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Atrial fibrillation: causes, symptoms, and treatments

In atrial fibrillation, the signals dictated by the heartbeat are altered. The heart beats irregularly and often too fast. Then it cannot pump as much blood to the body. This can lead to noticeable symptoms such as palpitations or fatigue.

The atrial fibrillation is often the result of other chronic disease, such as coronary heart disease or hypertension. Sometimes the cause remains unclear.

Atrial fibrillation is the most common form of cardiac arrhythmia. While it is not life threatening, it increases the risk of stroke and can permanently weaken the heart.

There are several ways to alleviate this discomfort and reduce the risk of stroke. Most people can lead normal lives despite atrial fibrillation.

Symptoms of atrial fibrillation

The most common symptom of atrial fibrillation clearly named in palpitations and pounding of the heart.

Because the pulse generally beats faster and more irregularly than normal - while a healthy resting heart rate is typically between 60 and 100 beats per minute, it can be significantly higher in atrial fibrillation.

Other symptoms include: weakness, drowsiness, and dizziness. However, there are times when atrial fibrillation is not felt at all - up to 30 out of 100 people have no clear symptoms or only have non-specific symptoms that do not directly indicate atrial fibrillation.

In people who have other heart conditions, more discomfort can be added.

For example, in heart failure, atrial fibrillation can dramatically reduce cardiac output and cause discomfort, such as shortness of breath and fatigue, especially during exercise.

Main causes

The heart is a muscle that contracts rhythmically. The heartbeat is regulated by a power line system. The impulse for the heartbeat arises in the so-called sinus node, a collection of special cells in the wall of the right atrium.

The sinus node is sometimes called a "natural pacemaker." This emits electrical signals, which are sent through conduction pathways to the so-called atrioventricular node (AV node).

Signals from the sinus node are sent to the chambers of the heart through the AV node. Normal heart rhythm is also known as sinus rhythm.

In people with atrial fibrillation, the irregular electrical impulses travel very quickly in the atria of the heart.

The sinus node is inactive during palpitation. As a result, the atria no longer contract and relax at a regular rate, but instead quiver rapidly and uncontrollably.

Normally, the atria help fill the chambers of the heart quickly with blood. They contribute about 20% to the pumping power of the heart. During atrial fibrillation, the heart's performance slows - but the ventricles continue to pump blood to the body, albeit irregularly.

Atrial fibrillation can have several causes. The most common triggers include:

·       Hypertension.

·       Coronary heart disease.

·       Heart attack.

·       Heart failure (can also be the result of atrial fibrillation).

·       Valvular heart disease.

Other possible causes include an overactive thyroid and certain medications. In about a third of those affected, the trigger remains unknown.

Risk factor's

The probability of developing atrial fibrillation increases mainly with age. It is estimated that around 2% of the total population and around 7% of those over 65 are affected by it.

Risk factors that may partially influence include excessive or frequent alcohol consumption, smoking, diabetes mellitus, high blood pressure, obesity, and pauses in breathing at night (sleep apnea).

How does this disease develop?

Atrial fibrillation usually begins with rare, short episodes and can progress to longer episodes or permanent atrial fibrillation over time. Depending on the duration of the episode, there are four different types:

·       In paroxysmal, atrial fibrillation usually returns to normal in about 48 hours without treatment and can also last up to seven days. The paroxysmal atrial fibrillation may occur once, but may also be repeated on future occasions and then last longer.

·       The fibrillation persistent atrial long - term persists for more than a year.

·       Finally, the most persistent is permanent atrial fibrillation.

However, the importance of this classification is limited: it is often unclear whether atrial fibrillation has already occurred or how long it has been. Additionally, persistent atrial fibrillation can also regress and reappear as an attack.

Importantly, all the different types of atrial fibrillation increase the risk of stroke. Therefore, ranking in the decision for or against anticoagulant drug treatment plays only a minor role currently.

Dangers of auticular fibrillation

Atrial fibrillation can produce some notable discomfort, but on the other hand it is also in most cases an imminent danger to life. In the long term, however, it can lead to various complications, in particular:

Heart failure: This causes the heart to beat faster and the atria do not contract properly, so the rest of the heart has to do more work. In the long run, this can overwhelm and weaken the heart. An existing heart failure can get worse.

Stroke - When someone has atrial fibrillation, the heart's atria no longer empty completely. As a result, blood in the atria can accumulate and form clots, especially in the left atrium, more precisely in the atrial ear.

When a blood clot travels to the brain through the bloodstream, it can close a vessel and cause a stroke.

The level of personal risk of stroke depends on whether there are other risk factors besides atrial fibrillation. Many people with this condition have other conditions, such as high blood pressure or coronary heart disease.

