Atrial fibrillation, fibrillatio atriorum (AF)
Atrial fibrillation is the most common
long lasting arrhythmia.
In atrial fibrillation the atria
contract randomly and sometimes so fast that the heart muscle cannot relax
properly between contractions. Electrical impulses move randomly to the
ventricles and cause irregular and often rapid heart beat. This reduces the
heart's efficiency and performance.
AF is rare with people under 60 years
old, but it becomes general with age so that 10 per cent of people over
75 years old ail it.
Paroxysmal
atrial fibrillation - this comes and goes and usually stops within 48
hours without any treatment.
Persistent
atrial fibrillation - this lasts for longer than seven days (or less
when it is treated).
Longstanding
persistent atrial fibrillation - this usually lasts for longer than a year.
Permanent
atrial fibrillation - this is present all the time and there are no more
attempts to restore normal heart rhythm.
Symptoms
Symptoms
can include palpitation, tiredness, shortness of
breath, dizziness or feeling of fainting. However, some people only
have mild symptoms, while other people have no symptoms at all.
Causes
Causes
include high blood pressure, heart valve disease, hyperthyreosis and excess
alcohol consumption. It is
also associated with coronary heart disease. But in many patients no underlying
cause can be found. Sometimes the AF can be resolved once the underlying
condition has been dealt with.
Complications
AF
can increase the risk of a blood clot forming inside the chambers of the heart,
which can lead to a stroke. AF increases stroke risk by around four to five
times.
Treatment
The
treatment of atrial fibrillation (AF) is chosen individually for each patient
taking into consideration the symptoms, co-existing illnesses, the risk factors
of thromboembolic complications, the duration of the arrhythmia and the
anticipated benefits and risks of the treatment.
1. Eliminating the factors that are
exposing and triggering arrhythmias.
Good treatment of basic diseases.
|
2.Rythm control
|
A. Rhythm transfer, restoration of sinus rhythm
|
B. Upkeep of sinus rhythm
|
3. Pulse rate control
|
|
4. Inhibition of thromboembolic
complications
|
|
Factors supporting rate control
In
elderly patients (> 65 years) with mild symptoms, it is justifiable to
abandon repeated attempts at cardioversion and concentrate on rate control and
anticoagulation, particularly in the presence of presdiposing diseases, e.g.
heart failure, coronary heart disease, hypertension or diabetes.
Other
factors supporting rate control:
·
symptoms improve with
rate controlling medication
·
rapid recurrence of
AF (< 2–3 months) despite prophylactic medication
·
echocardiogram shows
enlarged left atrium (> 5 cm)
·
the duration of AF
> 6–12 months
·
a physically inactive
patient
·
no contraindications
to anticoagulation.
Factors supporting rhythm control
The
restoration of sinus rhythm should be attempted, almost without exception in
all cases, of first occurrence of symptomatic AF.
Rhythm
control is the treatment approach of choice, despite the presence of co-existing
diseases, if the patient has severe symptoms or haemodynamic complications
despite maximal rate controlling medication
·
there is a good
response to antiarrhythmic prophylactic medication
·
the left atrium is of
normal size
·
the duration of AF is
< 6 months
·
the patient is young
and physically active
·
there are
contraindications to anticoagulation.
References
British Heart
Foundation
Evidence-Based
Medicine Guidelines
Käypä hoito.
Eteisvärinä.
http://www.kaypahoito.fi/web/kh/suositukset/naytaartikkeli/.../hoi50036
Mustajoki &
Ellonen 2012. Eteisvärinä (flimmeri). Lääkärikirja Duodecim.
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