Atrial fibrillation and atrial fibrillation. Treatment of atrial fibrillation

One of the most common rhythm disorders is atrial fibrillation, in particular atrial fibrillation (AF).

Despite the fact that many patients live with this condition for many years and do not experience any subjective sensations, it can provoke such serious complications as tachyform fibrillation and thromboembolic syndrome.

The disease is treatable; several classes of antiarrhythmic drugs have been developed that are suitable for continuous use and rapid relief of a sudden attack.

Atrial fibrillation is the name given to uncoordinated excitation of atrial myocardial fibers. with a frequency of 350 to 600 per minute. In this case, a full atrial contraction does not occur.

The atrioventricular junction normally blocks excessive atrial activity and transmits a normal number of impulses to the ventricles. However, sometimes there is rapid contraction of the ventricles, perceived as tachycardia.

In the pathogenesis of AF, the main role is played by the micro-re-entry mechanism. The tachyform of the disease significantly reduces cardiac output, causing circulatory failure in the pulmonary and systemic circles.

Why is atrial fibrillation dangerous? Irregularity of atrial contractions dangerous due to the formation of blood clots, especially in the atrial appendages, and their separation.

Prevalence

The prevalence of atrial fibrillation is 0.4%. Among the group under 40 years old this figure is 0.1%, over 60 years old – up to 4%.

It is known that in patients over the age of 75 years, the probability of detecting AF is up to 9%. According to statistics, the disease occurs one and a half times more often in men than in women.

The disease is based on the mechanism of re-entry of excitation into the atrial structures. This is caused by myocardial heterogeneity, inflammatory diseases, fibrosis, stretching, and previous heart attacks.

Pathological substrate cannot carry out impulses normally, causing uneven contraction of the myocardium. Arrhythmia provokes expansion of the heart chambers and failure of function.

Classification and differences between species, stages

According to the clinical course, there are five types of atrial fibrillation. They are distinguished by the characteristics of their appearance, clinical course, and susceptibility to therapeutic influences.

1. First identified form characterized by the first occurrence of atrial fibrillation in life. It is established regardless of the duration and severity of symptoms.
2. For paroxysmal fibrillation duration is limited to 7 days. The episode usually stops on its own within the next two days.
3. Persistent form does not spontaneously end within 7 days and requires drug treatment or electrical pulse cardioversion.
4. Long-term persistent fibrillation diagnosed when the disease lasts more than one year and with the chosen method of rhythm correction.
5. Permanent form characterized by the fact that attempts to restore sinus rhythm were unsuccessful, and a decision was made to maintain AF.

Based on the frequency of ventricular contraction, three forms of atrial fibrillation are distinguished:

• Bradysystolic, in which the heart rate is less than 60 per minute;
• at normosystolic the number of contractions is within normal limits;
• tachysystolic characterized by a frequency of 80 per minute.

Causes and risk factors

Various causes can contribute to the occurrence of rhythm disturbances, including non-cardiac diseases and congenital pathological syndromes. In addition, functional mechanisms and hereditary predisposition are possible.

The reasons are divided into the following groups:

• fickle reasons: low level of potassium in the blood, low hemoglobin content in red blood cells, open heart surgery;
• long acting: hypertension, coronary artery disease, heart and valve defects, cardiomyopathy, amyloidosis and hemochromatosis of the heart, inflammatory diseases of the muscular layer and pericardium, valvular structures, myxoma, Wolff-Parkinson-White syndrome;
• catecholamine-dependent fibrillation: provoke emotional overload, drinking strong coffee and alcohol;
• vagus-induced: occurs against a background of reduced heart rate, often at night;
• genetic forms.

Risk factors for young people include addiction to bad habits, excessive consumption of caffeine-containing drinks and alcohol, drugs; in older patients - previous myocardial infarction, a history of long-term arterial hypertension, and the presence of congenital heart diseases.

Symptoms and signs

The clinical picture of the disease is observed in 70% of cases. It is caused by insufficient blood supply, which accompanies dizziness and general weakness.

Tachyform Atrial fibrillation is characterized by rapid heartbeat and pulse, a feeling of interruptions in the functioning of the heart, and fear. When thrombotic masses occur in the atria, thromboembolic syndrome occurs.

The thrombus from the right atrium enters the right ventricle and pulmonary trunk, and accordingly enters the vessels supplying the lungs. When a large vessel is blocked shortness of breath and difficulty breathing occurs.

From the left atrium, a thrombus can travel through the systemic circulation to any organ, including the brain (in this case there will be a stroke clinic), lower extremities (intermittent claudication and acute thrombosis).

Paroxysmal form characterized by sudden onset, shortness of breath, rapid heartbeat intermittently, irregular heartbeat, and chest pain. Patients complain of acute lack of air.

Dizziness and a feeling of weakness often occur. Sometimes fainting occurs.

With permanent or persistent form symptoms (feeling of an irregular heartbeat) occur or worsen when performing any physical activity. The clinical picture is accompanied by severe shortness of breath.

For more information about atrial fibrillation and the tactics for eliminating it, watch the video with a doctor:

Clinical and instrumental research

Upon examination and auscultation they find irregular pulse and heart rate. The difference between heart contractions and pulse is determined. Laboratory tests are necessary to determine the etiology of the disease.

The diagnosis is confirmed by the method.

ECG signs of atrial fibrillation: instead of P waves, f waves are recorded with a frequency of 350-600 per minute, which are especially clearly visible in lead II and the first two chest leads. With tachyform, along with waves, the distance between QRS complexes will be reduced.

This is what atrial fibrillation looks like on an ECG:

In case of unstable form, it is indicated, which will help identify attacks of atrial fibrillation.

To stimulate possible myocardial activity, use transesophageal stimulation, intracardiac EPI. All patients require echocardiography to establish hypertrophic processes in the heart chambers and identify the ejection fraction.

Differential diagnosis

In addition to atrial waves, AF is distinguished from sinus rhythm by different distances between the ventricular complexes and the absence of the P wave.

When intercalary complexes occur, diagnosis with ventricular extrasystoles is required. When the coupling intervals are equal to each other, there is an incomplete compensatory pause, against the background there is a normal sinus rhythm with P waves.

Emergency care for paroxysmal atrial fibrillation consists of stopping the action and treating the cause that caused the disease and hospitalization in a cardiology hospital; to stop the attack, the tactics of medicinal rhythm restoration are used - 300 mg of cordarone intravenously.

Therapy tactics

How to treat atrial fibrillation? Indications for hospitalization are:

• first-time, paroxysmal form less than 48 hours;
• tachycardia more than 150 beats per minute, low blood pressure;
• left ventricular or coronary insufficiency;
• the presence of complications of thromboembolic syndrome.

Treatment tactics for different forms of atrial fibrillation - paroxysmal, persistent and constant (permanent):

Learn more about the disease and the common radiofrequency method of eliminating it from the video:

Rehabilitation

Depends on the disease that led to the occurrence of AF. After rhythm disturbances due to myocardial infarction after the inpatient stage follow-up treatment in cardiac sanatoriums is indicated lasting up to 21 days.

The most important thing is to maintain a normal heart rate and prevent thromboembolism.

Prognosis, complications and consequences

According to statistics, AF increases mortality by one and a half times. The risk of cardiovascular pathology against the background of an existing rhythm disturbance doubles.

To improve the forecast it is necessary to promptly identify and treat the disease, take maintenance therapy as prescribed by your doctor.

The most serious complications are thromboembolic, especially ischemic stroke. In the age group 50-60 years old, the risk is 1.5%, and over 80 years old it reaches 23%.

When AF is added to the patient’s existing ones, the risk of brain disorders increases 5 times.

Relapse prevention and prevention measures

Primary prevention of AF is used in cases of focal myocardial diseases and open heart surgery. Risk factors for cardiovascular disease need to be addressed: treat hypertension, lose weight, quit smoking, fatty foods. You should also limit your consumption of strong coffee and alcoholic beverages.

To prevent relapses and complications, prescribed antiarrhythmic therapy should be used daily and follow the doctor's instructions. The INR level is very important.

Subject to compliance with all instructions and elimination of risk factors the prognosis is favorable. It is necessary to carefully prevent thromboembolic complications, take anticoagulants, and monitor the heart rate.

Atrial fibrillation- This arrhythmia (irregular heartbeat), that is, one of the forms cardiac pathology, in which a person exhibits an irregular pulse. With atrial fibrillation, due to changes in the electrical activity of the atria, each muscle fiber in them contracts separately, and the heart beats at an incorrect rhythm. The term “fibrillation” very accurately describes the cause of this arrhythmia. In Latin, the word “fibra” means “fiber”, and fibrillation is the process of independent excitation and contraction of each muscle fiber. With atrial fibrillation, 400 to 700 contraction impulses are generated per minute. If each impulse is imagined as a flash of light, then figuratively this arrhythmia looks like a flicker. It is atrial fibrillation or atrial fibrillation that is the second name for this pathology.

Interesting facts about atrial fibrillation

Atrial fibrillation is considered the “grandfather of arrhythmias” because it was one of the first to be described. It is the second most common heart rhythm disorder among all. The disease is more common in men than in women. The incidence of atrial fibrillation increases with age. If under 40 years of age it occurs in 0.5% of people, then at the age of 40–70 years it can be found in 1.5% of people, and over 70 years of age, atrial fibrillation is detected in 10–15% of people. It was these statistics that made it possible to express the opinion that atrial fibrillation is not only the “grandfather of all arrhythmias,” but also the “arrhythmia of the grandfathers.”

Currently, it occurs often in young people, but it is difficult to determine how often, since its attack can be short and not recorded using electrocardiography ( ECG) .

Anatomy and physiology of the heart

The heart is one of the organs of the circulatory system; its function is to pump blood through the arteries. The heart has 4 chambers - 2 atria and 2 ventricles. The atria are the upper chambers of the heart into which venous blood enters, and the ventricles are the sections from which blood enters the arteries. The left atrium receives blood from the lungs through the 4 pulmonary veins, and the right atrium receives blood from the rest of the body through the vena cava ( top and bottom). Between the left atrium and left ventricle and the right atrium and right ventricle there are openings - valves. And between the 2 atria and 2 ventricles there are partitions ( interatrial and interventricular).

The valve of the left side of the heart is called the mitral or bicuspid valve ( has two doors), and the valve between the right parts of the heart is tricuspid or tricuspid. These valves open during the pause between ventricular contractions to allow new blood to flow from the atria. During ventricular contraction, the valve closes hermetically so that blood does not flow back into the atrium and rushes only into the artery ( into the aorta from the left ventricle and into the pulmonary artery from the right). While the ventricle contracts, the atrium fills with a new portion of blood.

The left parts of the heart are normally anatomically not connected in any way with the right parts of the heart, however, through the pulmonary circulatory system, changes in the left part can lead to changes in the “right heart”. This relationship can be represented as follows. From the right ventricle, blood enters the lungs through the pulmonary artery, and from there through the pulmonary veins into the left atrium. Thus, the change in pressure ( the presence of various diseases or pathologies in this area) causes changes in both departments.

In the heart, two groups of cardiomyocyte cells can be distinguished ( heart cells) – typical and atypical. Typical cardiomyocytes are responsible for the contraction of the heart, and atypical cells make up the cardiac conduction system - a group of cells in the form of bundles that regulate the electrical activity of the heart.

The conduction system of the heart consists of the following sections:

• sinus node ( SU) – located in the upper part of the right atrium;
• atrioventricular node ( atrioventricular, AV node) – located in the lower part of the interatrial septum;
• His bundle– continuation of the fibers coming from the AV node, located in the interventricular septum, has two legs ( right and left), which branch into numerous nerve fibers to conduct impulses to the left and right ventricles, respectively.

The heart has the following abilities:

• automatism– the ability to create an electrical impulse independently, in the absence of stimulation from the central nervous system ( this is how cardiac muscle differs from skeletal muscles);
• conductivity– the ability to transmit an impulse along the nerve fibers of the heart in order to deliver it from the area where it was formed to the myocardium ( heart muscle);
• excitability– this is the ability of cells to transition from their initial state of rest to readiness to contract under the influence of the received electrical impulse;
• contractility– the ability to carry out a contraction in response to the received impulse.

Cells that have the function of automaticity are called pacemakers ( literally – setting the rhythm) or pacemakers. Another name for these groups of cells is centers of automaticity. The main pacemaker is the sinus node ( 1st order automation center). It is this node that normally sets the rhythm of the entire heart and is a kind of “main leader”. Impulses with a frequency of 60 - 80 per minute come from this node in two directions - to the left atrium and to the ventricles. The maximum number of impulses that the sinus node can generate per minute is 150 - 160.

For an impulse to travel from the atria to the ventricles, it must pass through the atrioventricular node ( AV node). The atrioventricular node is the same group of cells that has the function of impulse conduction and automaticity. If the sinus node ( SU) works normally, then the automaticity function of the AV node does not manifest itself in any way ( The AV node is normally subordinate to the sinus node). The main task of the AV node is to somewhat slow down the conduction of the impulse to the ventricles, so that during this time the atria have time to complete their contraction and fill the ventricles ( if this pause does not occur, the filling of the ventricles with blood will be disrupted).

Myocardial contraction is called systole, and the period between two contractions is called diastole.

