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Atrial fibrillation (auricular fibrillation) — is one of the most common forms of rhythm disturbance. About 2% of the world's population suffers from this dangerous cardiovascular disease, which increases the risk of thrombembolia and other vascular accidents.
Exposure to atrial fibrillation progresses with the age of patients, what is associated with worsening of cardiac activity and an increased incidence of heart and vascular diseases. About 8% of the elderly (from 75 years and older) have a heart rhythm disorder by type of atrial fibrillation.
Normally, the heart cycle consists of three consecutive phases:
The atriums contract, the valvules, which flowing into the atria of the veins close, blood rushes into heart ventricles.
Ventricles contract, valvules connecting the atrium and ventricles are closed, blood rushes into the aorta and pulmonary artery.
The period of complete relaxation, during which the blood rushes from the veins through the open valvules, fills the atrium and partly the ventricles.
Periodicity of contraction of muscle groups is created and regulated by a conduction system of heart - a complicated complex of nerve nodes and fibers. The valves are designed in such a way that under the influence of blood pressure in the cavities their valvules can open and close depending on the phase of the heart cycle.
Atrial fibrillation is usually a complication of the following diseases:
Heart and blood vessels diseases:
arterial hypertension, ischemic heart disease, cardiomyopathy, myocarditis, other arrhythmias, the consequences of heart surgery.
Endocrine diseases:
pheochromocytoma, pathology of thyroid gland with an increase in its secretory function (hyperthyroidism).
Metabolic disorders:
a violation of the balance of potassium and magnesium, hypoxia.
Toxic damage:
alcohol intoxication.
Neurological diseases with CNS lesion:
stroke, transient cerebral blood flow disorder.
The effect of certain drugs:
cardiac glycosides, theophylline, etc.
In a number of cases, atrial fibrillation can develop against a background of complete health: in this case it's reasonably to talk about idiopathic auricular fibrillation. The idiopathic form accounts for about 1/3 of all patients with atrial fibrillation under the age of 60 years old. In a case where it is possible to identify the cause of arrhythmia, a diagnosis of secondary atrial fibrillation is exposed.
In addition to mentioned above diseases, the risk factors include:
obesity;
PND;
alcohol overuse;
physical overwork;
inflammatory disease;
inherited predisposition.
A clinical research, which was conducted in the USA aimed to identify a hereditary factor of atrial fibrillation revealed a very revealing fact: risk of auricular fibrillation increases threefold in individuals whose immediate relatives have suffered from this disease.
Previously it was believed that the gene factor is important only for idiopathic atrial fibrillation. However, the last received data suggest that secondary auricular fibrillation is more common in patients with a burden family medical history of the disease.
In the emergence of the disease, the gene of the renin-angiotensin-aldosterone system (RAAS), which is responsible for secretion of biologically active substances, which regulate the work of the heart and excretory system, is of great importance. However, there is no a single gene that encodes the morphological and physiological conditions for the onset of atrial fibrillation.
Nowadays, there are known several genes and their modifications, the detection of which indicates an increased risk of this disease.
Atrial fibrillation can have different duration, it can be constant and episodic.
The severity of disease is assessed by classification EHRA:
In some cases, patients do not complain about health at all: the arrhythmia is either detected accidentally, for example, during a preventive examination, or causes a vascular catastrophe (insult, myocardial infarction). This course of disease is characteristic of paroxysmal form of atrial fibrillation.
The remaining patients usually make the following complaints:
sensations of intermissions in a heart, its "fading", periodic strong heart pushes;
weakness, rapid fatigability;
dizziness;
short-windedness;
faintness.
To clarify the diagnosis, ECG, ECG monitoring, Echocardiography (according to doctor's indications, can be used an esophagus study), computed tomography, laboratory tests with obligatory analysis of thyroid hormones are performed. The examination is always aimed not only to confirm the diagnosis of atrial fibrillation, but also to determine its cause, which is extremely important for effectiveness of treatment.
Every day thousands of people are forced to spend huge sums for treatment of cardiovascular diseases.
