Contents
Atrial fibrillation is the most common type of heart rhythm disturbance. It also applies to young people, healthy, without accompanying diseases. It does not always give symptoms, and – as Marcin Witkowski, cardiologist emphasizes – the so-called silent atrial fibrillation is much more serious than symptomatic.
- Atrial fibrillation is the most common cardiac arrhythmia, and its incidence increases with age
- Sometimes it does not give symptoms, so the patient does not see a doctor and is not diagnosed. Often the first visible and perceptible symptom of arrhythmia is its most dangerous complication, i.e. a stroke
- Atrial fibrillation is an insidious arrhythmia, but we have more and more “smart” ways to treat it effectively – says Dr. Marcin Witkowski, cardiologist
- More information on interesting information can be found on the Onet homepage
Arrhythmia (not only) of seniors
Atrial fibrillation (AF) is the most common arrhythmia. Although its incidence increases with age, the arrhythmia may also affect young people. AF is more common in men. This arrhythmia is the rapid, uncoordinated activation of the atria, which causes the heart to contract very irregularly. This results, among other things, in a lower cardiac output, the volume of blood that the heart pumps into the blood vessels in one minute. According to the nationwide epidemiological study NOMED-AF, this arrhythmia affects as much as 23 percent. the population of patients over 65 years of age.
Atrial fibrillation is an arrhythmia, which is significantly influenced by risk factors such as: overweight, smoking, excessive alcohol consumption, diabetes, hypertension, heart failure, and coronary artery disease. However, it often happens that the diagnosis of arrhythmia fails to identify the specific cause of atrial fibrillation.
– It happens that seemingly completely healthy people, without accompanying diseases, show up at the cardiologist’s office with paroxysmal atrial fibrillation – explains Dr. Marcin Witkowski from the Department of Cardiology of the Medical University in Białystok, member of the Board of the Heart Rhythm Section of the Polish Society of Cardiology.
– Paroxysmal atrial fibrillation occurs when the patient has a normal, normal heart rhythm most of the time and arrhythmia (a completely irregular heartbeat) occurs from time to time. A single arrhythmia attack may last from several hours to several days. This form of atrial fibrillation may resolve spontaneously or be terminated clinically. Another form of AF is the surviving form. It occurs when atrial fibrillation is present continuously for several weeks or several months. If, for specific clinical reasons, we decide not to restore the normal heart rhythm or the correct rhythm cannot be restored, it is said to be permanent atrial fibrillation, ‘he adds.
(Not always) noticeable symptoms
Atrial fibrillation can be manifested by: feeling of rapid heartbeat, weakness, worse exercise tolerance, dizziness. Patients who take their blood pressure during an arrhythmia often find a high pulse and low – or vice versa – high blood pressure. However, atrial fibrillation does not always produce symptoms that are noticeable to the patient. It is then said to be a silent form of arrhythmia.
– Symptoms of atrial fibrillation may not be felt or felt to a very limited degree in patients with persistent or permanent atrial fibrillation. Undetectable or modest symptoms of arrhythmia may also occur in patients with implanted pacemakers, implanted due to atrioventricular block. Accelerated pulse in this group of patients will not occur because the pacemaker imposes a regular heart rate. When it comes to age dependence, older patients usually do not experience arrhythmia, especially in those over 80 years of age. The paradox is that it is also the group of patients most exposed to serious complications of arrhythmia, emphasizes Dr. Marcin Witkowski.
According to the specialist, silent atrial fibrillation is much more dangerous than symptomatic. The patient, unaware of arrhythmia and the risks associated with its complications, does not report to the doctor, is not diagnosed and properly treated. Often the first visible and perceptible symptom of arrhythmia is its most dangerous complication, i.e. a stroke.
(Und) appreciated diagnostics
There are many devices on the market that support population-based screening for atrial fibrillation diagnosis. According to cardiologists, some clues about the worrying work of the heart can be provided by cyclical manual pulse measurement (instructions from the Heart Rhythm Section of the Polish Cardiac Society on how to do it correctly can be found here) or a home examination with the use of a blood pressure device.
On a daily basis, various types of watches and wristbands with built-in algorithms that analyze the work of the heart (as doctors point out, it is important that they are certified devices with the status of medical devices) prove to be helpful. In strictly defined clinical cases, implantable arrhythmia recorders are also used in the diagnosis of atrial fibrillation. Among the group of cardiac patients with implanted pacemakers, telemonitoring is an important support.