The atria perform the following functions:

• blood accumulation- while the ventricles perform their contraction, the next portion of blood coming from the lungs accumulates in the atria ( into the left atrium) and from other organs ( into the right atrium);
• reduction ( systole) – after the ventricles have completed their contraction and relaxed ( diastole), blood begins to flow through the valves into the ventricles, and it is important to note that atrial systole does not occur immediately, but after some of the blood has passively entered the ventricles;
• reflex regulation– nerve receptors are located in the wall of the atria ( graduation), which are sensitive to changes in pressure in the atrial cavity and wall stretching, transmitting an impulse to the nervous system, thereby participating in the reflex regulation of heart function ( change in frequency and strength of contraction);
• endocrine function– stretching of the atrium wall is regarded as a consequence of the accumulation of excess fluid in the body, so some myocardial cells secrete atrial natriuretic hormone, which acts on the kidneys, causing them to remove sodium and water along with it from the body.

Neural regulation of heart rate

Nervous regulation of heart function is carried out due to the presence of sensitive nerve endings - receptors - in different parts of the conduction system of the heart and cardiac muscle. Central regulation ( coming from the brain) may have a stimulating effect ( sympathetic division) and inhibitory ( parasympathetic division). The sympathetic department works in conjunction with the adrenal hormone adrenaline, and is therefore called the sympathoadrenal system. The effects of this system correspond to the phenomena that occur in a person during a stressful situation. The parasympathetic department carries out its actions through the vagus nerve ( vagus).

Effect of the sympathetic and parasympathetic nervous system on the heart

Causes of atrial fibrillation

Atrial fibrillation is an arrhythmia that can have many causes. All heart rhythm disturbances, including atrial fibrillation, can be a consequence of either cardiac ( cardiac), or extracardiac ( extracardiac) pathology. Finding the specific cause of atrial fibrillation, if it has started recently, can relieve the patient of this arrhythmia. At the same time, if a person has had atrial fibrillation for a long time, then even if the causative factor is identified, the arrhythmia can rarely be eliminated.

Depending on the type of lesion there are:

• organic atrial fibrillation– there is a disease that causes anatomical or structural changes in the heart;
• functional ( neurogenic) atrial fibrillation– changes in the heart itself that could lead to arrhythmia are not detected, but there are dysfunctions of other organs, to which the heart reflexively reacts with the development of arrhythmia.

Organic atrial fibrillation occurs:

• valve– develops against the background of damage to the heart valves or in the presence of their prostheses;
• non-valvular– the heart valves are not affected.

If a person has any chronic heart disease, then he always has a risk of developing arrhythmia. Atrial fibrillation is associated with pathology of the left atrium.

Atrial fibrillation can be caused by any disease that causes the following changes in the left atrium:

• hypertrophy– increase in muscle mass of the atrium;
• dilatation– stretching ( within normal limits) and hyperextension ( pathology) cavity of the left atrium;
• sclerosis– compaction of the atrium wall, which impairs the function of contraction and relaxation;
• reflex irritation– impact on the sensory nerve endings in the atrium wall can cause a change in heart rhythm ( increase, decrease, arrhythmia).

Atrial fibrillation can be caused by the following cardiac pathologies:

• acquired heart defects;
• congenital heart defects;
• rheumatic diseases;
• infective endocarditis;
• arterial hypertension ( hypertension);
• heart surgery;
• pericarditis ( constrictive);
• heart tumors;
• sick sinus syndrome.

Atrial fibrillation is caused by the following non-cardiac pathologies:

• "Sunday heart" syndrome ( "festive heart");
• thyrotoxicosis;
• chronic lung diseases;
• acute pneumonia;
• electrolyte imbalance ( hypokalemia);
• stroke and subarachnoid hemorrhage;
• acute physical or emotional stress;
• spontaneous pneumothorax.

If the cause of atrial fibrillation cannot be identified, then this form is called idiopathic ( idios – special, own, independent). It is this form that is observed in young people and often has a family character. It is believed that it is caused by mutations in the genes of heart receptors, the irritation of which changes the heart rhythm.

Acquired heart defects

Acquired heart defects are damage to the heart valves that develop in a person during life in the presence of certain diseases. Heart disease causes valve destruction or deformation, which leads to a change in the usual ( natural) direction of blood movement inside the heart ( in medicine this is called hemodynamics, “hemo” - blood, “dynamics” - “movement”).

In order for blood to flow “correctly” from one chamber of the heart to another, the valve must perform the following two functions:

• opened sufficiently to allow blood to pass from one section to another;
• closed hermetically when one of the chambers of the heart performs its contraction ( this concerns the contraction of the ventricles).

Acquired heart defects can cause two types of valve damage:

• stenosis– this is a narrowing of the valve opening due to the fusion of its leaflets;
• valve insufficiency- this is the inability of the destroyed valves to completely close the valve opening ( When closing, an open area remains between the doors).

Most often, atrial fibrillation develops with mitral valve defects. With mitral stenosis, atrial hypertrophy is observed, since it is required to work under high pressure ( the smaller the valve opening, the thicker the atrium wall should be). With mitral regurgitation, during ventricular contraction, part of the blood flows back into the left atrium, so the latter is forced to increase its size ( stretch out) to be able to accommodate an additional portion of blood.

In addition to mitral valve defects, atrial fibrillation can develop with damage to the aortic valve ( located between the left ventricle and the aorta). Aortic valve defects ( both stenosis and insufficiency) increase the load on the left ventricle. When the left ventricle gets tired, it begins to expand. This leads to stretching of the mitral valve annulus ( the valve is not affected, but the flaps are “small” to close the enlarged hole). This condition is called mitralization of aortic defects. It is mitralization that leads to expansion of the left atrium and the development of arrhythmia.

Congenital heart defects

Congenital heart defects are developmental anomalies that form during the prenatal period. Despite this, not all congenital heart defects appear immediately after birth; some defects may make themselves known only years later, against the background of other heart diseases, or may not manifest themselves at all.

Atrial fibrillation most often develops with an atrial septal defect – the presence of communication between the left and right atrium. Through this defect, blood is discharged from one atrium to another during the contraction of the heart.

Atrial septal defect may result from:

• underdevelopment of the upper or lower part of the septum;
• patent foramen ovale ( a natural connection between the atria that is present in the fetus but closes after birth).

With underdevelopment, the defect usually appears from birth, gradually both atria dilate, and atrial fibrillation develops.

If after birth the foramen ovale does not heal, then in the future such a small defect can cause atrial fibrillation. This is possible if other diseases increase the load on the atria.

Rheumatic diseases

Rheumatic diseases are a group of autoimmune diseases that affect several organ systems of the body ( therefore they are also called systemic connective tissue diseases). Rheumatic diseases are one of the most common causes of acquired heart defects. Atrial fibrillation does not develop due to rheumatic diseases, but due to damage to the valves caused by these pathologies.

The heart is most often affected by rheumatism, rheumatoid arthritis, and systemic lupus erythematosus. The trigger for the development of rheumatism is a chronic infection in the body. With each exacerbation ( especially with sore throats) the body destroys not only infectious agents, but also its own tissues. The fact is that infectious agents are able to disguise themselves as body cells in order to avoid destruction. This is why immune cells confuse their own and foreign. This is called an autoimmune process.

Rheumatic diseases love to attack heart valves because the pathogens often change their genes so that they are mistaken for heart cells. When attacking an infection, the body also attacks its own heart valves.

Infective endocarditis

Infective endocarditis is an inflammation of the inner lining of the heart ( endocardium) caused by infection. The endocardium covers from the inside not only the cavities of the heart, but also the valves. Infective endocarditis causes destruction of valve structures and is the second cause ( after rheumatic diseases) acquired heart defects, which, in turn, lead to the development of atrial fibrillation.

Myocardial infarction and angina pectoris

Both pathologies are a consequence of atherosclerotic damage to the vessels supplying the heart muscle. With angina pectoris, the muscle starves, but does not die; with a heart attack, complete necrosis of a specific area occurs. If a muscle is starving, then the process of propagation of a nerve impulse in it is disrupted, heterogeneity occurs, and the “wave” of excitation is disrupted. When tissue is destroyed, a scar is formed in place of living cells, along which the impulse cannot spread ( "wave" hits "wall"). That is why arrhythmias often develop with these pathologies, including atrial fibrillation. It is characteristic that with angina pectoris, atrial fibrillation often occurs in the form of attacks, and after a myocardial infarction it can become permanent.

Arterial hypertension ( hypertension)

Arterial hypertension or essential hypertension is characterized by a persistent and significant increase in blood pressure. High blood pressure requires the heart to work harder, so the heart muscle increases its mass and wall hypertrophy develops. If the left ventricle becomes too muscular, its cavity becomes smaller, which means that the left atrium has to overcome a greater load with each heartbeat to push blood into the left ventricle. This over time leads to “fatigue” of the atrium and it begins to dilate, which contributes to the development of atrial fibrillation.

Heart failure

Heart failure is not an independent disease. This is always the outcome of some other heart disease that has exhausted the heart’s ability to work “to the limit.” Heart failure leads to circulatory failure. This means that the heart is no longer able to work to ensure that the required amount of blood is delivered to the entire body. Impaired ventricular pumping function increases the load on the atria. If the left ventricle weakens, the left atrium begins to work more actively, which in most cases causes atrial fibrillation.

Cardiomyopathies

Cardiomyopathy is a primary heart disease characterized by the development of changes without objective reasons. An objective cause is considered to be the presence of any pathology that can lead to similar changes in the heart ( heart defects, arterial hypertension, myocardial infarction and others). Cardiomyopathies often have a hereditary predisposition, that is, they arise due to genetic mutations. With cardiomyopathies, the heart muscle is either greatly stretched, thickened, or undergoes hypertrophy. All these factors contribute to the development of atrial fibrillation.

Myocarditis, pericarditis

Myocarditis is inflammation of the myocardium ( heart muscle), which can be caused not only by infection, but also by autoimmune diseases, intoxication, and tumor. Pericarditis is an inflammatory disease of the pericardial layers ( pericardium). If, as a result of inflammation, the leaves become denser, then their sliding is impaired. Such a compacted bag around the heart interferes with the filling of the heart cavities with blood ( To fill, the heart chamber must expand sufficiently), as a result of which the load falls on the upper parts of the heart, that is, the atria.

Heart tumors

Heart tumors can be either benign or malignant. Among benign tumors of the heart, myxoma is most often found - this is a polyp-like formation of soft tissue, often with a pedicle on which it hangs. Myxoma usually forms in the left atrium, disrupting the process of blood movement from the left atrium to the left ventricle, penetrating into the opening of the mitral valve itself with the blood flow. Thus, the atrium experiences stress and expands, as with mitral stenosis.

Other tumors that form in the wall of the atrium can also cause arrhythmias.

Sick sinus syndrome and other arrhythmias

Sick sinus syndrome is a disorder in the sinus node's ability to produce electrical impulses at a normal frequency. Since when the main pacemaker is weak, the heart seems to lose its “conductor,” each “violin in the orchestra” decides that it should set the rhythm. Thus, atrial fibrillation in this case is a replacement, forced rhythm for the heart. Other arrhythmias such as atrial tachycardias ( paroxysmal palpitations with a regular rhythm), can also progress to atrial fibrillation.

Heart surgery

Heart surgery can be compared to heart injury. Any intervention on the heart can temporarily disrupt the “baseline parameters”, which can be used by heart cells that want to dictate their rhythm. A special form of atrial fibrillation has been identified, which is called postoperative.

Most often, postoperative atrial fibrillation develops after the following interventions:

• coronary bypass surgery– creating a path for blood to bypass the place where the artery is blocked;
• heart valve surgery– with any valve surgery there is a risk of developing atrial fibrillation.

Sunday Heart Syndrome ( "festive heart") and alcoholism

“Sunday” or “holiday” heart syndrome includes those cases of atrial fibrillation that develop after a single dose of alcohol in fairly large doses. Often observed in young people and after holidays. In this case, the arrhythmia is paroxysmal and goes away on its own. This arrhythmia is caused by activation of the sympathetic nervous system, which increases the release of adrenaline and norepinephrine, and they, in turn, increase the excitability of the atrium cells. The higher the excitability of cells, the higher the risk of arrhythmias. With alcoholism, however, structural changes also develop in the sinus node and in the heart muscle itself, contributing to the development and maintenance of arrhythmia.

Thyrotoxicosis

Thyrotoxicosis is an increased function of the thyroid gland, which produces its hormones in excessive quantities. These hormones have a toxic effect on the heart. The heart, under the constant influence of thyroid hormones, is in an active state, as if a person were constantly in motion or in a state of nervous excitement. In this situation, the excitability of the atrium cells increases, and they stop paying attention to the sinus node and dictate their rhythm to the heart.

Chronic lung diseases, acute pneumonia, spontaneous pneumothorax

Chronic lung diseases include chronic bronchitis, bronchial asthma and other pathologies. Acute pneumonia is inflammation of the lungs. Spontaneous pneumothorax is a sudden injury to the layers of the pleura, which causes air to accumulate between these layers, which prevents normal breathing in the lungs.

Any lung disease has the potential to affect the rhythm of the heart. The fact is that lung disease is accompanied by hypoxia ( oxygen starvation) and vasospasm in the pulmonary system. Spasm of the pulmonary vessels increases the load on the right side of the heart. This is how pulmonary hypertension develops. Any pulmonary pathology contributes to an increase in heart rate, since the brain, experiencing oxygen starvation, stimulates the heart so that more oxygen flows to it per minute. A constantly rapid heart rhythm contributes to fatigue of the heart muscle and the development of various types of arrhythmias.

