What is atrial fibrillation. Atrial fibrillation of the heart - causes, symptoms and treatment, drugs

General information

(atrial fibrillation) - a violation of the heart rhythm, accompanied by frequent, chaotic excitement and atrial contraction or twitching, fibrillation of individual groups of atrial muscle fibers. The heart rate with atrial fibrillation reaches 350-600 per minute. With prolonged paroxysm of atrial fibrillation (more than 48 hours), the risk of thrombosis and ischemic stroke increases. With a constant form of atrial fibrillation, a sharp progression of chronic circulatory failure can be observed.

Atrial fibrillation is one of the most common variants of arrhythmias and accounts for up to 30% of hospitalizations for arrhythmias. The prevalence of atrial fibrillation increases with age; it occurs in 1% of patients under 60 years of age and in more than 6% of patients over 60 years of age.

Classification of atrial fibrillation

The basis of the modern approach to the classification of atrial fibrillation includes the nature of the clinical course, etiological factors and electrophysiological mechanisms.

There are permanent (chronic), persistent and transient (paroxysmal) forms of atrial fibrillation. In the paroxysmal form, the attack lasts no more than 7 days, usually less than 24 hours. Persistent and chronic atrial fibrillation lasts more than 7 days, the chronic form is determined by the ineffectiveness of electrical cardioversion. Paroxysmal and persistent forms of atrial fibrillation may be recurrent.

Distinguish for the first time an attack of atrial fibrillation and recurrent (second and subsequent episodes of atrial fibrillation). Atrial fibrillation can occur in two types of atrial arrhythmias: atrial fibrillation and atrial flutter.

With atrial fibrillation (fibrillation), individual groups of muscle fibers are reduced, as a result of which there is no coordinated contraction of the atrium. A significant number of electrical impulses are concentrated in the atrioventricular junction: some of them are delayed, others spread to the ventricular myocardium, causing them to contract with different rhythms. According to the frequency of contractions of the ventricles, there are tachysystolic (ventricular contractions of 90 or more per minute), normosystolic (ventricular contractions from 60 to 90 per minute), bradysystolic (ventricular contractions less than 60 per minute) forms of atrial fibrillation.

During paroxysm of atrial fibrillation, there is no pumping of blood into the ventricles (atrial supplementation). The atria contract inefficiently, therefore, in diastole, the ventricles are not completely filled with blood flowing freely into them, as a result of which there is no periodic ejection of blood into the aortic system.

Atrial flutter is rapid (up to 200-400 per minute) atrial contractions while maintaining the correct coordinated atrial rhythm. Myocardial contractions during atrial flutter follow each other almost without interruption, there is almost no diastolic pause, the atria do not relax, being in systole most of the time. Filling the atria with blood is difficult, and, consequently, the flow of blood into the ventricles is also reduced.

Every 2nd, 3rd, or 4th impulses can be delivered to the ventricles through the atrioventricular connections, providing the correct ventricular rhythm - this is the correct atrial flutter. In violation of atrioventricular conduction, a chaotic contraction of the ventricles is noted, i.e., an irregular form of atrial flutter develops.

Causes of atrial fibrillation

Both cardiac pathology and diseases of other organs can lead to the development of atrial fibrillation. Most often, atrial fibrillation accompanies the course of myocardial infarction, cardiosclerosis, rheumatic heart disease, myocarditis, cardiomyopathies, arterial hypertension, severe heart failure. Sometimes atrial fibrillation occurs with thyrotoxicosis, intoxication with adrenomimetics, cardiac glycosides, alcohol, and can be provoked by neuropsychic overload, hypokalemia.

Idiopathic atrial fibrillation also occurs, the causes of which remain unidentified even with the most thorough examination.

Symptoms of atrial fibrillation

Manifestations of atrial fibrillation depend on its form (bradysystolic or tachysystolic, paroxysmal or constant), on the state of the myocardium, valvular apparatus, and individual characteristics of the patient's psyche. The tachysystolic form of atrial fibrillation is much more difficult to tolerate. At the same time, patients feel palpitations, shortness of breath, aggravated by physical exertion, pain and interruptions in the heart.

Usually, at first, atrial fibrillation proceeds paroxysmal, the progression of paroxysms (their duration and frequency) is individual. In some patients, after 2-3 attacks of atrial fibrillation, a persistent or chronic form is established, in others, rare, short paroxysms are noted throughout life without a tendency to progress.

The occurrence of paroxysmal atrial fibrillation can be felt in different ways. Some patients may not notice it and only become aware of the presence of an arrhythmia during a medical examination. In typical cases, atrial fibrillation is felt by chaotic heartbeats, sweating, weakness, trembling, fear, polyuria. With an excessively high heart rate, dizziness, fainting, Morgagni-Adams-Stokes attacks can be observed. Symptoms of atrial fibrillation disappear almost immediately after the restoration of sinus heart rhythm. Patients suffering from a permanent form of atrial fibrillation cease to notice it over time.

During auscultation of the heart, chaotic tones of varying volume are heard. An arrhythmic pulse with different amplitudes of pulse waves is determined. With atrial fibrillation, a pulse deficit is determined - the number of minute contractions of the heart exceeds the number of pulse waves). Pulse deficiency is due to the fact that not with every heartbeat, blood is ejected into the aorta. Patients with atrial flutter feel palpitations, shortness of breath, sometimes discomfort in the region of the heart, pulsation of the veins of the neck.

Complications of atrial fibrillation

The most common complications of atrial fibrillation are thromboembolism and heart failure. In mitral stenosis complicated by atrial fibrillation, blockage of the left atrioventricular orifice by an intra-atrial thrombus can lead to cardiac arrest and sudden death.

Intracardiac thrombi can enter the arterial system of the systemic circulation, causing thromboembolism of various organs; of these, 2/3 with the blood flow enter the cerebral vessels. Every 6th ischemic stroke develops in patients with atrial fibrillation. The most susceptible to cerebral and peripheral thromboembolism are patients over 65 years of age; patients who have already undergone thromboembolism of any localization; suffering from diabetes mellitus, systemic arterial hypertension, congestive heart failure.

Heart failure with atrial fibrillation develops in patients suffering from heart defects and impaired ventricular contractility. Heart failure in mitral stenosis and hypertrophic cardiomyopathy may present with cardiac asthma and pulmonary edema. The development of acute left ventricular failure is associated with impaired emptying of the left heart, which causes a sharp increase in pressure in the pulmonary capillaries and veins.

One of the most severe manifestations of heart failure in atrial fibrillation may be the development of arrhythmogenic shock due to inadequately low cardiac output. In some cases, the transition of atrial fibrillation to ventricular fibrillation and cardiac arrest is possible. Most often, with atrial fibrillation, chronic heart failure develops, progressing up to arrhythmic dilated cardiomyopathy.

Diagnosis of atrial fibrillation

Atrial fibrillation is usually diagnosed during a physical examination. On palpation of the peripheral pulse, a characteristic disordered rhythm, filling and tension is determined. During auscultation of the heart, non-rhythmic heart tones are heard, significant fluctuations in their volume (the volume of the I tone following the diastolic pause varies depending on the size of the diastolic filling of the ventricles). Patients with identified changes are referred for consultation with a cardiologist.

Confirmation or clarification of the diagnosis of atrial fibrillation is possible using the data of an electrocardiographic study. With atrial fibrillation, there are no P waves on the ECG that register atrial contractions, and the ventricular QRS complexes are randomly located. With atrial flutter, atrial waves are determined at the site of the P wave.

A transesophageal electrophysiological study (TECG) is performed to determine the mechanism of development of atrial fibrillation, which is especially important for patients who are scheduled for catheter ablation or implantation of a pacemaker (artificial pacemaker).