– Telemonioration of implantable devices enables remote control of the patient’s heart. Patients with implanted: pacemakers, cardioverter-defibrillators or resynchronization therapy systems transmit (independently or automatically) cyclical reports on the work of their heart and the implanted device. If the patient develops atrial fibrillation (even if the arrhythmia is asymptomatic, not felt at all by the patient), the monitoring center will be notified. The doctor verifying the cyclically received reports will contact the patient and inform about further proceedings. Quick information about abnormalities is a greater chance for more effective protection of the patient against dangerous complications of arrhythmia – explains Dr. Marcin Witkowski.
Treatment: (not) only ablation
Experts from the Heart Rhythm Section of the Polish Cardiac Society point out that a definitive cure for atrial fibrillation is very difficult. Pharmacotherapy, i.e. drugs with antiarrhythmic effects designed to prevent further arrhythmias, have limited effectiveness. Experts explain that this means that drugs can significantly reduce the number of seizures, but will not cure the patient of the arrhythmia.
– In recent years, we cannot boast of successes in the field of new antiarrhythmic drugs, hence, among others, the trend towards the growing importance of a more effective therapy, which is atrial fibrillation ablation. The success rate of surgical treatment of atrial fibrillation is between 75 and 80 percent. Ablation is an effective method of therapy, which is confirmed by the latest scientific guidelines of the European Society of Cardiology (ESC), which indicate that atrial fibrillation ablation can be considered the treatment method of choice in patients with atrial fibrillation in whom drug treatment was not effective.
What is new in the latest ESC guidelines is the increased role of ablation in the treatment of persistent forms of this arrhythmia – it turns out that surgical treatment can effectively help improve the health and quality of life of this group of patients. The ESC guidelines also recommend considering re-ablation (usually with a different method) in those patients in whom it has already been used but, despite the initially good effect, symptoms have returned. The guidelines indicate that re-treatment can significantly improve the effectiveness of the therapy.
(Not only) pharmacological prevention of complications
The most serious complications of undiagnosed and / or improperly treated atrial fibrillation are ischemic stroke and heart failure, which may develop over time as a result of prolonged, rapid, chaotic atrial operation. According to specialists, these conditions can and should be prevented.
Oral anticoagulants are the gold standard in the prevention of ischemic stroke.
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– The latest ESC guidelines highlight the growing importance of so-called novel oral anticoagulants (NOACs). Currently, it is recommended to change and use this therapy even in patients previously treated with previous generation drugs (warfarin derivatives), especially if this treatment was not fully effective (the amount of time the blood thinning index remained within the therapeutic range was below 70%. ). As part of the prevention of complications of atrial fibrillation associated with stroke in some groups of patients, including those who have contraindications to the use of NOAC drugs or who have complications after their use, a surgical method – the so-called closure of the left atrial appendage, can be considered.
Watch out for the lifestyle!
An active search for arrhythmia, especially in the groups of people most at risk of developing it, plays an increasingly important role in preventing complications and effective therapy of atrial fibrillation. The latest scientific recommendations indicate that the active search for arrhythmias should be carried out, among others, in patients with arterial hypertension and obstructive sleep apnea. It is known that these groups of patients are more likely to develop atrial fibrillation, and the earlier the diagnosis is made, the earlier the treatment is started and the greater the chance of avoiding complications.
Each subsequent update of the scientific guidelines also places increasing emphasis on the role of lifestyle modification as a key component of effective atrial fibrillation therapy.
– If a patient is overweight or obese, one of the most important factors in the successful treatment of arrhythmias is supporting the patient in a healthy, safe and long-term weight loss. Proper control over comorbidities is no less important, including: proper treatment of arterial hypertension, coronary artery disease, and diabetes. Similarly, it is worth focusing efforts on eliminating stimulants, implementing daily physical activity, adapted to the needs and capabilities of the body. The more risk factors are reduced or eliminated, the greater the chances of improving the health and quality of life of patients are also greater. The key is a healthy lifestyle, active prophylaxis, the use of the most effective methods of therapy and prevention of complications, as well as constant health monitoring and regular intake of the prescribed therapy. Such a “clever” combination of various methods allows us to fight the insidious arrhythmia of atrial fibrillation more and more effectively – says Dr. Marcin Witkowski.