Pulmonary embolism

Pulmonary embolism is a blockage of a branch of the pulmonary artery by a piece of blood clot that has entered it through the bloodstream. Closing the lumen of any branch of the pulmonary artery leads to the cessation of blood flow to a certain segment of the lung. The presence of a “plug” causes an increase in pressure in the larger branches of the artery, the pressure is transmitted to the right parts of the heart, causing them to work hard. The expansion of the right atrium causes a reflex increase in heart rate and intense work of the sinus node. However, an overly stretched right atrium interferes with the conduction of impulses from the sinus node to the muscle ( weakness of the sinus node develops), which creates favorable conditions for the development of atrial fibrillation.

Sleep apnea syndrome

Apnea is the cessation of breathing. Sleep apnea syndrome ( obstructive sleep apnea syndrome) are short-term pauses in breathing during sleep. They are associated with the fact that during sleep the tone of the pharyngeal muscles decreases, so the walls of the upper respiratory tract may collapse ( the front wall “falls” onto the back). This causes severe snoring and disrupts ventilation ( air flow) lungs, which causes oxygen starvation, from which the brain “wakes up” and restores the tone of the muscles of the pharynx. After this, the brain “falls asleep” again. However, such episodes greatly deplete the body overnight, because in order to wake up, the brain must turn on the sympathetic nervous system, that is, the body’s stress system ( increased heart rate, increased load on the atria). This syndrome increases the risk of developing atrial fibrillation for this reason.

Stroke and subarachnoid hemorrhage

Stroke is a disorder of cerebral circulation due to damage to the blood vessels of the brain. Subarachnoid hemorrhage is characterized by the accumulation of blood in the subarachnoid space of the brain ( usually with injuries), which normally contains cerebrospinal fluid. Both conditions lead to an increase. Any increase in intracranial pressure affects the heart rhythm ( it's being cut back) and slow down the conduction of impulses through the heart, so these pathologies are considered a risk factor for the development of atrial fibrillation.

Pheochromocytoma

Pheochromocytoma is a tumor of the adrenal gland that secretes adrenaline and norepinephrine. The effect of these hormones on the heart increases cell excitability and the risk of developing atrial fibrillation.

Acute physical or emotional stress

The term “stress” should be understood as the body’s attempt to adapt to the action of an external factor. Adaptation is possible with activation of the stress sympathoadrenal system. It is this system that activates all organs, especially the heart and blood vessels, requiring them to be more active for the needs of the body. The amount of blood that circulates depends on the heart rate and blood pressure level ( flows) throughout the body per minute. In the presence of other risk factors, such “one-time” but severe stress can trigger atrial fibrillation.

Hypokalemia

Hypokalemia is a serum potassium level below 3.5 mmol/L ( norm 3.5 – 5.5 mmol/l). The reasons for the decrease in potassium may be low intake from food, large loss ( with urine, with diarrhea or vomiting), as well as changes in its level in tissues under the influence of certain drugs. The less potassium in the heart muscle, the higher its excitability, and the higher the likelihood of developing arrhythmias.

Mechanism of development of atrial fibrillation

All of the above diseases ultimately lead to changes in the conduction of nerve impulses in the left atrium. This is called remodeling and involves changes in the cardiomyocytes that completely transform the cells of the atria and change their mode of operation. The remodeling process creates the ground for future arrhythmia, and after the first attack, it triggers the mechanism for its maintenance. The longer the arrhythmia lasts, the less likely it is that the atria will be able to return to normal operation. The 48 hour mark is considered critical. After this mark, doctors say that “atrial fibrillation gives birth to atrial fibrillation.” This expression means that atrial fibrillation “learns” to maintain its existence, regardless of the factor that caused it.

Atrial remodeling includes the following changes:

• anatomical– expansion of the atria to a certain “critical” degree;
• electrophysiological- violation ( slowdown) conduction of the impulse through the atria.

Both factors are interconnected and reinforce each other. The larger the atrium, the slower the electrical impulse moves, and the slower it moves, the worse the atrium contracts and the more it expands.

If the impulse ceases to be transmitted through the atrium in the form of a wave, from one cardiomyocyte to another, then synchrony is disrupted. Synchronicity lies in the fact that excitation, contraction and restoration of the original state in the heart should also be in the form of a wave. To understand this principle, it is enough to remember the “wave” that football fans create in the stadium. Its “beauty” lies precisely in the presence of synchronous and consistent movement ( get up and sit down) of each participant. Each participant in the “wave” is a kind of “heart cell”. If each cell or group of cells begins to “get up” and “sit down” when it decides for itself, then the wave will no longer be a wave, but a random oscillation. It is this fluctuation that is called atrial fibrillation.

In atrial fibrillation, arrhythmia develops due to the following mechanisms:

• re-entry of excitation wave ( “re-entry” - re-entry, that is, re-entry) – the wave of excitation swirls inside a closed loop ( this process is reminiscent of a dog trying to grab its own tail);
• ectopic focus– the formation of new foci that produce more impulses per minute than the sinus node.

For atrial fibrillation to develop, the following three components must be present:

• arrhythmogenic substrate– structural change ( focus of increased excitability, damage to the heart muscle, reentry loop);
• modulating factor– a factor that increases impulse conduction disturbances ( influence of the nervous system on the heart);
• trigger factor ( trigger) – increased load on the heart ( heart attack, stress, fluid retention, changes in potassium levels, distension of the heart chambers).

Symptoms of atrial fibrillation

Atrial fibrillation in the vast majority of cases has quite pronounced symptoms, as it begins with attacks of rapid heartbeat, or the patient draws attention to an infrequent but irregular pulse. In rare cases, an asymptomatic variant of atrial fibrillation is observed, when the patient does not complain, and the arrhythmia is discovered “accidentally” when visiting a doctor for another reason. There may be no complaints, mainly in cases where arrhythmia has been present for many years, and such a rhythm has already become familiar ( the patient does not feel that there is anything wrong with his rhythm). Also, at the beginning of the disease, attacks can be so short-lived that the person does not pay attention to them ( for example, while under the influence of alcohol or at night in a dream).

Symptoms of atrial fibrillation

Symptom	Development mechanism	How does it manifest?
Tachyarrhythmia (fast and irregular rhythm)	Tachyarrhythmia ( takhi - quickly) develops due to the presence of independent areas in the atria that tend to take the place of the sinus node. These areas are called an ectopic focus. They are formed at the mouths of the pulmonary veins and generate impulses at a frequency of 350–700 per minute, that is, more often than the sinus node can normally afford ( maximum, 160 pulses). If any part of the heart begins to produce more impulses per minute than the main sinus node does, then it seems to “usurp” its right to dictate the rhythm of the entire heart. The more often the heart contracts, the less blood the heart muscle receives, since blood enters the vessels of the heart during the pause between contractions. As a result, a deterioration in myocardial nutrition and even the development of a heart attack is possible if the heart vessels are affected by atherosclerosis.	heartbeat; a feeling of interruptions in the work of the heart; feeling of "freezing"; irregular pulse;
Dyspnea (breathing disorder)	Impaired respiratory function during atrial fibrillation is due to the fact that with a rapid rhythm, the left atrium does not have time to accept the volume of blood coming from the lungs. As a result, congestion occurs in the lungs. Because the brain does not receive enough oxygen, it forces the lungs and breathing muscles to take more breathing movements per minute.	feeling of lack of air ( shortness of breath, suffocation).
Hypotension (low blood pressure)	With a fast and irregular rhythm, the heart cannot maintain blood pressure levels at the desired level. Blood pressure depends on the amount of blood in the ventricle before it contracts and on the force of ventricular contraction. If the heart beats too fast ( as in atrial fibrillation), then between pauses little blood flows into its cavity. A faster rhythm also means the heart spends less time pushing blood into the aorta. Thus, during fibrillation, the necessary powerful pressure is not created, so blood reaches the brain, as well as other organs, more slowly and in insufficient volume. As a result, the entire body suffers from a lack of oxygen, and each organ “expresses its dissatisfaction” in the form of specific symptoms. In some permanent forms of atrial fibrillation, low blood pressure is associated with a slow heart rate. Contracting too infrequently also reduces blood flow to the brain.	general weakness.
Heart failure	Heart failure is a condition in which the heart muscle weakens and stops pumping enough blood with each contraction. In atrial fibrillation, due to the lack of a complete contraction of the atria, the amount of blood that is ejected into the aorta with each contraction ( ejection fraction) decreases by 15 – 20%. That is, the amount of blood that flows to all organs decreases by almost a quarter. Due to muscle weakness, the bulk of the blood is not released into the vessels and remains in the cavities of the heart and veins. This state is called stagnation. Because of this stagnation, blood begins to flow out of the veins into the surrounding tissues ( fluid retention).	general weakness; fatigue; weight loss; swelling of the lower extremities; frequent urination.
Thromboembolism	In the dilated and poorly contracting atria, conditions are created for the formation of blood clots, that is, clots of coagulated blood. Blood clots form especially often in the left atrial appendage ( small "pocket"), where blood stagnation easily occurs. The source of blood clots can also be the right atrium. The separation of a piece or the entire blood clot causes a complication called thromboembolism. Depending on the blocked vessel ( vessel of the brain, kidneys, lungs and other organs) corresponding symptoms occur.	headache; dizziness; numbness in various parts of the body; inability to move an arm, leg or other muscles ( violation of facial expressions); speech disorder; rapid heartbeat; sudden attack of shortness of breath.

Classification of atrial fibrillation

Atrial fibrillation can take different forms, which relate to different aspects of this arrhythmia. Its classification can be based on the cause, ECG signs, symptoms, and chosen treatment tactics.

Doctors divide atrial fibrillation into the following forms:

• first identified– this is the designation for those cases when atrial fibrillation is first recorded on the ECG, and it does not matter how long the patient has been suffering from this arrhythmia;
• paroxysmal form– arrhythmia is observed in the form of attacks, sometimes often repeated, but usually self-liquidating ( the heart rhythm returns to normal on its own) within 2 – 7 days;
• persistent– this form includes cases when the heart rhythm does not recover on its own after 7 days, and medical intervention is required;
• long-term persistent– arrhythmia persists for about a year, but it is possible to eliminate it;
• constant ( permanent) – a form of atrial fibrillation in which normal sinus rhythm is not restored, even despite therapeutic measures.

These forms of atrial fibrillation are also stages of arrhythmia progression. Initially, the arrhythmia begins with paroxysm ( attack), which disappears on its own within 2 days. Each new attack ( relapse) becomes longer, although it is eliminated itself ( spontaneously) or through therapeutic measures. Subsequently, the arrhythmia becomes almost constant or persistent for a long time ( the patient has had it for about a year or more) and constant.

This classification is convenient for doctors. If any form of atrial fibrillation can be eliminated, that is, normal sinus rhythm can be restored, then the arrhythmia will be called “paroxysmal atrial fibrillation.” This means that doctors prescribe treatment to prevent new attacks. The permanent form means that the doctor, with the consent of the patient, decides not to restore the rhythm, since the heart is already “used to it.” If the arrhythmia is permanent, but the doctor decides that it is possible to restore the heart rhythm, then the diagnosis will read “long-term persistent arrhythmia.” Thus, the terms “persistent” or “constant” indicate the physician’s chosen tactics. In fact, atrial fibrillation for the patient himself is either paroxysmal ( paroxysmal), or constant.

Atrial fibrillation, depending on the cause, can be:

• primary– arrhythmia occurs as an independent pathology;
• secondary– arrhythmia develops against the background of another condition, for example, with myocardial infarction, myocarditis and other objective reasons.

According to the speed of development, atrial fibrillation can be:

• acute– develops suddenly in various acute pathologies ( for example, acute myocardial infarction, alcohol intoxication, electric shock);
• chronic– includes other slowly progressive cardiac and non-cardiac diseases.

A separate neurogenic form of atrial fibrillation is distinguished.

Variants of neurogenic atrial fibrillation

Option	Development mechanism	Features of symptoms
Vagal variant	This option is based on an increase in the influence of the vagus nerve on the heart ( "inhibitory" influences). The vagus nerve is active at night. Internal organs, especially the digestive organs, are rich in its receptors. When these organs are irritated, a reflex transmission of irritation to the heart develops.	characteristic of the male gender; the attack develops at night, after eating, when taking large doses of alcohol; observed at the age of 40–50 years; develops against the background of slow heart function ( rare pulse); often it is not possible to find serious causes of arrhythmia ( isolated fibrillation); The patient often has intestinal diseases, constipation, peptic ulcers, hiatal hernia ( reflux esophagitis); there is a tendency to fainting and dizziness.
Hyperadrenergic variant	The adrenergic response is a response that is associated with the effects of adrenaline ( as well as norepinephrine), that is, due to the activation of the sympathoadrenal system ( "stress" effects).	occurs more often in women; the attack occurs in the daytime, often during physical activity or emotional stress; phenomena such as trembling, sweating, cold extremities, and frequent urination are observed; is less common than the vagal variant.