Treatment of atrial fibrillation

The choice of treatment tactics for various forms of atrial fibrillation is aimed at restoring and maintaining sinus rhythm, preventing repeated attacks of atrial fibrillation, controlling heart rate, and preventing thromboembolic complications. For the relief of paroxysms of atrial fibrillation, the use of novocainamide (intravenously and orally), quinidine (orally), amiodarone (intravenously and orally) and propafenone (orally) under the control of blood pressure and electrocardiogram levels is effective.

A less pronounced result is obtained by the use of digoxin, propranolol and verapamil, which, however, by reducing the heart rate, improve the well-being of patients (reduction of shortness of breath, weakness, palpitations). In the absence of the expected positive effect from drug therapy, electrical cardioversion is resorted to (applying a pulsed electrical discharge to the region of the heart to restore the heart rhythm), which stops paroxysms of atrial fibrillation in 90% of cases.

With atrial fibrillation lasting more than 48 hours, the risk of thrombosis increases sharply, therefore, in order to prevent thromboembolic complications, warfarin is prescribed. To prevent the recurrence of attacks of atrial fibrillation after the restoration of sinus rhythm, antiarrhythmic drugs are prescribed: amiodarone, propafenone, etc.

When a chronic form of atrial fibrillation is established, a constant intake of adrenergic blockers (atenolol, metoprolol, bisoprolol), digoxin, calcium antagonists (diltiazem, verapamil) and warfarin (under the control of coagulogram parameters - prothrombin index or INR) is prescribed. With atrial fibrillation, it is necessary to treat the underlying disease that led to the development of rhythm disturbance.

The method that radically eliminates atrial fibrillation is radiofrequency isolation of the pulmonary veins, during which the focus of ectopic excitation, located at the mouths of the pulmonary veins, is isolated from the atria. Radiofrequency isolation of the orifice of the pulmonary veins is an invasive technique, the effectiveness of which is about 60%.

With frequently recurring attacks of atrial fibrillation or with its constant form, it is possible to perform RFA of the heart - radiofrequency ablation ("cauterization" with an electrode) of the atrioventricular node with the creation of a complete transverse AV blockade and implantation of a permanent pacemaker.

Prognosis for atrial fibrillation

The main prognostic criteria for atrial fibrillation are the causes and complications of rhythm disturbance. Atrial fibrillation caused by heart defects, severe myocardial damage (large-focal myocardial infarction, extensive or diffuse cardiosclerosis, dilated cardiomyopathy) quickly leads to the development of heart failure.

Prognostically unfavorable thromboembolic complications caused by atrial fibrillation. Atrial fibrillation increases mortality associated with heart disease by 1.7 times.

In the absence of severe cardiac pathology and a satisfactory condition of the ventricular myocardium, the prognosis is more favorable, although the frequent occurrence of paroxysms of atrial fibrillation significantly reduces the quality of life of patients. With idiopathic atrial fibrillation, well-being is usually not disturbed, people feel almost healthy and can do any work.

Prevention of atrial fibrillation

The goal of primary prevention is the active treatment of diseases that are potentially dangerous in terms of the development of atrial fibrillation (arterial hypertension and heart failure).

Measures of secondary prevention of atrial fibrillation are aimed at following the recommendations on anti-relapse drug therapy, cardiac surgery, limiting physical and mental stress, and refraining from drinking alcohol.

Atrial fibrillation (atrial fibrillation, atrial fibrillation) is one of the types of heart rhythm disorders, which is characterized by rapid irregular atrial contraction with a frequency of 350-700 per minute. If the paroxysm of atrial fibrillation lasts more than 48 hours, the risk of thrombosis and the development of severe ischemic stroke increases dramatically. The chronic form of atrial fibrillation contributes to the rapid progression of chronic cardiovascular insufficiency.

Patients with atrial fibrillation in the practice of a cardiologist are not uncommon. In the overall structure of the incidence of various types of arrhythmias, atrial fibrillation accounts for about 30%. Its prevalence increases with age. So, up to 60 years, this type of arrhythmia is observed in 1% of people, and after 60 years, the disease is already detected in 6%.

Atrial fibrillation is characterized by frequent excitation and contraction of the atria.

Forms of the disease

The classification of forms of atrial fibrillation is carried out taking into account electrophysiological mechanisms, etiological factors and clinical course.

According to the duration of the course of the pathological process, the following forms of atrial fibrillation are distinguished:

• paroxysmal (transient)- an attack in most cases lasts no more than a day, but can last up to a week;
• persistent- signs of atrial fibrillation persist for more than 7 days;
• chronic– its main distinguishing feature is the inefficiency of electrical cardioversion.

Persistent and transient forms of atrial fibrillation may have a relapsing course, i.e. attacks of atrial fibrillation may occur repeatedly.

Depending on the type of atrial arrhythmia, atrial fibrillation is divided into two types:

1. Flickering (fibrillation) of the atria. There is no coordinated contraction of the atria, since there is an uncoordinated contraction of individual groups of muscle fibers. The atrioventricular junction accumulates many electrical impulses. Some of them begin to spread to the myocardium of the ventricles, causing their contractions. Depending on the frequency of ventricular contractions, atrial fibrillation is divided into bradysystolic (less than 60 beats per minute), normosystolic (60-90 beats per minute) and tachysystolic (over 90 beats per minute).
2. Atrial flutter. The frequency of atrial contractions reaches 200-400 per minute. At the same time, their correct coordinated rhythm is preserved. With atrial flutter, there is almost no diastolic pause. They are in a constant state of systole, that is, they do not relax. This causes difficulty in filling them with blood and, as a result, its insufficient flow into the ventricles. If every second, third or fourth impulse enters the ventricles through the atrioventricular connections, then this ensures the correct rhythm of their contractions and this form of the disease is called correct atrial flutter. In those cases when there is a chaotic contraction of the ventricles, due to violations of the atrioventricular conduction, they speak of the development of abnormal atrial flutter.

During paroxysm of atrial fibrillation, the atria contract inefficiently. In this case, the complete filling of the ventricles does not occur, and at the time of their contraction, there is periodically no ejection of blood into the aorta.

Atrial fibrillation can turn into ventricular fibrillation, which is fatal.

Causes of atrial fibrillation

The cause of atrial fibrillation can be both heart disease and a number of other pathologies. Most often, the occurrence of atrial fibrillation occurs against the background of severe heart failure, myocardial infarction, arterial hypertension, cardiosclerosis, cardiomyopathies, myocarditis, rheumatic heart disease.

Other causes of atrial fibrillation are:

• thyrotoxicosis (thyrotoxic heart);
• intoxication with adrenomimetics;
• overdose of cardiac glycosides;
• alcoholic cardiopathy;
• chronic obstructive pulmonary disease;
• pulmonary embolism (PE).

If the cause of the development of atrial fibrillation cannot be established, the diagnosis of the idiopathic form of the disease is made.

Symptoms of atrial fibrillation

The clinical picture of atrial fibrillation depends on the state of the valvular apparatus of the heart and myocardium, the form of the disease (permanent, paroxysmal, tachysystolic or bradysystolic), as well as the characteristics of the patient's psycho-emotional state.

Tachysystolic atrial fibrillation is the most difficult to tolerate by patients. Its symptoms are:

• cardiopalmus;
• interruptions and pain in the heart;
• shortness of breath that worsens with exertion.

Initially, atrial fibrillation is paroxysmal in nature. Further development of the disease with a change in the frequency and duration of paroxysms in each patient occurs in different ways. In some patients, seizures occur extremely rarely, and there is no tendency to progression. In others, on the contrary, after 2-3 episodes of atrial fibrillation, the disease becomes persistent or chronic.

Patients feel different attacks of atrial fibrillation. For some, the attack is not accompanied by any unpleasant symptoms, and such patients learn about the presence of arrhythmias only when undergoing a medical examination. But most often the symptoms of atrial fibrillation are intensely pronounced. These include:

• feeling of chaotic heartbeats;
• muscle tremors;
• severe general weakness;
• fear of death;
• polyuria;
• increased sweating.

