In Poland, they can have up to 700. people. It’s a dangerous condition

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Atrial fibrillation is one of the most common arrhythmias. The risk of its occurrence increases with age. Atrial fibrillation is not self-limiting – it is associated with a specific cause. The risk factor is, inter alia, unsanitary lifestyle.

1. Diseases such as hypertension or coronary artery disease may be responsible for atrial fibrillation
2. The development of arrhythmia is also influenced by lifestyle – lack of physical activity, consumption of alcohol or smoking
3. Atrial fibrillation can have serious health consequences. People with this arrhythmia may develop, inter alia, for ischemic stroke
4. More information can be found on the Onet homepage.

Atrial fibrillation affects many Poles. It can be life threatening

Atrial fibrillation (AF) is the most common arrhythmia among complex arrhythmias, that is, other than single extrasystoles and pairs of extras. It is estimated that in 2016 almost 44 million people worldwide suffered from this arrhythmia.

According to the European Society of Cardiology (ESC), Poland belongs to the group of countries where atrial fibrillation occurs with a frequency of 600-699 cases per 100. residents. It seems, however, that these values ​​are underestimated and the number of people in Poland with various forms of this arrhythmia ranges from 500 to 700 thousand. Due to the fact that this arrhythmia causes a significant increase in morbidity and mortality in affected patients, it poses a significant burden on the health of society and the healthcare system.

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The percentage of patients who can be diagnosed with atrial fibrillation increases with age and, according to the multicentre Polish study NOMED-AF, the incidence of this arrhythmia in the population over 65 years of age. is as much as 23 percent. Moreover, one in three Europeans aged 55 will be diagnosed with this arrhythmia before the end of their lives.

Where does atrial fibrillation come from?

The deepening knowledge of the factors increasing the risk of AF caused that the authors of the ESC recommendations for the diagnosis and treatment of this arrhythmia published in 2020 believe that it is no longer possible to talk about the spontaneous form of AF. Every case has a cause, is due to some disease or clinical condition. Among almost 50 factors mentioned in the already cited recommendations, the most important are: arterial hypertension, coronary artery disease, valvular disease, heart failure, diabetes and pre-diabetes, acute diseases, including infectious (including COVID-19) and requiring surgery, chronic , obstructive pulmonary disease, obstructive sleep apnea, lipid metabolism disorders. The risk factors for this arrhythmia also include those related to lifestyle: lack of physical activity (of recreational intensity), excessive alcohol consumption, smoking and obesity. These factors not only increase the risk of atrial fibrillation, but also significantly reduce the effectiveness of treatment.

What is atrial fibrillation?

Atrial fibrillation is a disturbance of the rhythm in which there is rapid and disorderly activation from multiple, loop-shaped centers. The effect of this electrical activation is that the atrial walls shake, instead of contracting them in order. In this situation, the atria do not support the blood flow to fill the heart chambers more and increase the volume of blood ejected into the arteries with each contraction. Thus, in a patient with atrial fibrillation, the performance of the heart decreases.

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The second extremely important fact resulting from the appearance of AF is the risk of thrombus formation, which by breaking apart can close the lumen of the artery, including the cerebral artery, stopping blood flow, which can lead to ischemic stroke with all its consequences. Atrial thrombus formation in patients with atrial fibrillation is due to the fact that the inner surface of this heart structure is not smooth. It has many recesses and cavities, especially within the structure known as the left atrium appendage. The lack of blood flow, which is caused by the trembling of the walls, promotes blood clotting.

Thus, we have two effects of atrial fibrillation that can be devastating for people affected by this arrhythmia: the development of heart failure and the risk of thromboembolism favoring the occurrence of strokes, which are much more severe in people with AF and contribute to significant disability and even death.

The risk of a stroke in a patient with atrial fibrillation who does not take anticoagulants, depending on the risk of thromboembolism, may be as high as 20%. per year. The deterioration of the long-term prognosis in people with atrial fibrillation concerns, apart from the already mentioned: the development of heart failure (it affects 20-30% of patients with AF) and strokes (up to 30% of strokes are associated with the occurrence of this arrhythmia), as well as the increased risk of death (1,5 , 3,5-10 times), hospitalization (40-40% of patients with AF are hospitalized each year), cognitive impairment and dementia (by 60 and 16%, respectively), development of depression (increase by 20-60% .), including suicidal thoughts and in as many as XNUMX% there is a deterioration in the quality of life.

How does atrial fibrillation progress?