Diagnosis of atrial fibrillation and causes of this condition

Diagnosing atrial fibrillation is not difficult. Even when measuring the pulse, a doctor can easily suspect this arrhythmia using a stethoscope ( device for listening to the heart and lungs) carry out a simple test. If the number of heartbeats is greater than the number of pulse waves, then this is a characteristic sign of atrial fibrillation. This phenomenon is called “pulse deficiency.” The mechanism for the development of this phenomenon is explained by the fact that the force of some blows ( abbreviations) the heart during atrial fibrillation does not reach such a force as to develop into a pulse wave and reach the radial artery in the wrist area.

Diagnosis of atrial fibrillation includes the following 2 stages:

• identification of the arrhythmia itself;
• search for the causes of arrhythmia.

Direct signs of atrial fibrillation are detected only by electrocardiography, that is, recording the electrical activity of the heart. It is this that is disrupted by this arrhythmia. Other methods can only indirectly indicate the presence of this arrhythmia and determine its cause.

Normal rhythm(sinus)The ECG shows the following signs:

• there is a P wave- this is a low “bridge” of a semi-lunar shape, which goes in front of the “teeth” of high amplitude ( this is a sign of a complete contraction of both atria with one impulse from the sinus node, therefore this rhythm is called sinus);
• intervals between the two highest “swings” of the cardiogram ( R waves) are equal- this means that every contraction of the heart occurs under the guidance of the sinus node, which generates impulses at regular intervals;
• heart rate– with sinus rhythm, the number of R waves per minute ( they correspond to the contraction of the ventricles) is equal to 60 – 90.

Methods for detecting atrial fibrillation

Study	How is it carried out?	What are the signs of atrial fibrillation?
Electrocardiography (ECG)	The ECG is performed with the patient lying on his back. The doctor or nurse places six electrodes over the heart and 4 electrodes on the extremities ( wrist and ankle areas). Before attaching them, the skin is lubricated with saline solution. The patient is asked not to move and hold his breath for a few seconds ( chest movements can create fluctuations in the cardiogram). In some cases, the patient is asked to inhale and an ECG is recorded specifically while inhaling. This is necessary to distinguish changes associated with the position of the heart and its damage ( as you inhale, the heart changes its position slightly). An ECG within a few seconds can only detect a permanent form of atrial fibrillation. With rare exceptions, if the attack did not begin during the ECG recording, which happens extremely rarely. In some cases, the patient may spend some time in the hospital where a resting ECG will be recorded - a long-term recording.	absence of P wave– due to the lack of integral contraction of the atria; irregular rhythm– the intervals between the R waves are sometimes larger, sometimes smaller; flicker waves f ( f – fibrillation) – on a straight line there are many small waves that correspond to impulses coming from the atria.
Holter monitoring	Holter monitoring is long-term recording of an ECG using a portable recorder and electrodes. Disposable electrodes ( in quantities from 4 to 12) in the form of a sticker is attached to the skin over the heart area. Previously, the hair in this area in men is shaved off and a special gel is applied for better contact of the electrodes with the skin. The electrodes are connected to a recording device. The recorder is attached to the belt ( How did you attach the audio player before?) or hung around the neck ( if small) on a string. Monitoring usually lasts 24 hours, but in some cases it is possible to record an ECG for 3 days or a week. During the entire period of ECG registration, the patient must keep a diary and record his actions and the exact time of their implementation. This is necessary to distinguish between ECG changes during exercise and at rest. Data decoding is carried out on a computer after the recorder is removed from the patient. The data is interpreted by a doctor.	changes that are characteristic of atrial fibrillation ( the same as on a regular electrocardiogram).
Event-based ECG monitoring	Event-based monitoring differs from Holter monitoring in that ECG recording is carried out only at those moments when the patient feels complaints and presses the button of the device or phone that is connected to the electrode.	ECG changes characteristic of atrial fibrillation.

Despite the fact that atrial fibrillation begins with an attack of rapid and irregular heartbeat, later, with a constant form, the heart rate may vary.

Depending on the heart rate, atrial fibrillation has the following forms:

• tachysystolic ( systole – contraction) – the heart beats 100 to 200 times per minute;
• Bradysystolic ( Brady - not enough) – the frequency of ventricular contractions per minute is less than 60;
• normosystolic– the frequency of ventricular contractions is 60–90 per minute.

Tests that are done to identify the cause of atrial fibrillation

Study	How is it carried out?	What are the causes of atrial fibrillation?
Blood pressure measurement	Blood pressure is measured with the patient sitting or lying down. If the patient is sitting, it is important that the legs are not crossed and the palms are not clenched into a fist. A cuff is placed on the shoulder area just above the elbow, and a stethoscope is placed on the inner surface of the elbow. Air is pumped into the cuff using a bulb, after which it is slowly released. It is important to know that with a permanent form of atrial fibrillation, it is impossible to accurately determine the level of blood pressure, since each heart contraction occurs with a different amount of blood in the ventricle ( there is either more or less of it), so the pulse wave will also be of different completeness. In such cases, the doctor will measure your blood pressure several times and take the average value as the most likely blood pressure level.	arterial hypertension.
Echocardiography (EchoCG)	Echocardiography is a study of the heart using ultrasound waves. There are two methods of ultrasound examination of the heart - transthoracic and transesophageal. With transthoracic ( trans - through, thorax - chest) method, the sensor is installed above the heart area, with the patient lying on his back, slightly turned on his left side, and placing his left hand under his head. The doctor changes the position of the sensor to view the chambers of the heart from different positions. The sensor sends echo signals, they, reflected from different structures of the heart, are captured by the same sensor. Based on the degree of change in the reflected signal, images of the contracting heart are obtained in real time. With transesophageal echocardiography, the probe is inserted through the esophagus while the patient is under anesthesia ( such a study is usually performed before surgery).	heart defects; arterial hypertension ( thickening of the heart walls); heart failure; cardiomyopathy; infective endocarditis; myocardial infarction; heart tumors; pericarditis; myocarditis.
Chest X-ray	The examination is carried out in the X-ray room. The patient must stand between the screen and the X-ray tube, and it is important that the X-ray of the lungs is taken in two projections - anterior and lateral. The anterior projection is the position in which the patient stands with his back to the X-ray tube, and the lateral projection is if the tube is on the left.	chronic lung diseases; acute pneumonia; spontaneous pneumothorax; TELA ( pulmonary embolism); heart failure.
Intracardiac electrophysiological study (VSEFI)	Intracardiac EPI is a minor surgical intervention to clarify the electrical processes that occur in the heart. The study is carried out in a special X-ray operating room, where the patient through the femoral vein or brachial vein ( sometimes through the subclavian vein) electrodes are inserted using a probe ( long metal wire). The probe is pushed to the right side of the heart ( large veins drain into the right atrium). The doctor controls this entire process using x-rays ( the catheter itself is visible on x-ray, and a contrast agent is pumped through it to display the vessels). Usually 3–4 electrodes are inserted, each of which is installed in a specific area near the structures of the conduction system of the heart ( upper part of the right atrium, next to the tricuspid valve, right ventricular cavity). The installed electrodes record endocardial ( intracardiac) electrogram. Unlike a conventional ECG, with EPI it is possible to record the conduction of an impulse in each specific structure of the heart and identify “weak spots”. The method also allows you to stop ( eliminate) attack of arrhythmia.	sick sinus syndrome or other types of arrhythmias; the place where the arrhythmia wave spins.
Load tests	Stress tests are exercise tests combined with an ECG or echocardiogram. For tests, either a treadmill is used ( treadmill test), or an exercise bike ( bicycle ergometry). Before, during and after exercise ( about 15 – 20 minutes) an ECG is recorded, blood pressure is measured, or cardiac contractility is assessed using echocardiography. Against the background of stress, the ECG or heart contractility may change, and the doctor will see signs of certain disorders.	angina pectoris and myocardial infarction; arterial hypertension; sick sinus syndrome and other arrhythmias.
Ultrasound of the thyroid gland and adrenal glands	The study is carried out in a lying position. To better display the thyroid gland on the screen, the doctor will ask the patient to throw his head back. To study the adrenal glands, the patient is asked to lie on the right side, and then not the left side.	thyrotoxicosis; pheochromocytoma.
MRI of the heart	MRI is a method for examining internal organs and obtaining three-dimensional images of them. There is no radiation involved in MRI. During MRI, under the influence of a magnetic field in tissues, the position of charged particles changes ( protons) hydrogen, which begin to emit radio frequency signals. These signals are received by the tomograph and processed. During the examination, the patient is positioned on a retractable tomograph table. The patient's limbs are fixed, a coil is placed on the chest ( signal regulation device), and a contrast agent is injected through a vein to enhance the signal of the desired tissues. The table with the patient moves into the tunnel, where a magnetic field is created.	pericarditis; heart tumors; cardiomyopathy; heart defects ( congenital and acquired); myocardial infarction and angina pectoris; TELA.

Laboratory tests for atrial fibrillation

Laboratory tests for atrial fibrillation are performed both to identify the main cause of the arrhythmia and to assess the general condition of the body. The cardiologist must determine whether there is a serious heart condition, especially an acute one. If no acute heart pathologies are detected, then the entire body is carefully examined to identify any chronic process. In addition, the choice of medication or the decision to undergo surgical treatment depends on the condition of the internal organs.

If you have atrial fibrillation, you need to take the following tests:

• general blood test– may reveal an increase in ESR levels ( erythrocyte sedimentation rate) and leukocytes ( inflammation), increase ( oxygen starvation) or decrease ( anemia) red blood cell level, platelet count ( informs about the risk of thrombosis);
• general urine test– detects signs of kidney damage ( Kidney problems contribute to the development of arrhythmias);
• blood glucose test– high blood sugar ( diabetes mellitus) is a risk factor for the development of cardiac pathologies that lead to this arrhythmia;
• biochemical blood test– necessary to assess the condition of the kidneys ( urea, creatinine), liver ( bilirubin, ALT, AST, alkaline phosphatase), risk of recurrent episodes of fibrillation ( C-reactive protein level);
• coagulogram ( blood clotting test) – is mandatory for atrial fibrillation, includes indicators such as INR ( international normalized ratio), APTT ( activated partial platelet time), D-dimer and other indicators;
• lipid profile– includes analysis of cholesterol, lipoproteins and triglycerides ( fat metabolism indicators), a high level of which is a risk factor for the development of myocardial infarction;
• markers of myocardial damage- substances that enter the blood when the heart muscle is destroyed ( heart attack, myocarditis), includes indicators such as troponin, MB-CPK ( MB fraction of creatine kinase), LDH ( lactate dehydrogenase);
• brain natriuretic peptide level ( NT-proBNP ) – is an indicator of heart failure and allows you to determine its degree;
• ionogram– includes assessment of electrolytes ( potassium, calcium, sodium, magnesium);
• blood test for thyroid hormones- test for thyroid-stimulating hormones ( TSH) pituitary gland, thyroid hormone thyroxine ( T4).

When is drug treatment necessary for atrial fibrillation?

Drug treatment of atrial fibrillation begins immediately after its detection, regardless of the form of the arrhythmia. It is important to know that doctors treat this arrhythmia based primarily on its cause. This means that there is no universal treatment for atrial fibrillation. Each case requires an individual approach, since the same drug may be effective in one patient, but absolutely contraindicated in another. That is why the treatment of atrial fibrillation is usually carried out by very highly specialized cardiologists, who are called arrhythmologists.

Treatment of atrial fibrillation is carried out in the following areas:

• rhythm restoration;
• normalization of heart rate;
• elimination or mitigation of accompanying symptoms;
• prevention of complications;
• prevention of recurrent episodes.

Treatment strategies for atrial fibrillation include:

• rhythm control strategy– restoration and preservation of sinus ( normal) rhythm ( elimination of arrhythmia);
• heart rate control strategy– normalization of heart activity and elimination of symptoms of arrhythmia by reducing heart rate ( the arrhythmia itself remains, but the heart stops beating too fast).

Restoration of sinus rhythm, regardless of the chosen treatment method ( medicinal or non-medicinal), doctors call cardioversion or defibrillation.

Rhythm restoration during atrial fibrillation is possible in the following two ways:

• pharmacological cardioversion– medications are used;
• electrical cardioversion– electropulse therapy ( shock using a special defibrillator device).

Sometimes both drug and non-drug rhythm restoration are used. This therapy is called hybrid cardioversion.