How is it diagnosed?

Because atrial fibrillation does not always cause discomfort, it is sometimes detected by chance, for example, when investigating cardiac currents due to another condition.

To make an accurate diagnosis, find possible causes, and plan treatment, a series of investigations can help:

1.    Record of medical history: The doctor asks for previous complaints, pre-existing conditions, age and family history, as well as risk factors for heart disease.

2.    Physical exam: This includes, among other things, heart rate and blood pressure measurement.

3.    Electrocardiogram (ECG): An ECG graphically shows the electrical cardiac currents that regulate the heartbeat. The ECG can be used to detect atrial fibrillation with great certainty. To detect currents in the heart, several electrodes are attached to the body.

The exam itself usually takes no more than ten minutes. If atrial fibrillation is suspected despite the normal ECG, a 24- or 48-hour ECG can also be performed. To do this, a small ECG device is hung that records the heart rhythm for a day or two.

If cardiac currents need to be recorded for even a few months, an implantable ECG recorder can be placed under the skin of the breast, which is about the size of a USB stick.

4.    Blood tests: Among other things, thyroid function can be evaluated with a blood test. Hyperthyroidism or a high dose of thyroid medications can be the cause of atrial fibrillation. Electrolyte levels are also taken into account because atrial fibrillation can sometimes be associated with disturbances in electrolyte balance.

5.    Echocardiography: Echocardiography is an ultrasound of the heart. It is used, for example, to test your pumping power and to find rarer causes of atrial fibrillation, such as certain diseases of the heart valves.

Certain tests are particularly useful in planning treatment: levels of kidney and liver function are important because not all drugs are suitable for kidney or liver failure.

How to treat atrial fibrillation

Anyone who is diagnosed with atrial fibrillation is faced with several treatment decisions. On the one hand, the question arises as to how altered heartbeat should be treated.

The most important goal is to keep the pulse (medically called: heart rate) under control to relieve symptoms and ease the heart. You can also try to restore a normal heart rhythm (sinus rhythm). Consequently, there are two treatment strategies:

1. Check the heart rate

In the case of heart rate control treatment, the excessively high heart rate is permanently reduced with the use of medication, usually one of the beta blockers.

The pulse corresponds to the number of heart beats per minute (heart rate) and is measured at rest. Heart rate control treatment does not attempt to eliminate atrial fibrillation.

2. Stabilization of the heart rate

In heart rhythm stabilization treatment, an attempt is made to restore sinus rhythm and, if possible, maintain it. Sinus rhythm is usually restored by a measured electrical shock.

Treatment is usually carried out together with medications to prevent a relapse. Although the heart rate can be normalized with this treatment, many people still need a low-dose beta blocker to slow their heart rate.

Most heart rate control treatments are preferred because they are less complicated and have a lower risk of side effects. Heart rate stabilizing therapy is especially helpful if heart rate control therapy does not relieve symptoms sufficiently.

Medicines

The other question is whether you want to take medications to reduce your risk of stroke, and if so, which ones. So-called oral anticoagulants inhibit blood clotting and can reduce this risk very effectively.

The decision for or against anticoagulant treatment is best made with the doctor. It makes sense to weigh the pros (preventing strokes) and the cons (risk of bleeding) against each other. Personal risk factors can be used to determine personal risk for stroke and bleeding. Special risk calculators help.

Sometimes, despite a high risk of stroke, there are strong reasons against anticoagulant treatment, for example a very high risk of bleeding. On the other hand, you can try to reduce your risk of stroke with heart surgery. In this surgery, the so-called percutaneous closure of the left atrial appendage is carried out. However, the treatment methods used for this have not yet been tested enough and can have serious complications.

In rare cases, atrial fibrillation itself can become threatening and, for example, cause blood pressure to drop sharply. On the other hand, the heart rate is usually quickly restored by measured electrical shocks.

Sometimes atrial fibrillation is due to a treatable cause, such as a leaky heart valve or hyperthyroidism. Atrial fibrillation can then be treated through a heart valve operation or the treatment of possible hyperthyroidism.

How to live with this condition on a day-to-day basis

When your heart beats normally, you don't feel it. This can change with atrial fibrillation: the heart is clearly not beating as it should. This is so disturbing to many people who go to the doctor.

The diagnosis of atrial fibrillation is initially shock, but symptoms can usually be well controlled with various treatments. Trained people also provide assistance: they give information on how to treat the disease in everyday life and how to adapt the medication successfully.

However, many people remain insecure. Some wonder if they should take care of themselves or if they can continue to do their normal activities and play sports. Research says none of this should be a cause for concern. They suggest that moderate physical activity is not harmful to someone with atrial fibrillation and can improve fitness.

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