a kind of Holter monitoring is a portable device that allows to transmit on the phone electrocardiogram signals at the time of an attack.

Treatment of atrial fibrillation

Atrial fibrillation can wear paroxysmal( paroxysmal) and permanent character.

If we are dealing with an attack of atrial fibrillation, it should be attempted to stop( especially if this is the first occurrence of arrhythmia in your life).

If you have a permanent form of atrial fibrillation, you need constant medication to control heart rate and prevent stroke.

What are the methods for stopping atrial fibrillation?

The most effective drugs for stopping attacks of atrial fibrillation are Novokainamide( inside and intravenously) and quinidine( inside).The use of them is possible only according to the doctor's prescription under the control of the electrocardiogram and the level of arterial pressure. Cordarone( inside and intravenously) and Propanorm( inside) are also used.

The use of Anaprilin, Digoxin and Verapamil for relief of atrial fibrillation is less effective, but by reducing the heart rate, they improve the health of patients( reduction of dyspnea, general weakness, palpitation).

The most effective method of arresting atrial fibrillation is electrical cardioversion( about 90%).However, due to the need for short-term general anesthesia( anesthesia), it is resorted to when the patient's condition worsens against the background of arrhythmia progressively, the positive effect of drug therapy is absent or not expected( for example, because of the duration of the arrhythmia).

ATTENTION!If you develop an attack of atrial fibrillation, seek medical help urgently, since it is advisable to stop this arrhythmia within the next 48 hours( !).After this period, there is a sharp increase in the risk of intracardiac blood clots and related complications( stroke). Therefore, if atrial fibrillation lasts more than two days, it is necessary to take Warfarin( to reduce blood clotting) for 3-4 weeks and only then you can try to stop it. If successful outcome, taking Warfarin should be continued for another 4 weeks, while maintaining atrial fibrillation, it will have to be taken continuously.

After successful recovery of sinus rhythm, antiarrhythmic drugs are usually prescribed( Allapinin, Propanorm, Sotalex, Kordaron) to prevent repeated attacks of atrial fibrillation.

What kind of treatment is carried out with a permanent form of atrial fibrillation?

If you have established a permanent form atrial fibrillation ( that is, all attempts at arresting the arrhythmia were unsuccessful) it is important to perform two tasks: to control the heart rate( approximately 70-80 beats per minute at rest) and prevent the formation of thrombi. The first task will help to decide the constant intake of Digoxin, adrenoblockers( Egilok, Atenolol, Concor), calcium antagonists( Verapamil, Diltiazem) or their combination. The second solution ensures a constant intake of Warfarin under the control of the state of the blood coagulation system( prothrombin index or INR).

Are there methods for the radical elimination of atrial fibrillation( atrial fibrillation)?

The only method of radical elimination of atrial fibrillation is radiofrequency isolation of pulmonary veins. Due to complexity and high cost, this catheter operation is still conducted only in large federal centers. Its efficiency is 50-70%.

Also, with frequent paroxysms of atrial fibrillation and a permanent form of atrial fibrillation, it is possible to carry out RF-ablation of the AV node, at which an artificial complete transverse blockade( AV-blockade of the third degree) is created and a permanent pacemaker is implanted. In fact, atrial fibrillation remains, but the person does not feel it.

Atrial fibrillation is not associated with a high risk of sudden death, so it is not considered a fatal rhythm disorder, such as ventricular arrhythmias.