Drug therapy for atrial fibrillation

Medicine	How does it work?	Indications	Directions for use
Amiodarone (cordarone)	reduces the number of impulses that the AV node transmits from the atria to the ventricles, which leads to a slower rhythm; slows down the conduction of the impulse, as a result the wave in the loop moves more slowly and is interrupted; reduces the excitability of the ectopic focus ( center of arrhythmia), which prevents recurrent attacks.	restoration of heart rhythm in atrial fibrillation; control of heart rate with a constant form; prevention of recurrent attacks.	In the hospital, cordarone is administered intravenously until the rhythm is restored. At the clinic, the doctor will prescribe cordarone in the form of tablets ( "wait and see" method).
Digoxin	reduces heart rate by suppressing the AV node and its capacity; enhances the effect of the vagus nerve on the heart; increases the strength of heart contractions due to the ability to retain calcium inside the cell.	permanent form of atrial fibrillation in the presence of heart failure ( ).	It is used in tablet form or administered intravenously.
Bisoprolol, metoprolol (beta blockers)	slow down the heart rate by affecting the AV node ( like digoxin); reduce the excitability of ectopic foci; reduce the effect of thyroid and adrenal hormones on the heart ( blocks the receptors that hormones bind to); reduce blood pressure and, therefore, the load on the heart.	control of heart rate with permanent atrial fibrillation.	Used in tablet form.
Sotalol	acts as beta-blockers and cordarone at the same time.	attack of atrial fibrillation ( restoration of sinus rhythm); prevention of recurrent attacks ( especially against the background of coronary heart disease).	The drug is taken in tablet form and is also administered intravenously.
Verapamil, diltiazem (calcium channel blockers)	block the flow of calcium, which leads to inhibition of the function of the AV node, as a result, some impulses from the atria do not reach the ventricles and the rhythm slows down; reduce the excitability of the arrhythmia focus, which helps restore normal rhythm.	control of heart rate at a constant form ( especially if you have chronic lung disease); paroxysm of atrial fibrillation ( verapamil).	The drugs are used both intravenously and in tablet form.
Vernakalant	affects only the cells of the atria ( unlike other drugs that also affect the ventricles), reducing the excitability of the arrhythmia focus and interrupting the movement of the wave inside a closed loop.	recovery of recent atrial fibrillation ( if 7 days have not passed since the attack).	The drug is given intravenously in the hospital.
Propaphenone	reduces the excitability and automaticity of pathological foci in the atria ( "quenches rebellion"); reduces the effects of the sympathetic nervous system on the heart ( has a beta blocker effect); slows down the conduction of the impulse in a closed loop, as a result of which the circular motion of the wave is interrupted.	rare attacks of atrial fibrillation in people without structural heart disease ( in the absence of heart failure and cardiomyopathy).	Propafenone is often used in the form of “pill in the pocket” therapy, which involves patients taking it independently at the dose specified by the doctor at the time of an attack.
Dronedarone	reduces the influence of the sympathetic nervous system on the heart, which leads to a decrease in blood pressure and a decrease in heart rate (); interrupts the circular motion of the wave in excitation; reduces the excitability of the arrhythmia focus.	elimination of an attack of atrial fibrillation; prevention of recurrent attacks; control of heart rate with permanent atrial fibrillation.
Disopyramide	reduces the activity of the arrhythmia focus; reduces the number of impulses that pass through the AV node; has an inhibitory effect on the vagus nerve, which is important if atrial fibrillation develops against the background of increased activity of the vagus nerve.	prevention of recurrent attacks of atrial fibrillation ( vagal variant).	The drug is prescribed in tablet form.
Aspirin	prevents platelet aggregation ( antiplatelet effect), that is, it prevents the formation of a blood clot.		The drug is taken in tablet form.
Warfarin	reduces blood clotting by inhibiting the formation of coagulation factors in the liver.	prevention of strokes in permanent atrial fibrillation.	It is prescribed in the form of tablets, and the dose is controlled by coagulogram parameters ( INR).
Rivaroxaban, dabigatran	reduces blood clotting, having a direct inhibitory effect on the tenth coagulation factor.	prevention of strokes in permanent atrial fibrillation.	Taken orally ( does not require monitoring of blood clotting parameters).

From the above drugs, the cardiologist or arrhythmologist selects those that correspond to the intended treatment strategy.

Restoration of sinus rhythm(cardioversion)contraindicated in the following cases:

• thrombus in the left atrium;
• digoxin overdose;
• the cause of atrial fibrillation cannot be eliminated completely ( chronic lung diseases, severe heart defects, untreated thyrotoxicosis, severe heart failure);
• pronounced dilatation of the left atrium ( more than 60 mm according to echocardiography);
• arrhythmia lasts more than a year;
• the patient is over 65 years old and has a heart defect;
• the patient is over 75 years old and has angina pectoris or myocardial infarction;
• there is a risk of cardiac arrest ( the presence of rhythm disturbances such as atrioventricular heart block and sick sinus syndrome);
• the patient does not tolerate antiarrhythmic drugs well.

Electrical cardioversion ( defibrillation)

Electrical cardioversion is the restoration of normal heart rhythm using an electrical shock applied over the heart area. The procedure is better known as defibrillation. The prefix “de” means cessation, that is, defibrillation is the cessation of fibrillation. A strong electric current temporarily stops all electrical processes in the heart. After such an “electric shock,” all centers of automatism, including foci of arrhythmia, immediately “fall silent.” The impulse that comes from the defibrillator synchronizes the work of the entire conduction system of the heart - this is a kind of “reset”. The sinus node recovers fastest from shock and again takes on the function of a pacemaker.

Defibrillation or electrical cardioversion is performed in a hospital emergency room or intensive care unit under general or intravenous anesthesia.

Electrical cardioversion for atrial fibrillation is:

• urgent;
• planned.

Emergency electrical cardioversion for atrial fibrillation is performed in the following cases:

• attack of atrial fibrillation during acute myocardial infarction;
• an attack of fibrillation, which caused a sharp drop in blood pressure, acute heart failure or worsening symptoms of chronic heart failure;
• persistent ( ever present) a form of atrial fibrillation that does not respond to drug treatment.

Planned cardioversion is performed for those patients who do not have acute or severe circulatory disorders, but atrial fibrillation causes severe symptoms.

Anticipatory therapy

Arrhythmologists actively use therapy to prevent atrial remodeling when the patient has a disease that can lead to atrial fibrillation ( this is primary prevention) or in cases where an attack of fibrillation was recorded, and it is necessary to prevent the transition to a permanent form ( secondary prevention). This therapy is called "upstream therapy" ( upstream), that is, therapy “against the flow”. This term seems to indicate that the doctor prescribes drugs that change the course of events already running in the atria, in other words, affect the remodeling process ( it is considered as a “current” against which one must “swim”). Another name for this treatment is “anti-remodulating therapy.”

Upstream therapy includes the following drugs:

• ACE inhibitors ( "restraining" angiotensin-converting enzyme) – ramipril, enalapril;
• sartans– valsartan, candesartan;
• aldosterone antagonists– spironolactone, eplerenone;
• statins– atorvastatin;
• Omega-3 polyunsaturated fatty acids– omakor.

The drugs used in this therapy do not directly affect the heart's rhythm or the number of times it beats per minute. They are used for diseases such as myocardial infarction, arterial hypertension and heart failure, but their effect in preventing the development and progression of atrial fibrillation has been proven in numerous studies.

Upstream therapy has the following effects in atrial fibrillation:

• improves the condition of the heart muscle;
• prevents the development of hypertrophy;
• improves metabolism in cells;
• eliminates the adverse effects of various stress and toxic factors on the heart ( hormones and nerve stimulation);
• has an “anti-inflammatory” effect ( In this case, inflammation should be understood as an advanced process of cell damage in the absence of infection).

When is surgical treatment of atrial fibrillation with insertion of a pacemaker necessary?

Surgical treatment of atrial fibrillation can in some cases save a person from recurrence of attacks. Arrhythmologists, unlike cardiac surgeons, perform operations that do not exactly resemble operations, which is why they are called invasive or mini-surgical interventions. Invasion is a closed intervention in the functioning of an organ with minimal trauma and impact only on the desired area.

Surgical treatment of atrial fibrillation can be of the following types:

• open surgery;
• minimally invasive intervention;
• intervention using a catheter.

Open heart surgery for atrial fibrillation is rarely performed. Surgery for atrial fibrillation has 2 main indications - atrial fibrillation without a cause ( idiopathic form) and the need for heart surgery for another reason ( for example, when the patient has mitral valve disease and enlarged atria). Such an operation is considered justified, since it solves several problems at once, and the elimination of arrhythmia in this case is considered as an addition, and not the main stage of the operation.

Minimally invasive intervention and catheter ablation

The difference between minimally invasive interventions and other operations is that they are usually carried out under the control of some kind of study. In cardiology this is usually x-ray control or surgery using an endoscope ( tool with a video camera for examining the insides). The purpose of the operation is to influence the arrhythmogenic substrate ( center of arrhythmia).

The classic operation for atrial fibrillation is the “maze” or Maze operation ( "maze" - labyrinth in English). The electrical impulse cannot pass through scar tissue. Stumbling upon such a site in the heart, the impulse changes its direction. The “labyrinth” operation is based precisely on this principle - to give the correct direction to the impulse. It was originally an open heart surgery. The surgeon made incisions, sewing the desired areas so that the seams became the “walls” of the labyrinth. Currently, instead of incisions and sutures, linear ablations are performed using catheters ( catheter ablation) or devices inserted into the chest cavity ( modified Operation Maze).

Ablation ( ablation - taking away) is the destruction of any area under the influence

physical factors. Before the operation, mapping is carried out - identification of arrhythmogenic foci using intracardiac electrophysiological study ( EFI). Found foci of arrhythmia, which are usually located around the mouths of blood vessels ( pulmonary veins), are isolated from the main route along which the impulse must travel. Isolation involves the already mentioned linear ablations, that is, damage to the heart muscle along the lines.

Catheter ablation involves destruction of the pathological focus of arrhythmia ( arrhythmogenic substrate) during cardiac catheterization. Cardiac catheterization is performed in the same way as intracardiac EPI. The catheter is inserted into the right atrium, after which the doctor pierces the interatrial septum and inserts the catheter into the left atrium. The main method of ablation is radiofrequency exposure - heating the desired area and cauterizing it.

In addition to radiofrequency ablation, cryoablation is also used in cardiac surgery ( freezing), laser and ultrasound ablation.

Ablation is indicated in the following cases:

• paroxysmal and persistent forms of atrial fibrillation;
• drugs for the treatment of arrhythmia are contraindicated for the patient ( or he doesn’t want to take medication for the rest of his life);
• a person's profession is connected with the lives of other people ( driver, pilot) and the occurrence of an attack can have tragic consequences;
• There are no objective causes of atrial fibrillation that could be eliminated.

Radiofrequency ablation is not performed if the patient has the following pathologies:

• thrombus in the atrium;
• infectious disease ( acute);
• endocarditis;
• severe heart failure;
• allergic reaction to contrast agents administered during catheter ablation;
• acute myocardial infarction;
• anemia ( deficiency of red blood cells or hemoglobin);
• low potassium levels.

For better results, arrhythmologists perform hybrid operations, that is, they cauterize the desired areas from the inside ( through a catheter), and outside ( through an instrument inserted into the chest cavity). To cauterize the source of arrhythmia from the outside, a mini-incision is made on the chest wall on the right ( mini-thoracotomy), video equipment is introduced ( endoscope) and the necessary tool. Such bilateral cauterization is necessary so that the “walls” of the labyrinth are formed only by scar tissue. The fact is that it is necessary to cauterize the desired area to its full depth, otherwise the impulse will find an undamaged area and be able to bypass the wall.

Minimally invasive operations for atrial fibrillation are contraindicated in the following cases:

• presence of a thrombus in the left atrium;
• sick sinus syndrome ( if the sinus node is not working well, then atrial fibrillation is a forced rhythm for the heart);
• adhesions in the pericardial cavity;
• chronic lung diseases ( there may be difficulties with artificial ventilation);
• left atrium is too enlarged ( more than 55 mm).

Pacemaker insertion

The insertion of a pacemaker is also a minimally invasive procedure, that is, it does not require open heart surgery, everything is carried out in a “closed mode”. A pacemaker is an artificial pacemaker for the heart. It is a device that generates electrical impulses and stimulates the heart muscle through electrodes inserted into the heart cavity. The pacemaker consists of a “box” and electrodes. The electrodes are inserted through the subclavian vein into the cavity of the right atrium and/or right ventricle. The pulse generator is located in the subcutaneous fat of the chest ( usually on the left side).

A pacemaker for atrial fibrillation is usually used in cases where, in addition to this arrhythmia, a person has other disorders of the heart rhythm or impulse conduction.

A pacemaker for atrial fibrillation solves the following problems:

• eliminates symptoms such as fainting and dizziness– if the patient has a bradysystolic form of atrial fibrillation ( usually associated with sick sinus syndrome), then a single-chamber pacemaker is installed;
• heart rate control– if, despite no drug treatment, the heart beats too quickly during fibrillation ( 110 beats per minute), then the AV node is destroyed using ablation and a two-chamber ( with two electrodes) pacemaker ( one for atrial stimulation, the other for ventricular stimulation).

A pacemaker is not administered to patients who do not complain about rhythm disorders ( such patients are called asymptomatic).

What to do if atrial fibrillation is detected?

Atrial fibrillation is detected on an ECG and in some cases it occurs "by chance" when a person needs an ECG for reference or before any surgery. If atrial fibrillation is detected in a patient for the first time, the doctor will diagnose “newly diagnosed atrial fibrillation” and refer the patient to a cardiologist or arrhythmologist. Even if detected atrial fibrillation does not cause any complaints in the patient ( This is observed if arrhythmia has been present for a long time), then you should definitely contact a cardiologist. The fact is that atrial fibrillation almost always has a very serious cause, and the older the patient, the more dangerous this cause can be. Unlike many other arrhythmias, atrial fibrillation leads to severe complications if left untreated.

What are the possible consequences of atrial fibrillation?

Atrial fibrillation can have very serious, life-threatening consequences if this arrhythmia is eliminated or at least its symptoms are controlled. Sometimes atrial fibrillation is asymptomatic. This flow is called “silent” or “quiet”. The danger of this form of arrhythmia is that its first signs may be its complications, and not the symptoms of the arrhythmia itself.

