Atrial Fibrillation

Innocent phenomenon or dangerous if neglected?

The heart works like a well-tuned clock with its rhythm normally varying in an adult when it is at rest from 60 to 100 beats per minute. However, this orderly function can be disturbed for various reasons and cardiac disorders can occur. rhythm, the so-called arrhythmias. Some of them are completely innocent, but some can be very serious and possibly fatal. The presence of atrial fibrillation does not necessarily mean the existence of organic heart disease

The most common arrhythmia and why it concerns us so much?

One of the most frequent and important forms of arrhythmia is atrial fibrillation. The current estimate of the incidence of atrial fibrillation in the developed world is approximately 1.5-2% in the general population, according to estimates by the European Society of Cardiology. The average age at which the majority of this arrhythmia occurs is 75 to 85 years. Atrial fibrillation is associated with a fivefold higher risk of stroke and a threefold increased incidence of congestive heart failure and greater overall mortality. Hospitalizations of patients with atrial fibrillation are generally common. Atrial fibrillation is a challenge for Cardiologists and at the same time creates a great social and economic problem in the states, while the predictions for the future are ominous. Fortunately, new treatment techniques give a note of optimism in the management of this arrhythmia.

Forms

A. Paroxysmal. It lasts less than 1 week (usually <48 hours) and resolves on its own.

B. I persisted. Lasts more than 1 week.

C. Chronically Persistent ( > 1 year).

D. Permanent

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High risk groups

Apart from the elderly, other people who have a greater risk than the general population of having atrial fibrillation are, in principle, people who have a problem with their heart. The most common problems that cause atrial fibrillation are heart failure, coronary artery disease, high blood pressure, valvular diseases (mainly mitral valve diseases) and cardiomyopathies. This category also includes people who have supplementary bundles, i.e. who were born with a problem in the system of producing and conducting the electrical stimulus in the heart.

But it can  to have extracardiac causes.

In other words, it is possible for someone to have atrial fibrillation without having a heart problem but due to other health problems such as hyperthyroidism, lung diseases and infections.

There are also cases of atrial fibrillation in which neither a heart problem nor any other health problem is found. In these cases we speak of lone atrial fibrillation.

Finally, one can get atrial fibrillation from the consumption of caffeine, alcoholic beverages and even drugs.

Patients should therefore not forget that the presence of atrial fibrillation does not necessarily mean the presence of organic heart disease.

A "flutter" in  chest the most common symptom

Some people may have atrial fibrillation and not feel anything. In symptomatic patients, a flutter in the chest is most common.

When atrial fibrillation results in a high heart rate, i.e. very high pulses, especially in those cases where the patient has an organic heart problem, it can manifest itself with shortness of breath, chest pain, dizziness and general malaise. These symptoms are more common in the elderly and those with heart disease.

Doctor visit

 Anyone experiencing the above-mentioned symptoms should see a doctor because the arrhythmia may be a manifestation of heart or other disease

He also points out that there are cases of many patients who accidentally discover this arrhythmia, with a classic example being those who measure their blood pressure with an electronic sphygmomanometer and see elevated and abnormal pulses. In these cases they are worried, they resort to the doctor to get a cardiogram - and they do well - and they discover atrial fibrillation.

However, atrial fibrillation is usually not serious, so patients who discover it for the first time should not panic.

It is extremely rare that atrial fibrillation causes severe symptoms and can lead to death.

Let's not forget that according to the guidelines of the European cardiology society, an electrocardiogram is indicated for all people over 65 years of age.

The exams that must be done

The investigation of atrial fibrillation should begin with the clinical cardiological examination. Then a simple cardiogram should be done which usually establishes the diagnosis.

When it is a permanent chronic condition with a simple cardiogram you diagnose it. The problem is the paroxysmal forms of atrial fibrillation where it may be necessary to place a holter rhythm, i.e. a recorder of the electrocardiogram for one or more 24 hours.

Another examination that must be performed is the echocardiogram.

In addition, blood tests should be performed, including tests for the thyroid (thyroid hormone control) and electrolytes (K, Na).

Of course, people who are likely to have coronary heart disease, if nothing is found in the previous tests, functional tests should be done, e.g. fatigue test, myocardial scintigraphy, etc.

Basic directions of treatment

A key element in the treatment of atrial fibrillation is the control of the heart rate. It's different for someone to have atrial fibrillation and have 160 beats per minute, so they can't stand and have problems, and to have 70 beats. It is important in cases where this is possible to restore the normal rhythm of the heart called sinus rhythm.

In addition, treatment should aim to prevent recurrence of the episode. In other words, medication or other actions should be taken as a precaution so that the condition does not reoccur.

Last but not least, people with permanent or recurrent atrial fibrillation should be given anticoagulants to prevent a possible stroke.

The success of treating Atrial Fibrillation often depends on its etiology.

Medicines

Science today has many drugs for Atrial Fibrillation. So there are bradycardia drugs (β-blockers, bradycardia calcium (Ca) antagonists, and digitalis) used to control the heart rate. There are also drugs used to reverse the arrhythmia (ie restore the heart's normal rhythm).

The most commonly used are amiodarone, sotalol, propafenone and ibutilide, some of which are given chronically and to prevent recurrence of seizures.

And of course there are also anticoagulant drugs (coumarin and newer) which are given to patients who have the indications for the prevention of embolic episodes.

When is invasive treatment needed?

In those cases where drugs cannot restore the normal rhythm, it may be necessary to perform synchronized electrical defibrillation, which of course is done in hospitals.

In cases of patients who show very frequent relapses that cannot be prevented with drugs, a special operation called ablation (cauterization) of the ectopic foci that trigger the creation of Atrial Fibrillation can be performed in the Electrophysiological Laboratory.

 It is a method that is not completely simple, it is done in specialized centers abroad as well as in Greece, and its chances of success reach 70-90%".

Helpful lifestyle changes

Those experiencing atrial fibrillation should:

· stop smoking

· limit or even stop the consumption of coffee, tea, cola-type soft drinks that contain caffeine

· limit alcohol consumption

· be careful and consult their doctor before taking any medicine as some medicines affect the heart rate.

Sources: European Society of Cardiology, Hellenic Society of Cardiology.

MD, MSc Galitsianos Ioannis

CARDIOLOGY SPECIALIST

Cardiologist at Transbalkanic Medical Center of Thessaloniki

Scientific Associate of the 1st Cardiology University Clinic G.N.TH A.X.E.P.A.

Master's Degree in Clinical Pharmacology & Therapeutics

Retrained in Emergency Pre-Hospital Medicine of EKAV

Private Practice at Makedonamachon 21-Asvestochori, Thessaloniki

tel: 2315522542

email: igalitsi@yahoo.gr