In severe cases, there is severe dizziness, fainting, Morgagni-Adams-Stokes attacks develop.

After the restoration of a normal heart rhythm, all signs of atrial fibrillation stop. With a constant form of the disease, patients eventually cease to notice the manifestations of arrhythmia.

With atrial fibrillation during auscultation of the heart, random tones are heard at various volumes. The pulse is arrhythmic, pulse waves have different amplitudes. Another symptom of atrial fibrillation is a pulse deficit - the number of pulse waves is less than the number of heartbeats. The development of a pulse deficit is due to the fact that not every contraction of the ventricles is accompanied by the release of blood into the aorta.

With atrial flutter, patients complain of a pulsation of the jugular veins, discomfort in the region of the heart, shortness of breath, and a feeling of palpitations.

Diagnostics

Diagnosis of atrial fibrillation is usually not difficult, and the diagnosis is already made during the physical examination of the patient. On palpation of the peripheral artery, the disordered rhythm of the pulsation of its walls is determined, while the tension and filling of each pulse wave is different. During auscultation of the heart, significant fluctuations in volume and irregularity of heart tones are heard. The change in the volume of the I tone following the diastolic pause is explained by the different diastolic filling of the ventricles with blood.

An electrocardiogram is recorded to confirm the diagnosis. Atrial fibrillation is characterized by the following changes:

• chaotic location of QRS ventricular complexes;
• the absence of P waves or the definition of atrial waves in their place.

If necessary, daily monitoring of the ECG is carried out, which allows to clarify the form of atrial fibrillation, the duration of the attack, and its relationship with physical activity. To select antiarrhythmic drugs and identify symptoms of myocardial ischemia, exercise tests (treadmill test, bicycle ergometry) are performed.

Echocardiography (EchoCG) makes it possible to assess the size of the heart cavities, identify the presence of intracardiac thrombi, signs of possible damage to the pericardium and valvular apparatus, cardiomyopathy, and evaluate the contractile function of the left ventricle. The results of echocardiography help in the choice of drugs for antiarrhythmic and antithrombotic therapy.

In the overall structure of the incidence of various types of arrhythmias, atrial fibrillation accounts for about 30%.

For the purpose of detailed visualization of the structures of the heart, multislice or magnetic resonance imaging of the heart is performed.

The method of transesophageal electrophysiological research helps to determine the mechanism of formation of atrial fibrillation. This study is performed in all patients with atrial fibrillation who are scheduled for implantation of an artificial pacemaker (pacemaker) or catheter ablation.

Treatment of atrial fibrillation

Treatment of atrial fibrillation is aimed at restoring and maintaining the correct heart rhythm, preventing the occurrence of recurrent paroxysms, preventing the formation of blood clots and the development of thromboembolic complications.

To interrupt an attack of atrial fibrillation, antiarrhythmic drugs are administered intravenously to the patient under the control of the ECG and blood pressure level. In some cases, cardiac glycosides or slow calcium channel blockers are used, which help to improve the well-being of patients (reducing weakness, shortness of breath, palpitations) by reducing the heart rate.

With the ineffectiveness of conservative therapy, the treatment of atrial fibrillation is carried out by applying an electrical pulsed discharge to the region of the heart (electrical cardioversion). This method allows you to restore the heart rhythm in 90% of cases.

If atrial fibrillation lasts more than 48 hours, the risk of thrombus formation and the development of thromboembolic complications increases dramatically. For their prevention, anticoagulant drugs are prescribed.

After the heart rhythm is restored, long-term use of antiarrhythmic drugs is indicated to prevent repeated episodes of atrial fibrillation.

In the chronic form of atrial fibrillation, treatment consists in the constant intake of anticoagulants, calcium antagonists, cardiac glycosides and adrenoblockers. Active therapy is being carried out for the underlying disease that caused the development of atrial fibrillation.

In order to radically eliminate atrial fibrillation, radiofrequency isolation of the pulmonary veins is performed. During this minimally invasive procedure, the focus of ectopic excitation located at the mouth of the pulmonary veins is isolated. The effectiveness of radiofrequency isolation of the pulmonary veins reaches 60%.

With a constant form of atrial fibrillation or frequently recurring paroxysms, there are indications for radiofrequency ablation (RFA) of the heart. Its essence lies in cauterization of the atrioventricular node using a special electrode, which leads to a complete AV blockade with further installation of a permanent pacemaker.

Diet for atrial fibrillation

In the complex therapy of atrial fibrillation, an important role is played by proper nutrition. The basis of the diet should be low-fat protein and vegetable products. Food should be taken often in small portions. Dinner should be no later than 2.5-3 hours before bedtime. This approach prevents excessive stimulation of the vagus nerve receptors, which affects the functions of the sinus node.

Patients with atrial fibrillation should give up strong tea, coffee, alcoholic beverages, as they can provoke an attack.

With atrial fibrillation, the diet should include a large amount of foods rich in potassium and magnesium. These products include:

• soya beans;
• nuts (cashews, almonds, peanuts);
• wheat germ;
• wheat bran;
• Brown rice;
• beans;
• spinach;
• cereals;
• oranges;
• bananas;
• baked potato;
• tomatoes.

To preserve the maximum amount of trace elements and vitamins in dishes, it is best to steam or bake them. It is useful to include vegetable, fruit or berry smoothies in the menu.

The presence of atrial fibrillation increases mortality in cardiac diseases by more than 1.5 times.

Possible complications and consequences

The most common complications of atrial fibrillation are progressive heart failure and thromboembolism. In patients with mitral stenosis, atrial fibrillation often causes the formation of an intra-atrial thrombus that can block the atrioventricular orifice. This leads to sudden death.

The resulting intracardiac clots with arterial blood flow are carried throughout the body and lead to thromboembolism of various organs. In about 65% of cases, blood clots enter the vessels of the brain, causing the development of an ischemic stroke. According to medical statistics, every sixth ischemic stroke is diagnosed in patients suffering from atrial fibrillation. Factors that increase the risk of developing this complication are:

• old age (over 65 years);
• previously transferred thromboembolism of any localization;
• the presence of concomitant pathology (arterial hypertension, diabetes mellitus, congestive heart failure).

The development of atrial fibrillation against the background of a violation of the contractile function of the ventricles and heart defects leads to the formation of heart failure. With hypertrophic cardiomyopathy and mitral stenosis, developing heart failure proceeds as cardiac asthma or pulmonary edema. Acute left ventricular failure always develops as a result of a violation of the outflow of blood from the left heart, which leads to a significant increase in pressure in the system of pulmonary veins and capillaries.

The most severe manifestation of heart failure against the background of atrial fibrillation is arrhythmogenic shock due to low cardiac output.

Atrial fibrillation can turn into ventricular fibrillation, which is fatal.

Most often, atrial fibrillation is complicated by the formation of chronic heart failure, which progresses at one speed or another and leads to the development of dilated arrhythmic cardiomyopathy.

Forecast

The prognosis for atrial fibrillation is determined by the cause that caused the development of cardiac arrhythmia, and the presence of complications. Atrial fibrillation, which arose against the background of heart defects and severe myocardial damage (dilated cardiomyopathy, diffuse or general cardiosclerosis, large-focal myocardial infarction), quickly leads to the development of heart failure.

The presence of atrial fibrillation increases mortality in cardiac diseases by more than 1.5 times.

The prognosis is also unfavorable for atrial fibrillation complicated by thromboembolism.

A more favorable prognosis in patients with a satisfactory condition of the ventricles and myocardium. However, if paroxysms of atrial fibrillation occur frequently, the quality of life of patients deteriorates significantly.

The idiopathic form of atrial fibrillation usually does not cause a deterioration in well-being, patients feel healthy and lead an almost habitual lifestyle.

Prevention

In order to prevent atrial fibrillation, it is necessary to detect and actively treat diseases of the cardiovascular and respiratory systems in a timely manner.