Atrial fibrillation can cause the following complications:

• Blood clot formation. If the atria do not contract synchronously, that is, there is no integral contraction, then blood stagnation occurs, and the atrium cavity expands. Expansion of the atrium cavity causes damage to the inner lining ( endocardium) hearts. These factors create favorable conditions for the formation of blood clots. Intracardiac blood clots are dangerous because they can break off, be carried away by the blood stream and clog blood vessels. This complication is called thromboembolism. If a blood clot forms in the left atrium, there is a risk of blocking an artery in the brain ( stroke), kidneys, less often other internal organs, and if a blood clot forms in the right atrium, pulmonary embolism develops.
• Weakening of the ventricular muscles. Atrial fibrillation significantly impairs heart function, since the heart gets tired faster with a fast rhythm. As a result, energy reserves are quickly depleted, and the muscle stretches and contracts weakly. This condition is called “heart failure”. In addition to the rapid rhythm, during atrial fibrillation, the so-called atrial “pumping” stops working, that is, the active pushing of blood from the atria into the ventricles when the atria contract.
• Risk of life-threatening arrhythmias. Some people have additional pathways in their hearts that allow electrical impulses to travel from the atria to the ventricles. Unlike the main path ( through the atrioventricular node or AV node), the additional "routes" do not have a so-called "checkpoint", so any impulse passes through these additional routes to the ventricles. If a person with such a pathology ( may not show up at all) atrial fibrillation begins, there is a risk that it will develop into ventricular fibrillation. The latter is essentially cardiac arrest.

How is atrial flutter different from atrial fibrillation?

Atrial fibrillation and flutter are arrhythmias that are associated with the atria ( the upper two chambers of the heart where blood from the veins collects). Previously, they were considered two forms of the same arrhythmia and were called atrial fibrillation. Currently, atrial flutter is identified as an independent form, since, nevertheless, these two arrhythmias are quite different.

Atrial fibrillation and atrial flutter have the following differences:

• Atrial fibrillation is characterized by frequent and completely irregular heartbeat, while atrial flutter is characterized by a very frequent but regular rhythm, that is, the intervals between contractions are relatively equal.
• If we consider the terms and their meanings, the word “fibrillation” reflects the fact of independent contraction of each muscle fiber of the heart muscle ( fiber - fiber). The term "flutter" can be described as a vibration or vibration that has the same amplitude or frequency ( like the fluttering of wings - quickly but regularly).
• The source of arrhythmia in atrial fibrillation is usually located in the left atrium, while in atrial flutter, pathological changes are found in the right atrium.
• With atrial fibrillation, several small foci of arrhythmia are detected ( loops in which a wave of excitement swirls), and with atrial flutter - one large one;
• On the ECG, large F waves are visible during atrial flutter ( flutter - fluttering), the intervals between which are equal, in contrast to fibrillation waves - chaotic, irregular and small.

It should be noted that sometimes a patient may have both arrhythmias, while the transition from flutter to fibrillation and vice versa can be observed on the ECG.

What is non-valvular atrial fibrillation?

Atrial fibrillation of non-valvular origin is the presence of this arrhythmia and the absence of damage to the heart valves, that is, defects. Atrial fibrillation was first discovered in a patient suffering from mitral stenosis ( a defect of the bicuspid valve, which is characterized by a sharp narrowing of its lumen). Due to the fact that atrial fibrillation was more often found in people with heart defects and less often in people with other heart pathologies, the concepts of “valvular” and “non-valvular” atrial fibrillation were introduced.

For a long time, valvular fibrillation united all cases of arrhythmia against the background of valvular heart defects. Currently, valvular fibrillation includes only atrial fibrillation, which develops when the mitral valve is damaged by rheumatic diseases ( rheumatism, rheumatoid arthritis, systemic lupus erythematosus and others), as well as in the presence of a prosthetic mitral valve. All other types of atrial fibrillation are considered non-valvular atrial fibrillation.

The causes of non-valvular atrial fibrillation can be:

• coronary heart disease ( angina and myocardial infarction);
• hypertension;
• heart failure;
• cardiomyopathy;
• myocarditis;
• heart surgery;
• pericarditis;
• heart tumors;
• other arrhythmias;
• alcohol abuse;
• diseases of the endocrine systems ( thyrotoxicosis, pheochromocytoma);
• chronic obstructive pulmonary diseases ( chronic bronchitis, bronchial asthma);
• acute pneumonia;
• low potassium levels;
• peptic ulcer of the stomach and duodenum;
• cerebrovascular accident ( stroke and subarachnoid hemorrhage);
• acute physical or emotional stress;
• electrical injury.

What is the life expectancy for atrial fibrillation?

Prognosis for paroxysmal form ( seizures) atrial fibrillation is better than the permanent form. It is the presence of constant atrial fibrillation, when restoration of the normal rhythm is not possible or is contraindicated, that leads to adverse consequences. Moreover, it is important to know that in the absence of treatment, adverse outcomes can develop as early as 6 months after the onset of atrial fibrillation.

The life expectancy of patients with atrial fibrillation depends on many factors. Firstly, it is important which disease caused the arrhythmia. This is what determines the main risk. Secondly, the more contractions the heart makes per minute, the faster heart failure develops. Thirdly, untreated atrial fibrillation leads to serious complications, the main of which is the formation of a blood clot in the atrium and the risk of stroke.

There is a category of patients with atrial fibrillation in whom it is not possible to identify any objective reason that could lead to this arrhythmia. This form is called isolated or idiopathic. The prognosis for this form is favorable.

To increase life expectancy and reduce the risk of adverse effects, a patient with atrial fibrillation is prescribed a number of drugs ( carvedilol, ramipril, omacor, valsartan, spironolactone), which do not affect the heart rhythm, but can reduce the risk of repeated episodes of fibrillation and prevent the transition to a permanent form. Early detection, elimination and prevention of recurrent attacks improve the prognosis of this disease.

What is the heart rhythm during atrial fibrillation?

With atrial fibrillation, the rhythm is irregular, that is, absent altogether. Irregular rhythm means different times between heartbeats. The irregular heart rhythm of atrial fibrillation can vary in frequency. The heart can beat fast, slow, or within normal limits ( 60 – 90 beats per minute). If the heart rate per minute is more than 90, then this condition is called “tachycardia”. Considering that with atrial fibrillation there is an irregular rhythm, the term “tachyarrhythmia” is used ( arrhythmia - rhythm disturbance). The difference between tachycardia and tachyarrhythmia is that tachycardia can be a normal phenomenon ( for example, when a person is nervous or performs physical activity, the heart should normally beat faster), and tachyarrhythmia is always a sign of pathology.

A permanent form of atrial fibrillation may not be combined with a fast rhythm. In some cases, the rhythm is not only irregular, but also rare - less than 60 per minute. This condition is called bradycardia or bradyarrhythmia. In this case, the patient often has not only atrial fibrillation, but also damage to the main pacemaker - the sinus node.

Is there a disability requirement for atrial fibrillation?

In the case of paroxysmal atrial fibrillation and the absence of serious cardiac pathology, disability is not required, since the problem can often be eliminated and effective prevention can be carried out. If the patient has not received adequate therapy, he cannot receive disability. If, despite the prescribed treatment and the patient’s compliance with all recommendations, the patient’s condition cannot be returned to the level that is necessary to perform his work, then he is entitled to disability. The issue of disability is decided by a medical and social examination, which includes a group of medical experts.

Medical and social examination examines the following criteria for assessing disability:

• inability to work in the profession due to illness;
• whether the disease is a persistent disorder or can be eliminated.

Simply having atrial fibrillation is not sufficient to qualify for disability. The patient is entitled to disability if he develops heart failure, that is, the inability to ensure sufficient blood circulation throughout the body. However, it is important to know that the diagnosis itself is not a reason for disability.

Indicators of heart failure for disability are:

• ejection fraction;
• severity of symptoms.

Ejection fraction is the amount of blood that the heart ( or rather the left ventricle) can, during its contraction, “push out” the aorta ( main artery leaving the heart). Of the total blood volume present in the ventricle, more than 55–60% is normally pushed into the aorta ( There is no such thing as 100% ejection fraction). This indicator is determined using echocardiography ( Ultrasound of the heart). In atrial fibrillation, the amount of blood that flows from the atria into the ventricles is reduced because there is no solid contraction ( systole) atria, pushing blood into the left ventricle. That is why, in part, the presence of this arrhythmia can change the ejection fraction. Disability can be obtained if the ejection fraction is less than 40%.

The EHRA scale is used to assess the severity of symptoms and severity of atrial fibrillation ( European Heart Rhythm Association - European Heart Rhythm Community).

The EHRA scale includes the following points:

• EHRA 1– the patient has no symptoms of atrial fibrillation;
• EHRA 2– symptoms are mild and do not affect the patient’s daily activities;
• EHRA 3– severe symptoms that interfere with the patient’s daily activities;
• EHRA 4– the patient cannot perform normal, everyday activities ( disability).

This is one of the possible heart rhythm disorders, with fibrillation being perhaps the most common disorder. As a rule, those changes in the normal functioning of the heart that will be discussed occur as complications IHD ().

However, although coronary heart disease is the main, it is far from the only cause leading to atrial fibrillation. These may also include increased function of the thyroid gland, which, in turn, also occurs against the background of characteristic diseases.

In medicine, atrial fibrillation is distinguished in two forms: constant (also called chronic ) And temporary (also called paroxysmal ).

Speaking briefly about the symptoms of atrial fibrillation, we can note their similarity with. The patient also feels periodic interruptions in the heart rhythm; a pre-fainting or fainting state may periodically occur, which is accompanied by darkening of the eyes. In this regard, a synonym for fibrillation is atrial fibrillation .

Although the disease itself is a complication of coronary artery disease, it can also have negative consequences for the body and cause other ailments. The most common consequences are those arising as a result.

The formation of blood clots in the arteries is facilitated by changes in heart rhythm. As a result, clots may appear in the blood - thrombi, which immediately end up in the atrium. There, sticking to the inner wall, they develop.

All this suggests that the disease should under no circumstances be neglected, and that the doctor’s recommendations should be strictly followed. It has been proven that if atrial fibrillation is diagnosed in a timely manner and the patient follows the procedure for taking appropriate medications, the risk of thrombosis, as well as other complications, is significantly reduced.

Manifestation of atrial fibrillation

As we have already noted, atrial fibrillation is one of the types of heart rhythm disturbances. In a normal state, this main organ of the human body works like a high-precision mechanism, each part of which is coordinated with each other. In the case of the described disease, atrial contractions can become significantly more frequent, up to six hundred contractions per minute.

If the same frequency were transmitted to ventricles , then the disease would be even more serious than it is. However, despite the lack of coordination between the atria and ventricles, only a frequency of up to 200 impulses/minute can reach them. This is due to the fact that the atrioventricular node cannot produce a larger number of contractions and, in fact, acts as a filter of excessive frequency. Naturally, at the same time sinus node no longer fulfills its function of “setting” the rhythm.

We said that atrial fibrillation exists in two forms. If the temporary form is several hours, then the risk of blood clots is relatively small. The same cannot be said about cases where the duration of fibrillation is several days. In this case, the risk of stroke increases significantly. Over time, the paroxysmal form can become permanent, then the probable development is added to the risk of stroke heart failure .

Symptoms of atrial fibrillation

All the main symptoms of atrial fibrillation are associated with increased heart rate. Naturally, such a frequency cannot go unnoticed by a person who suddenly clearly feels a heartbeat and feels weak. Disturbance in rhythm leads to lack of oxygen , so the patient most often feels. To the described characteristics may also be added chest pain .

Symptoms of atrial fibrillation may vary in duration. As a rule, they appear and disappear simultaneously with the attacks. That is, they can take from a couple of seconds to several hours, up to a day (during this time, the degree of manifestation may vary).

In the first few days, the symptoms of atrial fibrillation disappear in a short time, even without the use of any medications. But you need to understand that such attacks never come alone. After the first, short attack, the next one will come. Therefore, when the first signs occur, you should seek treatment from a specialist.

Risk group for atrial fibrillation

Scientists have been able to identify several main factors that significantly increase the risk of developing atrial fibrillation . These include age, heart disease, some chronic diseases, and alcohol abuse. Next, we will explain the impact of each factor separately.

As you know, changes in some human organs with growing up are just some of the manifestations of old age. Similar changes affect the atria, which puts older people at risk.

Heart defects and other organic diseases of this organ also increase the likelihood of disruption of the rhythm of its work. Moreover, this also applies to already suffered diseases that were cured thanks to surgical intervention.

And finally, atrial fibrillation occurs much more often in individuals who abuse alcohol. During alcohol intoxication, the nature of the functioning of the body as a whole, and its individual organs, differs significantly from normal. Therefore, frequent drinking is a direct path to a risk group.

Diagnosis of atrial fibrillation

There are two main methods for detecting the disease: ECG And Holter monitoring . We will not dwell on the description of the electrocardiogram, since this is a well-known diagnostic procedure, but we will briefly talk about Holter monitoring in this article.

This term refers to the continuous recording of heart rhythm over one or several days. As a result, the doctor has a complete picture of the patient’s heart condition, which helps to make a correct diagnosis in a timely and accurate manner.