Head off the disease: take the DNA test on the genetic predisposition to atrial fibrillation and create reliable protection for your heart.
Atrial fibrillation is fraught with serious complications that can worsen the general condition, lead to disability and cause death.
Uncoordinated contractions of muscle fibers of atria lead to disruption of normal blood flow and its stagnation in individual zones. This becomes the cause of blood clots formation, which can enter the vessels to any remote organ. The most frequent and dangerous thromboembolic complication is an insult — an acute disorder of cerebral circulation with necrosis of a site of nervous tissue. In a number of cases, an insult that has developed against the background of atrial fibrillation is asymptomatic, so many experts recommend all patients with newly diagnosed auricular fibrillation should have an MRI of the brain.
If the disease is accompanied by tachycardia (rapid contraction of ventricles of heart), there is an overload of the myocardium. Nutrition of heart muscle becomes worse, it stretches, reducing contractility of myocardium.
It can be outcome of cardiomyopathy, or it can occur with a severe attack of atrial fibrillation.
Timely treatment with regular ECG control avoids complications or significantly reduces their severity and consequences.
If auricular fibrillation is detected, treatment should begin as soon as possible.This approach shows the best long-term results. Treatment of the disease is always complex with mandatory correction of cause of arrhythmia (if it was establied).
Tactic of therapy is developed individually, taking into account special characteristics of the disease, concomitant pathology and complicating conditions. For patients with atrial fibrillation there are two fundamentally different approaches to treatment: in one case, attempts are made to eliminate arrhythmia and restore the normal heart rhythm; in another one, a decision is made to maintain arrhythmia with medication control of heart rate to reduce risk of complications and to improve quality of life.
This treatment strategy is usually chosen for young patients with satisfactory somatic condition and absence of severe concomitant diseases. The rhythm is restored by one of two ways:
Pharmacological cardioversion:
it is carried out with the help of antiarrhythmic drugs. The dose should be selected individually. The duration of pharmacological cardioversion is several hours: during this time the patient is under the supervision of a doctor.
Electroimpulse cardioversion (defibrillation):
is more effective, but it involves certain risks and need for light anesthesia.
Both methods are aimed at eliminating rhythm disturbance. After an effective cardioversion, dynamic observation and maintenance therapy are prescribed, as a rule. Relapses of atrial fibrillation after successful cardioversion occur in almost half of the patients, so the goal of maintenance therapy is not complete elimination of arrhythmia, but reduction in frequency and severity of attacks.
For elderly patients with severe tachycardia (rapid ventricular contraction), clear heart damage and prolonged course of atrial fibrillation, treatment with lowering heart rate is more suitable. Such therapy improves quality of life, but does not inhibit progression of pathological process.
With a high risk of thromboembolic complications, drugs that reduce blood clotting and prevent the formation of blood clots are prescribed. Treatment is carried out with dynamic control of coagulability indicators with a goal to prevent dangerous bleeding.
Surgical treatment of atrial fibrillation is usually performed by the method of catheter ablation - radiofrequency cauterization. Usually, the part of the conducting system of heart that is the source of chaotic impulses is subjected to destruction. The operation is carried out in a closed way: all manipulators are brought to the ablation area by catheters through the vessels. The accuracy of the impact is controlled by computerized systems.
Another variant of ablation is complete intersection of main bundles of conduction system of heart with subsequent installation of an artificial pacemaker. Such an operation is prescribed for patients with a severe course of disease, which is not amenable to standard methods of treatment.
Prevention of auricular fibrillation is based on several points:
active lifestyle;
control of weight and blood pressure;
smoking and alcohol overuse cessationg;
timely treatment of heart disease and endocrine system;
regular preventive examinations;
well-balanced work and rest schedule.
DNA test is the only diagnostic technique that allows to determine genetic predisposition to atrial fibrillation. Basing on the results of test, the specialist will be able to select a survey plan with an individual set of diagnostic procedures and his own visit schedule.
Take care of your heart condition: start effective arrhythmia prevention as early as possible!