Secondary prevention of atrial fibrillation is aimed at preventing the occurrence of new episodes of cardiac arrhythmias and includes:

• long-term drug therapy with antiarrhythmic drugs;
• performing cardiac surgery if indicated;
• refusal to drink alcohol;
• limitation of mental and physical overload.

Video from YouTube on the topic of the article:

If you feel that your pulse is out of rhythm, and your heart is working intermittently, you may have atrial fibrillation. Another name for it is atrial fibrillation. During an attack of this disease, the heart muscle either speeds up its work, then the beats become slower, then they disappear completely for a second or two.

This condition occurs when the work of the atria is disrupted. Instead of powerfully contracting 60-80 times per minute and pushing the blood through the ventricles, these parts of the heart tremble and tremble non-rhythmically.

The attack of the disease brings discomfort. There is pain in the chest, a lump in the throat, a panic attack may occur. You can get rid of these phenomena with the help of medicines, but the main danger is different. Atrial fibrillation causes the formation of a blood clot in the atrium. This blood clot can travel through the vessels to the brain and cause a stroke or even death.

Atrial fibrillation is a very common heart disorder. 2% of the world's population suffer from this type of arrhythmia. The number of patients increases year by year, these are people of all ages. Men are more likely to suffer from this disease. After the age of 40, they have a 26% risk of getting sick, and 23% for women. After 80 years, 8% of people make this diagnosis.

Scientists have calculated that people with this diagnosis are 4 times more likely than others to get a stroke. In addition, acute heart failure and other diseases of the cardiovascular system may appear. But modern medicine is in a hurry to reassure: taking the right medications and a healthy lifestyle will help to avoid attacks and the consequences of atrial fibrillation.

Anatomy of the conduction system of the heart

Normally, our heart beats at a rate of 60-80 beats per minute. We do not need to make any effort to control its activities. The autonomous work of the heart (automatism) is ensured by its unique structure.

The heart consists of four sections: the right and left atria, the right and left ventricles. The atria receive blood from the veins, they fill and contract, pushing blood into the ventricles. And these structures with a powerful push send blood through the arteries into the body. The work of the heart is quite complex and it needs to be managed. Performs a leadership function conducting system of the heart .

The system consists of special cells that can create electrical impulses. Cells do not contract well, but generate and conduct impulses well. These electrical discharges are commands to contract different parts of the heart. By the way, on the cardiogram we see these impulses in the form of teeth.

conduction system of the heart This is a special formation in the heart muscle. It consists of nodes that generate electrical signals and beams through which they are transmitted. The system can be divided into two parts.

1. The sinoatrial part regulates the work of the atria. It includes:
   • sinoatrial(sinus node or pacemaker) - it is the main component that ensures the normal activity of the heart. The node is located in the right atrium, its dimensions are 15/5/2 mm. The right parasympathetic and sympathetic nerves of the heart approach it. They set the pace for the work of the body, depending on our emotions and physical activity.
   • Three bundles of internodal fast conduction are "wires". Their task is to transmit a signal from the atria to the ventricles.
   • Interatrial bundlespeedy transmits a signal from the right atrium to the left.
2. The atrioventricular part regulates the work of the ventricles. It includes:
   • atrioventricular node(AV node) controls the work of the ventricles. Its main part lies on the interventricular septum, the dimensions are smaller - 6/3 mm. The main task of the AV node is to slightly delay the nerve impulse. This is necessary so that the ventricles are excited after the atria contract and fill them.
     If, due to illness, the sinus node does not cope with its task, then the atrioventricular node ensures the automatism of the heart, setting a pace of 40-60 beats per minute.
   • Bundle of His- coordinates the work of the atria and ventricles. It splits into two legs that terminate in the right and left ventricles.
   • Purkinje fibers – fibers that extend from the bundle of His into the muscular wall of the ventricles.

Causes of atrial fibrillation

The main cause of atrial fibrillation is considered to be a malfunction in the conduction system of the heart. In this case, the order of contractions of the heart is disturbed. Muscle fibers do not contract all together, but individually - "anyhow." The atria do not make one powerful push every second, but, as it were, tremble, finely and often, without pushing blood into the ventricles.

Doctors named the culprits of this phenomenon. The sinus node does not do its job well, it does not command its “subordinates” rigidly enough. And saboteur cells are trying to control the work of the atria. They cause the muscle wall to contract small, often and irregularly. As a result, trembling or flickering occurs in different parts of the atria.

The causes of atrial fibrillation are divided into cardiac and non-cardiac.

cardiac causes

1. Increased blood pressure. With hypertension, the heart works in an enhanced mode and pushes a lot of blood into the vessels. But the heart muscle from such a load increases, stretches and weakens. As a result, disturbances occur in the sinus node and conduction bundles.
2. Diseases of the arteries of the heart. The sinus node and other components of the conduction system of the heart need a constant supply of arterial blood to supply them with oxygen. If its supply is broken, then the functions are poorly performed.
3. Valvular heart disease. For example, mitral or aortic valve prolapse. This valve defect usually causes atrial fibrillation in young people. The valve does not close tightly, so when the ventricles contract, part of the blood returns to the atria and joins a portion of the venous blood. As a result, the volume of the atria and the thickness of their walls increase. This weakens the heart and impairs its work.
4. congenital heart defects. With these diseases, the vessels that feed the heart do not develop enough, and the heart muscle is weakly formed in places.
5. Consequences of heart surgery. After surgery, conductive fibers may be damaged or scar tissue may appear. It replaces the unique cells of the conduction system of the heart, so the nerve impulse travels in other ways.
6. heart failureb can be both a cause and a consequence of atrial fibrillation. The heart begins to work worse due to overwork caused by hypertension or defects. As a result, its automatism is violated.
7. Pericarditis and myocarditis. These diseases cause inflammation of the walls of the heart. As a result, conductivity is impaired. That is, the commands that the nervous system or the sinus node sends remain unheard in other parts of the heart.
8. Tumors of the heart. The tumor causes a violation in the structure of the conduction system of the heart and interferes with the passage of the impulse.

non-cardiac reasons

1. Alcohol and bad habits. Large doses of alcohol cause attacks of atrial fibrillation, which are called "holiday arrhythmia." Nicotine, amphetamines, and cocaine can cause arrhythmias and more serious heart damage.
2. stress. Nervous shocks cause discord in the central and autonomic nervous system, which affects the rhythm of the heart. In addition, in stressful situations, adrenaline is released, which speeds up the speed of blows.
3. Physical exercise. Muscle work requires a large blood flow. At the same time, the heart speeds up to its rhythm by 2 times. During this period, the conducting system does not have time to coordinate its work.
4. Large dose of caffeine. Coffee and strong tea contain a lot of this substance, which accelerates the pulse.
5. Medication. Adrenaline, atropine, diuretics affect the functioning of the heart, disrupting the balance of microelements that are involved in creating an electrical impulse.
6. Viral diseases. An increase in temperature by 1 degree accelerates the pulse by 10 beats per minute. In addition, during illness, intoxication disrupts the functioning of the autonomic nervous system. Together, these factors cause the sinus node to malfunction.
7. Thyroid diseases. Enlargement of the thyroid gland (hyperthyroidism) is accompanied by high levels of hormones. 3-iodine-thyronine increases the number of heart beats per minute and can make the rhythm irregular.
8. Electrolytic disorders. Eating disorders and various diets for weight loss can cause a lack of potassium and calcium, magnesium. Deficiency of these trace elements in the blood and heart cells causes disturbances in automatism. An electrolytic impulse is not formed and is not conducted through the tissues of the heart.
9. Chronic lung disease. Diseases of the respiratory system can cause oxygen starvation, and it has a very bad effect on the conduction system of the heart. As a result of a lack of oxygen, the sinus node cannot generate impulses evenly.
10. Diabetesaccompanied by obesity. This disease disrupts the metabolism and blood supply to all organs. The heart and brain are more sensitive than others to a lack of oxygen, and as a result, their work is disrupted.
11. sleep apnea syndrome. Stopping breathing during sleep for 10 seconds or more causes oxygen starvation and a violation of the biochemical composition of the blood. These causes worsen the work of the sinus node, although the mechanism of the violation has not been fully elucidated.
12. electric shock. The correct contraction of the heart is provided by electrical impulses, and after an electric shock, this well-functioning mechanism fails. Sites of electrical excitation occur not only in the conduction system, but also in other cells, causing random atrial contraction.