One of the types of Holter monitoring is recording paroxysms online. It is carried out using a special device, which is connected to the patient for the entire duration of the study. As soon as the patient's heart rhythm is disturbed (an attack begins), the device transmits ECG signals through the telephone line. This research method allows the patient not to interrupt his usual activities, which is why this diagnosis of atrial fibrillation is becoming more popular every day.

Treatment of atrial fibrillation

The method of treating the disease directly depends on its form. In the temporary form, attacks are stopped; in the permanent form, medications are taken regularly.

Cupping This is a treatment for atrial fibrillation, which consists of stopping the attack under the influence of effective drugs. These include quinidine . Please note that you should never start taking them on your own. Moreover, a doctor's prescription alone will not be enough; a specialist must be nearby during the administration of novocainamide or quinidine, and a continuous cardiogram is taken to monitor the heart.

An alternative to the medications mentioned may be or. Symptoms of atrial fibrillation may be relieved by and/or. Although they are not effective enough for treatment, they significantly alleviate the patient’s condition.

In addition to medications, there is also a special cupping procedure called electrical cardioversion . According to observations, the effectiveness of this method can reach up to 90%. The widespread use of electrical cardioversion is hampered by the need general patient, so for now it is used only in particularly difficult cases, when there is a threat to the patient’s life, or other methods have exhausted themselves.

We draw your attention to the fact that cupping is effective only in the first time after an attack. After just two days, with an ongoing attack, the risk of thrombosis and, as a consequence, stroke increases. If symptoms of atrial fibrillation persist for a long time, it is imperative to start taking medications that reduce blood clotting. As a rule, doctors prescribe it, which has a quick positive effect. If relief is successful, then the drug is continued for up to 1 month.

Unfortunately, if during this time it was not possible to get rid of the disease, then this medicine or its analogues will become your companion for the rest of your life. If the relief is successful, it is replaced with drugs that prevent the recurrence of arrhythmia. It could be cordarone and others.

If the disease has passed from a temporary to a permanent form, then further treatment of atrial fibrillation should pursue two goals. First, it is necessary to ensure that the heart works in a normal rhythm. And secondly, everything possible must be done to prevent the occurrence of blood clots.

Both of these can now be successfully resolved by taking medications. For example, it could be digoxin And warfarin respectively. During the treatment process, the patient's heart function and blood condition are constantly monitored.

In fairness, we note that there is also a radical treatment for atrial fibrillation, which can permanently rid the patient of this disease. This method is radiofrequency isolation of pulmonary veins . The reason for the small spread of the operation is its high cost, which is unaffordable for the average patient, and its effectiveness, in which in every second or third patient atrial fibrillation reappears after some time.

A permanent form of atrial fibrillation is a cardiac pathology, a type. This disorder is characterized by chaotic contraction of the muscle fibers of the atria. Most often, the pathology develops after the age of 40, but it can occur earlier.

General characteristics of the pathology

A permanent form of atrial fibrillation develops under the influence of cardiac diseases. This is the most stable type. If it occurs, it is impossible to normalize sinus rhythm for a long period of time. The risk of developing such a pathology increases with age.

Atrial fibrillation (another name is atrial fibrillation) is a disturbance in the rhythm of heart contractions that occur chaotically. As a result of inconsistent contraction of muscle fibers, the pumping function of the atria, and then the ventricles and the entire heart as a whole, is disrupted.

Under normal conditions, the sinus node determines the frequency of contractions of the heart muscle. This figure is approximately 60-80 contractions per minute. If for some reason the sinus node does not function fully, then the atria generate impulses with a frequency of up to 300 times or more. But under such conditions, not all impulses enter the ventricles.

Due to such disorders, the ventricles cannot perform their main function, which causes the pumping functions of the heart muscle to decrease. Atrial fibrillation is said to be a permanent form if the duration of the disorder episode is 10 days.

As an independent phenomenon, a permanent form of atrial fibrillation does not pose a danger to the patient’s life, but can cause negative consequences in the form of the formation of blood clots in the vessels of the brain. Such complications threaten human health and life.

Reasons

In most cases, fibrillation occurs against the background of various cardiovascular diseases, but it can also be caused by other reasons. The disorder develops as a result of factors such as:

• arrhythmias of one nature or another;
• inflammatory processes in the heart muscle (,);
• violation of the valve structures of the heart muscle;
• coronary heart disease;
• type 2 diabetes mellitus, especially in the context of obesity;
• various cardiomyopathies;
• intoxication;
• acquired and some congenital heart defects;
• tumors of the heart muscle;
• endocrine pathologies (in particular, thyrotoxicosis);
• diseases of the central nervous system;
• prolonged stay in rooms with elevated air temperatures;
• performing surgical interventions in the heart area;
• diseases of the gastrointestinal tract (calculous cholecystitis);
• alcohol abuse, nicotine, smoking;
• prolonged exposure to vibrations on the body;
• regular stress;
• intense physical activity;
• kidney diseases.

As for the age factor, the likelihood of progression of the pathology increases if a person turns 55 years old. The risk increases as the body ages.

Persons who have been exposed to electric current are also at risk.

Symptoms

A permanent form of atrial fibrillation occurs in approximately 75% of cases. The asymptomatic course of this disorder is observed in 25 patients out of 100.

The main symptoms of heart rhythm disturbances are:

• rapid heartbeat;
• pain in the chest area;
• attacks of fear or panic;
• a feeling of interruptions in the functioning of the heart, which manifests itself in the fact that the heart first freezes for a short time, and then begins to function again;
• presyncope, fainting;
• weakness;
• darkening of the eyes;
• fatigue;
• dizziness;
• dyspnea;
• irregular pulse of different contents;
• cough.

In some cases, the pathology may manifest itself in frequent urination.

Typically, symptoms indicating the presence of fibrillation appear after physical activity, even if it is minor.

The clinical picture of the deviation is aggravated in the presence of coronary heart disease, hypertension, and valve defects.

Symptoms with this form of pathology can increase over several years.

Diagnostic methods

The permanent form of atrial fibrillation is determined using the following methods:

• visual inspection;
• electrocardiogram;
• analysis of hormones produced by the thyroid gland;
• Holter monitoring, monitoring of rhythm readings throughout the day.

When making a diagnosis, clinical manifestations such as:

• irregularity or deficiency of the patient's pulse;
• different sonority of heart sounds;
• the presence of specific changes on the cardiogram;
• presence of signs of an underlying disease (pathology of the cardiovascular or endocrine system);
• excessive urination after attacks, indicating a permanent form of atrial fibrillation;
• presence of signs of heart failure (wheezing in the lungs, enlarged liver, shortness of breath);
• arrhythmic activity of the heart.

The criteria for permanent atrial fibrillation are:

• shortness of breath, cough and fatigue after exercise;
• dull pain in the heart area;
• interruptions in heart function.

Treatment of permanent atrial fibrillation

Treatment of the disease requires regular use of specific medications that control heart rate, as well as drugs to prevent stroke. They should be taken for life.

This disorder is treated by a cardiologist.

Conservative treatment methods

The chronic form of the pathology cannot be corrected, so therapeutic measures are aimed at preventing complications that may be caused by the disorder.

Patients are prescribed the following groups of drugs:

• antiarrhythmics (Flecainide, Amiodarone, Propafenone);
• calcium antagonists (Diltiazem, Verapamil);
• adrenergic blockers (, Atenolol);
• drugs that slow down the heart rate: they are prescribed if other drugs have not helped restore the heart rhythm (Digoxin, Propranolol);
• diuretics and vitamin complexes can also be used to eliminate arrhythmia;
• to prevent the possibility of blood clots forming inside the vessels of the heart, anticoagulants are prescribed (Warfarin, Cardiomagnyl), and the blood coagulation system is monitored during the therapeutic course;
• To improve blood flow in the heart muscle, taking complexes containing potassium and magnesium is indicated.

Restoring heart rhythm cannot be carried out in the presence of certain health indicators. Such contraindications include the following:

• increase in the size of the left atrium (more than 6 cm);
• the presence of a blood clot in the cavity of the heart muscle;
• untreated thyrotoxicosis;
• age over 65 years;
• the presence of concomitant types of arrhythmia;
• side effects from taking antiarrhythmic drugs.

Also, drugs to restore heart rhythm are not prescribed if patients have congenital abnormalities of the heart muscle. In this case, the course of treatment is determined individually.

Surgical intervention

Surgical treatment for a permanent form of atrial fibrillation is indicated if antiarrhythmic drugs do not have an effect or the patient is intolerant to such drugs, as well as in the case of rapid progression of heart failure. In these cases, cauterization or ablation is performed.

During radiofrequency ablation, areas of the atria in which pathological pulsations are observed are exposed to an electrode, at the end of which there is a radio sensor. It is administered through the femoral vein. The intervention is performed under general anesthesia.

If the main cause of the pathology is heart defects, then surgical intervention will get rid of the main risk factor and prevent relapses of atrial fibrillation.

Features of the diet for a permanent form of atrial fibrillation

Diet is important in the process of correcting the patient’s condition. This is due to the need to control weight, excess of which creates additional stress on the heart muscle, as well as eliminating foods and drinks from the diet that can adversely affect the functioning of the organ.

Patients should follow the following nutritional principles:

• dishes should be warm, both cold and hot foods should be avoided;
• the last meal should be taken no later than 2-3 hours before bedtime;
• You should eat food only when you feel hungry;
• Any type of food must be chewed thoroughly.

It is necessary to exclude from the patient’s diet:

• smoked meats;
• salty;
• spicy;
• fat;
• roast.

The listed products increase the risk of the formation of cholesterol plaques in the vessels, which impede blood flow and further aggravate the patient’s situation.

You can eat:

• different types of cereals;
• fresh fruit;
• protein-rich foods;
• lean meats - chicken, turkey, lean pork;
• green;
• fermented milk products;
• vegetables;
• dried fruits.

For permanent atrial fibrillation, coffee and tea are contraindicated. The drinking regime must be observed, drinking up to 2.5 liters of water per day (this figure does not include the volume of consumed meat or vegetable broth). If there are significant problems with the cardiovascular system or kidneys, you should drink less fluid to avoid swelling and not put additional stress.

Traditional methods

Traditional treatment methods can complement a comprehensive course of treatment. They can only be used on the recommendation of a doctor.

The following recipes are known for correcting the permanent form of atrial fibrillation:

• Calendula infusion. To prepare, pour a tablespoon of plant flowers and 300 ml of hot water. Place the container with the composition in a warm place for an hour. Strain, take half a glass before meals, three times a day.
• Infusion of calendula and mint. You need to take 4 calendula flowers, a teaspoon of fresh chopped mint. Brew the resulting mass with 200 ml of boiling water. Leave the liquid covered for half an hour, then strain. Take 200 ml of the prepared drink 3-4 times a day.
• A decoction based on rose hips. You need to take a tablespoon of fruits, after removing the seeds from them, pour two glasses of boiling water over them, boil for 10 minutes, then strain. Take the decoction chilled, half a glass 30 minutes before meals, 4 times a day. You can add natural honey to the drink to taste.
• Infusion of motherwort and hawthorn fruits. You need to take equal parts of dry grass and dry fruits. Take a tablespoon of the resulting plant mixture, pour 300 ml of boiling water over it, wait 2 hours, then strain. Take the finished decoction 3 times a day, 100 ml each time.
• Viburnum infusion. To prepare it, you need to grind 3 cups of berries and pour the resulting mass with two liters of hot water. Leave the container with the composition, wrapped, for 6 hours. After this, you need to strain the tincture and add 200 g of natural honey to it. It is recommended to take one glass of this product per day before meals. The daily amount should be divided into three doses.
• Juice from grapes and turnips. Finely chop fresh white turnips of medium size and squeeze out the juice using gauze or a juicer. Squeeze red or dark grapes (one large brush is enough) to obtain juice. For each dose, mix 150 ml of the resulting juices. Take twice daily.
• Herbal medicine. You need to take plant materials in equal parts: rosemary, peppermint, valerian root, St. John's wort. Take a tablespoon of the resulting mixture and pour a glass of boiling water. Place in a water bath and hold for 15-20 minutes. Do not bring the liquid to a boil. After 2 hours, strain the broth. Drink 4 times a day, 5 ml, regardless of meals.

Prognosis and possible complications

The most common complication of permanent atrial fibrillation is pulmonary embolism due to the formation and detachment of a blood clot. Other consequences of the pathology include acute heart attack and stroke, acute heart failure.

It is observed in 5% of patients in the first 5 years after the development of pathology. Due to chronic ischemia, chronic heart failure develops, which can subsequently cause myocardial infarction.

The prognosis for life with the described deviation primarily depends on the cause that caused it.

A history of atrial fibrillation doubles the risk of developing pathologies of the cardiovascular system, and the risk of death increases by 1.5 times. At the same time, constant use of medications recommended by a doctor and regular medical examinations create conditions for a favorable prognosis.

Prevention

Primary methods of prevention, that is, measures to prevent the development of a permanent form of atrial fibrillation, are as follows:

• maintaining a healthy lifestyle;
• giving up bad habits;
• monitoring blood pressure indicators;
• promptly consult a doctor if alarming symptoms appear;
• timely treatment of chronic diseases.

Secondary prevention is relevant when pathology is identified. Measures in this case are aimed at preventing the possibility of deterioration of the patient’s condition and the development of complications. Prevention consists of regularly taking antiarrhythmic drugs in the dosage specified by a specialist, monitoring the heart rate, and preventing the formation of blood clots.