Atrial fibrillation is a progressive rhythm disturbance. Initially, attacks of this arrhythmia occur infrequently, are short-lived, and resolve spontaneously. Over time, arrhythmias occur more frequently, last longer, and require medical attention to terminate the arrhythmia. In the final stage of the disease, not only is it not possible to maintain normal sinus rhythm in the long term, but even stopping AF becomes impossible.

In many patients, especially in the initial stage of arrhythmia, it may be completely asymptomatic, which does not mean that there is no risk of a stroke. In extreme forms, the symptoms of atrial fibrillation are so severe that normal existence is impossible.

What are the symptoms of atrial fibrillation?

The most common symptoms seen in patients with atrial fibrillation include palpitations (fast, completely chaotic, uneven heartbeat), shortness of breath, and fatigue. Feelings of heaviness, pressure, chest pain, decreased exercise tolerance, dizziness, loss of consciousness and sleep disturbance may occur.

In the most severe cases, especially in patients with advanced structural heart disease, apart from loss of consciousness, symptomatic hypotension, pulmonary edema, significant myocardial ischemia or even cardiogenic shock, i.e. life-threatening conditions, may also appear.

How is atrial fibrillation diagnosed?

The basis for the diagnosis of AF is a classic electrocardiographic examination or a 30-second recording of one surface ECG channel, which indicates the occurrence of this arrhythmia. In the early stages of atrial fibrillation, ECG documentation of this arrhythmia may be difficult due to its paroxysmal nature and short duration. Therefore, various activities are undertaken to early recognize this arrhythmia and effective treatment, which significantly reduces the risk of the above-described complications.

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In people over 65 years of age each medical visit should assess whether AF occurs – on the basis of auscultation of the heart, pulse testing, or even an electrocardiogram. In people over 75 years of age it is worth actively looking for atrial fibrillation through more frequent visits to the doctor and performing additional tests, e.g. 24-hour ECG recording with the Holter system. This mainly applies to patients with heart palpitations, irregular heartbeats and those at high risk of thromboembolism. Self-monitoring of heart rate should become a common screening test for anyone over 65 years of age. Finding irregular heart rate, which lasts continuously for at least 30 seconds, should be reported to your doctor. Especially if the symptoms discussed above appear during it.

Treatment for atrial fibrillation

As mentioned, one of the most dangerous complications of AF is ischemic stroke and other thromboembolic episodes. A thromboembolic risk scale has been proposed, which is used in every patient with AF, and the calculated low risk should be confirmed in subsequent index calculations at intervals of 4-6 months. Thromboembolic risk factors include: heart failure or hypertrophic cardiomyopathy (1 point), age 75 or older (2 points), 65-74 years (1 point), hypertension, including those treated with normal target values ​​(1 point ), diabetes (1 point), previous ischemic stroke, transient ischemic or peripheral thromboembolic episode (2 points), vascular disease (coronary, peripheral, aortic plaque – 1 point), and finally female (1 point). The vast majority of people with a low risk of thromboembolism (men – 0 points, women – 1 point) do not require chronic thromboembolism to prevent stroke. Anticoagulation treatment should be considered in persons with a risk score of 1 – men and 2 – women, and at higher values, anticoagulation should be done.

Other pillars of treatment of patients with atrial fibrillation, apart from the prevention of strokes, are the reduction of symptoms related to AF and the intensive treatment of comorbidities, lifestyle modification, including – which is very strongly emphasized – the fight against overweight and obesity. Symptoms related to atrial fibrillation are reduced primarily by controlling the heart rate during an arrhythmia. Secondly, the possibility of restoring and maintaining sinus rhythm (termination of atrial fibrillation) is assessed. Emergency termination of atrial fibrillation is achieved by cardioversion: pharmacological or electrical, preceded by at least 3 weeks of anticoagulant therapy. In exceptional cases, restoration of the sinus rhythm is possible without several weeks of anticoagulant preparation, however, it requires specialized tests confirming a low risk of stroke. In addition, drugs and non-pharmacological methods – ablation are used to control the heart rate and restore sinus rhythm.

The elimination of risk factors for the appearance of atrial fibrillation, its early diagnosis, effective treatment of the arrhythmia itself, as well as accompanying diseases and conditions, and effective prevention of strokes are the canons of management of atrial fibrillation. An effective system of care for this group of patients will significantly reduce complications, hospitalization and mortality, which in the long run will bring savings for the health care system.

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