Symptoms and signs of atrial fibrillation

The main symptom of atrial fibrillation is increase in heart rate . Moreover, the atria can make up to 600 beats per minute, and the ventricles up to 180. But the heart cannot withstand such a frantic rhythm, and it takes a break. At the same time, it may seem that "the heart either beats or not." There is also a form of atrial fibrillation, in which the heartbeat is slow. This is due to the fact that the conduction is broken. Not all nerve impulses reach the ventricles and cause the heart to contract.

Chest pain . The heart during an attack of atrial fibrillation works for wear and tear. The heart muscle is rich in nerve endings, and when it overworks or the coronary arteries do not bring enough blood to it, a person experiences pain.

People with atrial fibrillation need to consume the following foods daily:

• lemons, oranges;
• onion garlic;
• walnuts, cashews, almonds, peanuts;
• cranberries and viburnum;
• dried fruits: prunes, dried apricots, raisins;
• germinated grains of wheat;
• dairy products;
• vegetable oils.

It is forbidden to eat: alcohol, coffee and chocolate, lard and fatty meats. You should not eat sweet and flour dishes, canned and smoked meats, strong rich broths.

A delicious and healthy mixture of dried fruits will help saturate the body with useful minerals. In equal proportions (200 g each) take: lemons, dark raisins, dried apricots, walnuts and honey. All products are washed, scalded with boiling water and dried on a paper towel. Then they need to be crushed in a blender or meat grinder, mix thoroughly and store in the refrigerator. Every day before breakfast, eat a full tablespoon of this mixture. For the course, you must use the entire portion. Repeat treatment every 3 months.

Apple cider vinegar will help thin the blood, prevent blood clots and saturate the heart with potassium. 2 tsp diluted in a glass of warm water. Also add a teaspoon of honey. You need to drink this drink 30-40 minutes before meals for 2-3 weeks.

Treatment of arrhythmias with medications

An attack of atrial fibrillation can pass on its own in a few minutes, or it can last for hours or even days. If you feel an attack of non-rhythmic heartbeat, then this must be reported to the doctor. And if the attack lasts for several hours, then this is an occasion to urgently seek medical help.

In the event that the attack lasts less than a day, doctors will immediately begin to restore the normal rhythm of the heart. If atrial fibrillation lasts more than 24 hours, then you will have to take blood thinners for 10-14 days. Such treatment will help get rid of blood clotsthat could form in the heart during an attack.
Various groups of drugs are used to treat atrial fibrillation.

Drug group	Mechanism of action on the heart	Name of the drug	How the drug is taken	The effect of taking the drug
Beta blockers	Neutralize the action of the hormones of adrenaline and norepinephrine, block receptors that are sensitive to these substances. Balance the action of the sympathetic and parasympathetic nervous systems and reduce the number of heartbeats. Reduce pressure. Reduce the concentration of potassium ions due to this, the contractility of the heart decreases. Disappears excitation in different parts of the atria. Thanks to this action, it is possible to get rid of atrial flutter, which occurs with atrial fibrillation.	Atenolol	To relieve an attack, take 1 tablet (50 mg), but the doctor may increase the dose to 4 tablets. Take the tablet before meals with water. To maintain the rhythm, it is enough to take half a tablet a day.	The pressure decreases, the nervous system calms down, the normal rhythm of the heart is restored.
		Anaprilin	Take 1 tablet (10 mg) 3-4 times a day 30-40 minutes before meals. As prescribed by the doctor, the dose can be gradually increased several times. The doctor prescribes a long course along with cardiac glycosides: Korglikon, Strofantin.	The work of the nervous system improves, the pulse and pressure decrease.
		metoprolol	Take with food. 1 tablet (5 mg) 3-4 times a day to maintain a rhythm. To stop an attack in severe cases, 2-5 mg is administered intravenously. Then they switch to taking pills.	Decreased blood pressure and heart rate. Reduces the risk of attacks of atrial fibrillation and heart attack.
		Obzidan	Take a whole or half a tablet 3 times a day. The daily dose is 60-120 mg. The tablets must not be chewed. Consume 15-20 minutes before meals with water. If there is no effect, then the dose can be increased.	Decreases blood pressure and heart rate. The drug helps prevent attacks of atrial fibrillation (with frequent contractions) and migraines.
Antiarrhythmic drugs	Reduce excitability in the heart muscle and conduction in the atria. Areas of uncontrolled excitation that cause atrial flutter disappear. Increase the pause between heartbeats, bringing the rhythm back to normal. Relax the blood vessels, which leads to a decrease in pressure.	Quinidine	Dose 2 tablets (0.4 g) every 6 hours until the attack is relieved. If there is no effect, then the doctor can double it. To prevent recurrent attacks, the doctor selects the dose individually. Tablets should be swallowed whole, without chewing. You can drink water or milk.	Pain subsides, heart rate and blood pressure decrease. Fights an attack of atrial fibrillation and helps maintain a normal pulse.
		Novocainamide	To relieve an attack, 100-500 mg is administered intravenously. After the attack has passed, take the drug orally, 3 tablets every 3-6 hours, with water. The doctor prescribes the exact dose.	A normal heart rate of 60-100 beats per minute is restored. The pressure decreases and the condition of the heart improves.
		Kordaron	The dose is selected individually. The first 10-14 days it can be 3-4 tablets throughout the day. After such a course, small doses are prescribed to maintain a normal rhythm: half a tablet 1 time per day	Eliminates atrial fibrillation resistant to other drugs. Prevents the appearance of new attacks of atrial flutter.
Cardiac glycosides (calcium blockers)	They make the contraction of the heart strong, powerful and short, increase the pause between heartbeats. Slow down the impulses that pass through the conduction system of the heart.	Digoxin	Taken 3 times a day. 2 tablets in the morning, one in the afternoon, and half a tablet in the evening. This is the most common scheme, but it is not suitable for everyone. Therefore, the doctor selects the dose separately for each patient.	Normalizes the number of contractions of the heart, facilitates its work. Edema and shortness of breath disappear.
		Celanide	To bring the heart rhythm back to normal during an attack, the drug is administered intravenously in 1-2 ml of a 0.02% solution. To maintain a normal rhythm, half a tablet is prescribed in the morning and evening. Take a long time.	Reduces the number of heartbeats per minute, relieves swelling, has a diuretic effect. Small doses of the drug help to maintain the heart rate at the right level.
Anticoagulants and antiplatelet agents	Reduce blood clotting and prevent blood clots from forming. They prevent blood cells from sticking together and forming blood clots. Reduce the activity of thrombin and the production of prothrombin in the liver.	warfarin	In most cases, take 1 tablet (2.5 mg) per day. But in different patients, the dose can vary greatly. Take after meals with water. The course of treatment is 6-12 months.	It thins the blood and prevents the formation of a blood clot in the atria during an attack of atrial fibrillation.
		Acetyl salicylic acid (aspirin)	The dose is selected individually by 0.5 or by the whole tablet 3 times a day. Aspirin is taken after meals. It must be dissolved in 100 ml of water and drunk.	Makes the blood more fluid and reduces the risk of blood clots.

Please note that only an experienced doctor should select the drug and dose. All drugs for the treatment of atrial fibrillation have contraindications and side effects. In addition, a remedy that helped one person can cause a new attack of the disease in another.