Permanent atrial fibrillation is the most persistent type of arrhythmia. This type of pathology cannot be completely cured. To prevent complications, it is necessary to correct the patient’s condition with the help of special medications.

A permanent form of atrial fibrillation is a form of atrial fibrillation. With this rhythm disturbance, a chaotic contraction of the muscle fibers of the atria occurs. This is one of the most common heart disorders.

A permanent form of atrial fibrillation, which has an international classification code of ICD 10, can develop both at a young age and in adulthood. However, most often it is diagnosed in people after 40-60 years of age. This is due to the fact that a number of cardiac diseases contribute to its appearance.

With age, the risk of developing the disease increases. If at the age of 60 years this type of arrhythmia occurs in 1% of 100, then at 80 years it occurs in 6%.

Decoding the elements of the cardiogram

The contraction of the heart is determined by the work of the so-called sinus node. It generates impulses that cause the atria and ventricles to contract in the correct sequence and rhythm. Normally, the heart rate varies between 60-80 beats per minute. The atrioventricular node, in turn, is responsible for preventing the passage of impulses exceeding 180 per minute during contractions.

If the sinus node malfunctions for some reason, the atria begin to generate impulses with a frequency of up to 300 and higher. In this case, not the entire number of impulses enters the ventricles. As a result, they cannot work fully: the atria are not completely filled with blood, and its supply to the ventricles occurs unevenly and in small quantities. A decrease in the pumping function of the atria entails a gradual decrease in the pumping functions of the entire heart.

Atrial fibrillation can be paroxysmal (paroxysmal) or permanent. You can read more about this in a separate article on our website.

According to research, the development of a permanent form is preceded by a stage when the patient experiences attacks of atrial fibrillation from time to time.

An increase in symptoms may develop over a number of years.

The American Heart Association classifies all attacks that last more than one week as permanent. If an episode of sinus node dysfunction lasts up to 2 days, we are talking about the paroxysmal form. The duration of the attack from 2 to 7 days indicates the development of a persistent form of the disease.

In the paroxysmal form, normal activity of the sinus node is restored by itself.

However, it has already been proven that with frequent attacks over a long period of time, changes occur in the atria, as a result of which the paroxysmal form can eventually transform into persistent and then permanent. Therefore, the appearance of the first attacks of fibrillation requires contacting a cardiologist.

An important sign of persistent atrial fibrillation is the inability to maintain sinus rhythm without medical assistance. Also, this type of arrhythmia is extremely rare in healthy people. As a rule, it is accompanied by a number of diseases of the cardiovascular system.

Causes of atrial fibrillation

External and internal causes can provoke the development of the disease. External ones include:

• taking arrhythmogenic drugs;
• long-term alcohol consumption;
• long-term smoking;
• some types of surgery;
• exposure to vibrations in the workplace;
• intoxication with toxic substances;
• intense physical activity;
• hyper- and hypothermia.

It is important to note that these factors can provoke the development of atrial fibrillation, in particular permanent atrial fibrillation, in persons predisposed to cardiac diseases and already having changes in the functioning of the heart, since in this case there is already a violation of the automatic regulation of the cardiovascular system.

Risk factors include:

• coronary heart disease;
• arterial hypertension (high blood pressure);
• valve dysfunction and pathological changes;
• cardiomyopathies of various types;
• heart tumors;
• thyrotoxicosis (hyperfunction of the thyroid gland);
• chronic lung diseases;
• calculous cholecystitis;
• kidney disease;
• hiatal hernia;
• Diabetes mellitus is predominantly type II.

Various inflammatory diseases of the heart muscle can cause the development of atrial fibrillation:

• pericarditis;
• myocarditis.

It is believed that pathological changes in the nervous system can also be a trigger for the development of arrhythmia. Thus, persons with cardioneuroses and cardiophobia should be carefully examined and receive adequate treatment to prevent the development of the disease.

The disease develops in 5-10% of patients with arterial hypertension and in 25% of people with coronary artery disease and heart failure. At the same time, coronary artery disease and the permanent form of atrial fibrillation mutually aggravate each other.

There is a connection between the development of the disease and the presence of severe hypertrophy (enlargement) of the left ventricle and left ventricular dysfunction of the diastolic type. Mitral valve defects dramatically increase the likelihood of developing the disease.

Symptoms of a constant form

25% of patients may not feel any symptoms of rhythm disturbance. However, most often this is a consequence of the fact that a person does not pay attention to a number of changes in well-being, considering them a sign of age, vitamin deficiency or fatigue.

The presence of persistent atrial fibrillation can be indicated by:

• weakness and fatigue;
• frequent dizziness and fainting;
• feeling of heart failure;
• feeling of heartbeat;
• chest pain;
• cough.

As a rule, such symptoms occur after physical activity. The degree of it does not matter - even small physical efforts can cause similar symptoms.

During attacks, a feeling of panic may appear. Atrial fibrillation differs from vegetative disorders with panic attacks and hypertensive crisis of the vegetative type in that at the time of the attack there is not a rise, but a fall in blood pressure.

A distinctive sign of constant fibrillation is an irregular pulse with different contents. In this case, there is a pulse deficiency when its frequency is less than the heart rate.

Hypertension, coronary artery disease, angina pectoris, and valve defects aggravate the symptoms of the disease.

Diagnostic methods

Main research methods:

• personal examination;
• electrocardiogram;
• ECG-Holter monitoring.

It is important to differentiate the disease from diseases with similar symptoms, such as:

• various forms of tachycardia;
• atrial extrasystoles;
• with panic attacks.

From this point of view, the most informative method is the ECG, which is specific for each type of arrhythmia.

The permanent form on the ECG is manifested by irregular rhythm and irregular R-R intervals, absence of P waves, and the presence of erratic F waves with a frequency of up to 200-400. The ventricular rhythm may or may not be regular.

Holter monitoring is a valuable research method because it allows you to identify all rhythm fluctuations during the day, while a regular ECG study may not provide a complete picture.

During a personal examination, the doctor reveals the irregularity of the pulse and interruptions in its filling. An irregular heartbeat can also be heard.

Treatment methods

With this type of arrhythmia, the doctor rarely has the goal of normalizing sinus rhythm. Although, with an unsevere form of the disease, you can try to restore normal sinus rhythm with the help of drug treatment or electrocardioversion. If it is impossible to achieve this, the task is to normalize the heart rate (HR) in the range of 60-80 beats per minute at rest and up to 120 beats during physical activity. It is also important to reduce the risk of blood clots and thromboembolism.

Contraindications to restoring sinus rhythm are:

• the presence of intracardiac thrombi,
• weakness of the sinus node and bradycardic form of atrial fibrillation, when the heart rate is reduced;
• heart defects requiring surgical intervention;
• rheumatic diseases in the active stage;
• severe arterial hypertension 3 degrees;
• thyrotoxicosis;
• age over 65 years in patients with heart disease and 75 years in patients with coronary heart disease;
• dilated cardiomyopathy;
• left ventricular aneurysm;
• frequent attacks of atrial fibrillation, requiring intravenous administration of antiarrhythmics.

Rhythm restoration is carried out with the help of antiarrhythmic drugs such as Dofetilide, Quinidine, as well as with the help of electrical pulse therapy.

In the case of persistent atrial fibrillation, the effectiveness of medications in restoring rhythm is 40-50%. The chances of success when using electropulse therapy increase to 90% if the disease lasts no more than 2 years and are the same 50% if the disease lasts more than 5 years.

Recent studies have shown that antiarrhythmic drugs in people with cardiovascular diseases can have the opposite effect and worsen the arrhythmia and even cause life-threatening side effects.

The doctor may refuse to restore rhythm if there is doubt that sinus rhythm can be maintained for a long time in the future. As a rule, patients tolerate the permanent form of atrial fibrillation more easily than the return from sinus rhythm to atrial fibrillation.

Therefore, the first choice is drugs that reduce heart rate.

B-blockers (drugs for the treatment of permanent atrial fibrillation - metoprolol) and calcium antagonists (verapamil) in combination can help reduce heart rate to the required limits. These drugs are often combined with cardiac glycosides (). Periodically, the patient must undergo monitoring of the effectiveness of treatment. For this purpose, Holter ECG monitoring and bicycle ergometry are used. If it is not possible to normalize the heart rate with medication, then the question arises of surgical treatment, which involves isolating the atria and ventricles.

Since the formation of blood clots is one of the most serious and frequent complications of permanent atrial fibrillation, treatment involves the parallel administration of anticoagulants and aspirin. As a rule, such treatment is prescribed to patients over 65 years of age with a history of stroke, high blood pressure, heart failure, diabetes mellitus, thyroid dysfunction, and coronary heart disease.

For people over 75 years of age, anticoagulant therapy is prescribed for life. Also, such drugs are prescribed on an ongoing basis to those who have a high risk of developing stroke and thromboembolism. The only absolute contraindication to the use of anticoagulants is an increased tendency to bleed.

In the brady form (sparse pulse) of the disease, electrical cardiac stimulation has shown high effectiveness. Stimulation of the ventricles with electrical impulses can reduce rhythm irregularity in patients with a tendency to bradycardia at rest when taking drugs to lower heart rate.

Simultaneous ablation of the atrioventricular node and installation of a pacemaker can improve the quality of life of patients who do not respond to antiarrhythmic drugs, as well as those who have a combination of left ventricular systolic dysfunction in combination with high heart rate.

It should be borne in mind that after installation of a pacemaker, mortality from ventricular arrhythmias reaches 6-7%, the risk of sudden death varies around 2%. Programming the pacemaker to a base rate of 80-90 beats per minute 1 month after installation allows you to reduce the indicators.

Treatment with folk remedies

Traditional methods should be used in parallel with medications prescribed by a doctor. This significantly alleviates the patient’s condition and reduces the risk of side effects. Also, herbal medicine will help reduce the dose of medications taken or gradually abandon them.

First of all, decoctions and tinctures of plants that normalize heart rhythm are used. These include hawthorn, calendula, and motherwort. The effects of mixtures are most effective.

To treat arrhythmia, you can prepare infusions from the above-mentioned plants, taken in equal proportions. You should drink the infusion three times a day, a quarter glass. Treatment is long-term, over several years.

You can mix ready-made tinctures of hawthorn, calendula and motherwort. Drink the mixture three times a day, 30 drops.

Decoctions and infusions of yarrow and mint have proven themselves well. Yarrow, mint, calendula are brewed with boiling water and mixed with honey. The mixture is taken 150 mg 3-4 times a day. Tea made from viburnum, cranberries and lemon mixed with honey has a beneficial effect on well-being.

Lifestyle with permanent atrial fibrillation

If you have arrhythmia, it is extremely important to start leading a healthy lifestyle. You should stop eating fatty, spicy, smoked foods and increase the amount of grains, vegetables and fruits in your diet. Preference should be given to those that are healthy for the heart: figs, dried apricots, persimmons, apples, bananas.

Atrial fibrillation is not an absolute contraindication for physical activity. It is important to choose the most optimal degree of load for yourself.

Gymnastics, daily walks, walking, swimming will help train the heart muscle and lower blood pressure. However, patients will have to give up high-impact sports, as they can cause a worsening of the condition.

It is necessary to constantly monitor your condition and regularly visit your doctor. During drug treatment with anticoagulants, if bruising occurs, you should immediately stop the drug and consult a doctor to eliminate the risk of internal bleeding.

It is important to inform your doctors about the medications you are taking, especially if you are undergoing dental surgery.

Possible complications

Atrial fibrillation is not considered a life-threatening disease, although it can significantly reduce its quality. However, it aggravates the course of existing concomitant diseases of the cardiovascular system. This is the main danger of the disease.

Persistent atrial fibrillation causes persistent circulatory disorders and chronic oxygen starvation of tissues, which can negatively affect myocardial and brain tissue.

The vast majority of patients experience a gradual decrease in tolerance (tolerance) to physical activity. In some cases, a detailed picture of heart failure may appear.

The presence of this form of arrhythmia increases the risk of developing heart failure to 20% in men and 26% in women from the population average values ​​of 3.2% and 2.9%, respectively.

Coronary and cerebral reserve is reduced, which means the risk of development and stroke. Today, persistent atrial fibrillation is considered one of the main causes of ischemic strokes in older people. According to statistics, the incidence of strokes in patients with permanent atrial fibrillation is 2-7 times higher than in others. Every sixth case of stroke occurs in a patient with atrial fibrillation.

Life forecast

If you receive constant adequate treatment, it is quite favorable. The patient’s standard of living at the desired quality can be maintained with medication for a long time. The most favorable prognosis is for patients who do not have severe cardiac or pulmonary diseases. In this case, the risk of thromboembolism is minimized.

With age, with increasing symptoms of heart disease, an increase in the size of the left atrium may occur. This increases the risk of thromboembolism and death. Among people of the same age, mortality in the group with atrial fibrillation is twice as high as in those with sinus rhythm.

Useful video

What atrial febrillation is is shown very clearly and in detail in the following video:

Persistent atrial fibrillation is a disease that requires regular monitoring by a cardiologist and ongoing treatment. Moreover, in each specific case, treatment is selected by the doctor based on the individual characteristics of the patient. Only in this case can the development of life-threatening complications be prevented.