"Pill in your pocket" strategy

This name was given to the tactics of combating attacks of paroxysmal atrial fibrillation. Doctors prescribe it to those patients in whom atrial fibrillation does not appear often. In this case, there is no need to constantly take drugs to maintain the heart rhythm. But you should always have medicine with you to relieve an attack. In this case, take Propanorm or Propafenone. These antiarrhythmic drugs successfully relieve attacks in 45-80% of patients in 2-4 hours.

Electrical cardioversion

This is another method of restoring the normal rhythm of the heart. It is carried out when, during an attack of atrial fibrillation, the condition deteriorated sharply, pulmonary edema, shock, cerebral ischemia began.

In such a situation, it is necessary to act quickly, so the patient is given intravenous anesthesia and the heart is started in the correct rhythm using a high-voltage defibrillator. A strong discharge of current passes through the heart and causes its muscle fibers to contract at the same time. After that, the ability to control the rhythm returns to the sinus node.

Surgery for atrial fibrillation, pacemaker

Surgery for atrial fibrillation is needed if medications do not help to cope with the disease. In this case, the doctor will recommend one of the types of surgical treatment.

Catheter ablation

This method does not require a large incision and is considered to be less traumatic. The operation takes place under local anesthesia. Through the femoral or subclavian vein, the doctor inserts electrodes into the heart. At this time, the surgeon with the help of x-rays controls everything that happens.

At the first stage of the operation, the doctor conducts an examination. With the help of special sensors, he determines where the zones are that cause atrial fibrillation. An intracardiac ECG shows the reaction of the heart to tests performed by a doctor.

At the second stage of the operation, the doctor “neutralizes” the atrial zones in which flicker occurs. He does this with RF energy using a "healing" electrode. Also for these purposes, you can use a laser and chemicals. It destroys small groups of cells that produce an impulse that makes the atria flutter.

Pacemaker implantation

A pacemaker or artificial pacemaker is a special medical device that restores the normal heart rate.

What does a pacemaker look like? The stimulator is a small metal box and thin electrodes 20-30 cm long. The body of the device is made of a special alloy that does not cause rejection in the body. The pacemaker housing contains a microprocessor and a battery. While a person's heart is working normally, the pacemaker is inactive. But when he catches that the rhythm has gone astray, the device sends weak electrical impulses to the heart through the electrodes. They force the heart muscle to contract at the desired frequency.

The pacemaker can cause contraction of the atrium only (single chamber) or the atrium and ventricle (dual chamber). Most modern stimulants adapt to the physical stress that a person experiences. Therefore, during sports or other activities, they will help speed up the heart rate in order to better supply blood to the muscles and lungs.

Also, stimulants store information about the work of your heart in memory. During visits to the clinic, the doctor will be able to read it using a computer.

How is the operation going? The operation to implant (implant) a pacemaker takes place under local anesthesia and lasts less than two hours. It has several stages:

• make a skin incision under the collarbone;
• electrodes are inserted through a vein into the cavity of the heart under x-ray control;
• check the operation of the electrodes;
• the ends of the electrodes are fixed in the right place with the help of small tips in the form of hooks or a corkscrew;
• in the subcutaneous fatty tissue near the collarbone, a bed is formed where the pacemaker body will be located;
• the stimulator is connected to the electrodes;
• put stitches.

How to live after the installation of a pacemaker? The pacemaker brings many benefits, improves general condition and makes you more resilient. But from the moment of the operation, you will have to remember that you are constantly carrying a complex device with you.

The first day after the operation, it is advisable not to get out of bed. But the very next day they are allowed to walk, and after 3-5 days you can return home. Doctors will tell you how to process the seam. If the temperature suddenly rises, the seams open or discharge from the wound appears, then you need to urgently inform the doctor about this.

You will have to visit a cardiologist regularly:

• 3 months after the operation;
• in 6 months;
• thereafter 1-2 times a year.

The first month you need to take care of yourself. If you feel very tired, then take time and rest. It is better to postpone sports activities for 2-3 months.

Modern pacemakers are not sensitive to radiation from household appliances. But still, it is not recommended to stand near a working microwave and keep a mobile phone near a pacemaker. It is impossible to be near powerful sources of magnetic and electromagnetic fields (transformer substations, power lines).

After the operation, a special document will be issued that confirms that you have a pacemaker installed. This certificate will be useful, for example, at the airport. You won't need to go through a scanner that could damage the pacemaker.

There are things you can't do after having a pacemaker installed. You will have to come to terms with the fact that you are forbidden:

• magnetic resonance imaging (computed tomography is allowed);
• physiotherapy;
• Ultrasound on the area of ​​the stimulator;
• blows to the pacemaker area;
• any exposure to electric current (at home, during operations or cosmetic procedures).

To summarize: there are many ways to deal with atrial fibrillation. Properly selected treatment will help you live for many years without attacks of the disease and avoid complications.

A disease called atrial fibrillation manifests itself in the form of a chaotic heart rhythm disorder. But it is not the disease itself that is terrible, but its complications, which is why it is so important to diagnose it in time.

According to statistics, atrial fibrillation disease is the most common reason for hospitalization with cardiac arrhythmias, accounting for 30% of such cases. There is a picture of an increase in the proportion of such a pathology with age: people under 60 suffer from it in 1% of cases, and older than this milestone - already in 6%.

What is atrial fibrillation?

Atrial fibrillation is expressed by characteristic cardiac arrhythmias, which become inherent randomness in the frequency of contractions and excitations experienced by the atria, or twitching and fibrillation of individual muscle groups of the myocardium. The heart rate in this condition can reach 600 beats per minute.

A prolonged paroxysm of atrial fibrillation lasting up to 2 days threatens the formation of a blood clot and ischemic stroke. Constant atrial fibrillation leads to a rapid increase in the chronic form of circulatory failure.

Video about what is atrial fibrillation:

Causes of atrial fibrillation of the heart

The most common causes of atrial fibrillation of the heart are in the group of cardiovascular diseases:

• chronic ischemic heart disease (ischemic heart disease);
• hypertension;
• cardiomyopathy;
• heart defects resulting from a previous rheumatic disease.

Attacks of paroxysmal atrial fibrillation are often observed at the time of cardiac surgery or immediately after surgery. When such atrial fibrillation occurs, its causes, as a rule, are not associated with drug intervention.

Other causes of atrial fibrillation:

• Frequent use of not only drugs, but also drinks containing caffeine, since it activates myocardial contractility.
• The systematic use of alcohol, which causes intoxication and alcoholic cardiomyopathy.
• In patients with thyroid pathology complicated by signs of hyperthyroidism, atrial fibrillation occurs in a quarter of cases. This frequency is explained by the fact that catecholamines act potentiated on the excitability of the atrial myocardium.
• Taking certain groups of medications (atropine, adrenaline, diuretics) increases the risk of rhythm disturbances, since these drugs directly affect the functioning of the myocardium and change the balance of microelements involved in the generation of electrical impulses.

Atrial fibrillation in young people most often occurs due to congenital mitral valve prolapse. Diseases that occur with a high temperature increase the heart rate and cause a malfunction of the autonomic nervous system, and this causes a disruption in the work of the primary pacemaker - the sinus node. With an acute lack of electrolytes in the body, automatism is disturbed, the myocardial conduction system fails.

An important factor in the manifestation of atrial fibrillation is the state of the human nervous system. With the activity of certain of its links, various variants of arrhythmia arise, among which hyperadrenergic and vagal varieties of atrial fibrillation stand out. The vagal variety is more common in men and is provoked by overeating, lying down while resting, and wearing tight clothing. Another type is more often inherent in women, and there is a clear relationship between the onset of an attack and the emotional state.

With the idiopathic variant of atrial fibrillation, it is not possible to reliably determine the cause of the attack. This form of arrhythmia occurs in 30% of cases.

Forms of atrial fibrillation

Forms of atrial fibrillation may differ in the characteristics of the clinical manifestation of the disease, etiological factors or mechanisms of electrophysiology.

Constant atrial fibrillation is divided into:

• Paroxysmal - lasts up to 1 week, divided into daily periods.
• Persistent.
• Chronic.

The last two types of atrial fibrillation last more than 1 week.

Such types of cardiac arrhythmias as persistent and paroxysmal can be recurrent. In this form, an attack can either manifest itself for the first time or return with a relapse, in the latter case, a second and subsequent cases of manifestation of fibrillation appear.

Classification of atrial fibrillation according to the type of rhythm disturbances:

• Atrial fibrillation or fibrillation caused by the contraction of disparate groups of muscle fibers, which does not allow the atrium to contract in a coordinated manner. Electrical impulses are volumetrically concentrated in the atrioventricular node, due to which some of them are delayed, and the rest are sent to the myocardium, causing the ventricles to contract in a certain rhythm.
• atrial flutter. In this case, the contractions of the heart increase to 200-400 per minute, while the atrial rhythm remains clear and coordinated. In this case, the following picture is observed: myocardial contractions follow one after another, almost without any pauses, and there is also no diastolic pause. At the same time, relaxation of the atria also does not occur, this is due to the fact that they are in a systolic state most of the time. Since the atria in this mode are hardly filled with blood, it also enters the ventricles in a noticeably smaller amount. With this form of atrial fibrillation, impulses propagating along the atrioventricular connections reach the ventricles only in every second, third and fourth case, due to which the correct ventricular rhythm is observed, which is characterized by the term "correct flutter". If, for one reason or another, blockade is observed and conduction is disturbed, then the ventricles begin to contract randomly. The result of this is that the atrial flutter also acquires a distorted form, which is called "wrong flutter".

Classification of arrhythmia according to the frequency of contractions:

• Bradysystolic arrhythmia - when the ventricles beat no more than 60 times per minute. With paroxysm, blood is not pumped into the ventricles, since the atria work inefficiently, the ventricular diastole is filled naturally and only partially. As a result, the ejection of blood into the aortic system practically stops.
• Tachysystolic arrhythmia - contractions occur with a frequency of 90 beats.
• Normosystolic arrhythmia - ventricular contractions can be kept within 60-90 beats.

Symptoms of atrial fibrillation

Symptoms of atrial fibrillation of the heart depend on its form (bradysystolic, tachysystolic, constant or paroxysmal). In addition, the picture of the disease changes the state of the myocardium, the system of its valves, the mental state of the patient.

The most dangerous is the condition that characterizes the tachysystolic symptoms of atrial fibrillation, in which there is:

• dyspnea;
• cardiopalmus;
• heart pain and interruptions in the work of the heart;
• any physical exertion aggravates these symptoms.

Atrial fibrillation passes paroxysmal, with the progression of paroxysms. In this case, their duration and frequency are always individual. In some patients, after several attacks, a chronic (persistent) form of the disease may develop, while in others, only rare and short-term paroxysms appear throughout life, without a tendency to progress - the prognosis of such atrial fibrillation is favorable.

Sensations in paroxysms of atrial fibrillation are also individual. Some patients may not notice them at all and learn about them by chance with an ECG.

Concerning typical signs of atrial fibrillation, then it could be:

• chaotic heartbeat;
• fear;
• polyuria (more urine is produced than usual);
• weakness and trembling.

With excessive heart rate, the patient may experience fainting and dizziness, and in more severe cases, signs of Morgagni-Adams-Stokes syndrome (loss of consciousness, convulsions, respiratory failure, pallor, drop in blood pressure and even temporary cardiac arrest).

When sinus rhythm is restored, atrial fibrillation immediately loses symptoms and no longer requires treatment. Patients often do not notice persistent atrial fibrillation. Auscultation (listening) of the heart can determine the presence in its work of tones that have different degrees of loudness. The amplitude of the pulse waves is different, and the pulse is arrhythmic. With atrial fibrillation, there is a pulse deficit, which is due to the peculiarities of the work of the heart: not every contraction of it leads to the release of blood into the aorta.

In the event of atrial flutter, the symptoms will be as follows:

• dyspnea;
• increased perceived heart rate;
• pulsation of the veins in the neck;
• sometimes some discomfort in the cardiac region.

A clear and accessible video about atrial fibrillation (why and how it manifests itself, what to do with it):

Diagnosis of atrial fibrillation

Before determining what treatment atrial fibrillation requires, its diagnosis will be required, for which it is used:

• Holter monitoring - round-the-clock ECG recording in a patient leading a normal rhythm of life;
• recording of paroxysms in real time (when the Holter monitor is able to transmit signals by phone in case of an attack).

Atrial fibrillation on the ECG is reflected as follows:

• All leads lack the R wave.
• Irregular frequent f-waves of atrial fibrillation appear, which reflect their erratic contractions and excitations. The amplitude of the coarse f-wave form exceeds 1 mm and has a frequency of 350 to 450 waves per minute. This form of atrial fibrillation is characteristic of atrial hypertrophy, it occurs in patients with chronic pulmonary heart and mitral stenosis.
• The amplitude of the fine-fibered form of the f-wave is so small that sometimes it is invisible on the ECG, and its frequency reaches 600-700. A similar form occurs in elderly people who have survived a heart attack, suffering from atherosclerotic cardiosclerosis, myocarditis, thyrotoxicosis, and intoxication with cardiac glycosides.
• Arrhythmia of ventricular QRS complexes is expressed by different duration of R-R intervals. The size and shape of the QRS complexes are usually normal.

Treatment of atrial fibrillation

With the diagnosis of atrial fibrillation, the treatment is determined by the cardiologist, taking into account the clinical picture of the disease. Initially, pharmacological treatment of atrial fibrillation is prescribed, the preparations of which have an antiarrhythmic effect.

At the moment, there are a number of ways to treat this pathology.

Conservative treatment (with an efficiency of 10-15%)

In the early stages of atrial fibrillation, treatment with rate-regulating pills can reverse symptoms and progression of the disease.

The following drugs are used for atrial fibrillation:

• Beta blockers(betaxolol, carvedilol, nebivalol, metoprolol, pindolol, propraolol, celiprolol, esmolol) and calcium blockers (verapamil, diltiazem) - they slow down the heart rate. These medicines for atrial fibrillation prevent the overly rapid contraction of the ventricles, but do not regulate the heart rate.
• Also, in the diagnosis of atrial fibrillation, drugs are used that prevent the formation of blood clots and the occurrence of strokes(warfarin, pradaxa).
• For antiplatelet therapy are prescribed anticoagulants, which do not exclude the formation of blood clots, but reduce the risk of this, and, consequently, the occurrence of strokes (heparin, fondaparinux, enoxaparin).
• Blood thinners prevent the formation of blood clots - disaggregants.
• Antiarrhythmic drugs(amiodarone, dronedarone, ibutilide, novocainamide, propafenone, sotalol, flecainide).

Regular blood tests are required to monitor drug exposure. Only a doctor will be able to choose the right pills for atrial fibrillation, since many of them have serious contraindications, as well as proarrhythmic activity, when the drug itself can unexpectedly provoke atrial fibrillation.

Before treating atrial fibrillation, the patient's comorbidities should be taken into account. Sometimes medication is started in a hospital, where it is easier for doctors to control the body's response and heart rate. With this therapy, in 30-60% of cases, the patient's condition improves, but over time, the effectiveness of the drugs may decrease. In this regard, doctors often prescribe several antiarrhythmic drugs at once.

Surgical intervention (with efficiency up to 85%)

Operations for atrial fibrillation are carried out only with the ineffectiveness of drug therapy:

With catheter ablation, myocardial cells that provoke atrial fibrillation are neutralized. During the procedure, the surgeon separates the fused fibers that disrupt the conduction ability and heart rhythm. There is no need to completely open the chest here: small incisions are made in it, through which the catheter penetrates to the myocardium.

There are several impact options:

• laser;
• cold;
• a chemical;
• electrical impulse.

Implantation of an artificial pacemaker (pacemaker) - a special device that maintains the correct heart rhythm in people suffering from atrial fibrillation. This compact device is sewn under the skin in the region of the collarbone. An electrode is connected to it, penetrating into the cavity of the heart through the subclavian vein. The pacemaker periodically generates impulses that cause the heart muscle to contract at the required frequency. During implantation, the ribs are not affected, but only the skin is cut, so this operation is minimally traumatic.

Traditional medicine methods (with efficiency up to 50%)

Sometimes a doctor, in addition to pharmacological drugs, may recommend alternative treatment for atrial fibrillation:

• A decoction of viburnum berries. They are pre-dried, after which a glass of dried berries is poured with a glass of boiling water, and the container is set on low heat, brought to a boil, after which it is removed from the heat, covered with a lid and cooled. A similar viburnum decoction for the prevention of atrial fibrillation should be taken in the morning and before bedtime, approximately 150 g each.
• Yarrow tincture. Fresh yarrow grass is collected and crushed, then poured into a liter bottle (up to half the volume) and filled with ethyl alcohol. The bottle is tightly closed and placed in a dark place for 10 days. For prophylactic purposes, it should be taken in the morning and before lunch, 1 teaspoon of infusion.
• Infusion of dill seeds. A third of a glass of these seeds is poured with a glass of boiling water (it is best to do this in a thermos). The infusion is aged for 20 minutes, after which it is filtered. Prevention of atrial fibrillation consists in taking the infusion 3 times a day before meals for a third of a glass.

Why is atrial fibrillation dangerous? Possible Complications

Most often, when answering the question of why atrial fibrillation is dangerous, you will hear one thing - it leads to complications in the form of heart failure or thromboembolism.

Mitral stenosis complicated by atrial fibrillation can cause blockage of the atrioventricular orifice by an intra-atrial thrombus, cardiac arrest and sudden death.

If intracardiac thrombi enter the arteries of the systemic circulation, they can lead to organ thromboembolism, and 2/3 of them enter the cerebral vessels with blood flow. Therefore, patients with atrial fibrillation account for 15% of ischemic strokes.

Peripheral and cerebral thromboembolism are most susceptible to elderly patients (after 65 years), and in addition to them - those suffering from congestive heart failure, diabetes mellitus, systemic arterial hypertension and who have previously undergone any type of thromboembolism. With atrial fibrillation, heart failure develops in patients suffering from impaired ventricular contractility and heart defects. In hypertrophic cardiomyopathy and mitral stenosis, heart failure can be manifested by pulmonary edema and cardiac asthma.

Acute left ventricular failure occurs against the background of poor emptying of the left heart, which leads to a sharp increase in pressure in the pulmonary veins and capillaries.

With atrial fibrillation, the most severe manifestation of heart failure is the development of arrhythmogenic shock due to too low cardiac output. Sometimes atrial fibrillation ends with ventricular fibrillation and complete cardiac arrest.

More often, chronic heart failure develops against its background, which can progress to dilated arrhythmic cardiomyopathy.

Forecast of life with atrial fibrillation

Many people ask the question, how long do they live with atrial fibrillation? In fact, the prognosis of life with atrial fibrillation depends on the causes of rhythm disturbance and complications from it.

Caused by severe myocardial damage (large-focal infarction, dilated cardiomyopathy, diffuse or extensive cardiosclerosis), atrial fibrillation leads to the rapid development of heart failure. Speaking about how many people live with atrial fibrillation, the thromboembolic complications caused by it give unfavorable prognosis.

Mortality from cardiac diseases complicated by atrial fibrillation increases by 1.7 times.

But with a satisfactory condition of the ventricles and the absence of severe pathologies, the prognosis becomes more favorable, but even at the same time, the frequent occurrence of paroxysms significantly reduces the patient's quality of life.

Idiopathic atrial fibrillation usually does not disturb the well-being of patients who can do any work, feeling healthy.

Have you or your loved ones experienced atrial fibrillation? Did this disease cause any complications, and how did you deal with it? Share your experience in the comments - help others.

Atrial fibrillation (atrial fibrillation) is the most common heart rhythm disorder, which occurs in 1 - 2% of the world's population. The frequency of occurrence strongly depends on age, under 40 years of age is 0.5% of the entire population, over 65 - 5%, and in those over 80 - 10%. The pathogenesis of the disease is based on a change in the automatism of myocardial cells, in which the sinus node ceases to be the main source of heart rhythm. With this pathology, pathological nerve impulses are generated in the muscle tissue of the atria, which "manage" the work of the heart. It is believed that with atrial fibrillation there are from 350 to 800 signals per minute.

The disease got its name because of its specific reflection on the ECG, where instead of P waves, asymmetric different-amplitude f waves with a very high frequency appear. Looking at them gives the impression of atrial fibrillation.

Causes of the disease

Atrial fibrillation, like any other disease, can develop against the background of an already existing pathology. The main precursor diseases are:

• IHD (ischemic heart disease);
• mitral valve defects (located between the left atrium and ventricle);
• WPW syndrome (Wolf-Parkinson-White);
• arterial hypertension;
• diabetes;
• thyrotoxicosis;
• alcoholic myocardial dystrophy (heart damage due to constant alcohol consumption);
• electrolyte deficiency - in most cases - a lack of magnesium and potassium.

Often provoke an attack of atrial fibrillation can:

• increased physical activity or emotional arousal;
• drinking alcohol, coffee;
• smoking;
• plentiful food intake.

Rarely enough, the cause of the disease and provoking factors cannot be identified. In this case, atrial fibrillation is considered idiopathic.

The nervous system plays an important role in the occurrence of pathology. The increased tone of its particular department can provoke seizures. The vagal type of atrial fibrillation develops with the active influence of the parasympathetic link. The sympathetic division causes hyperadrenergic atrial fibrillation.

The mechanism of development of atrial fibrillation

The disease occurs when heterogeneity of the atrial myocardium. Because of this, pathological foci appear in certain areas of the muscle tissue, in which nerve signals are generated. Unlike atrial flutter, in this case there is not one or two foci, but a much larger number of them. As a result of the joint conduction of excitation from all these sources through the atrial myocardium, an uncoordinated and inefficient contraction of the latter occurs.

If all these impulses were transmitted to the underlying sections, then the ventricles would contract by analogy with the atria: ventricular fibrillation would develop. This would lead to a violation of the ejection of blood from the heart and death.

To prevent such a situation, the conduction system of the heart is equipped with a special "filter". It is the atrioventricular node located between the atria and ventricles. Due to this structure, there is a special delay in the excess amount of nerve signals and the frequency of contractions of the ventricles is much lower than that of the atria. This protects the body from sudden death during ventricular fibrillation.

Classification

Depending on the mechanism of occurrence, as mentioned above, there are two types of atrial fibrillation:

1. Hyperdrenergic.
2. Vagus.

Characteristics of the vagal type of atrial fibrillation:

• more often occurs in the male half of the population;
• attacks begin with meals or at night;
• no dependence on physical activity or stress;
• provoking factors may be a tightly tied tie or scarf, a state of rest or a horizontal position of the body, a tightly tightened belt or bloating.

The hyperdrenergic variant is characterized by:

• the occurrence of seizures at any time of the day, rarely at night;
• the dependence of the attack on the physical or emotional state of the body;
• frequent occurrence in women.

The course of the disease can take the following forms:

1. Permanent - chronic atrial fibrillation without restoration of sinus rhythm.
2. Paroxysmal - periodic "breaks" of the rhythm with its subsequent restoration.

Clinical manifestations, symptoms of atrial fibrillation

Paroxysmal form
The peculiarity of this variant of the course of atrial fibrillation is the alternation of normal heart function with the leading source of rhythm from the sinus node and atrial fibrillation. The frequency of seizures can range from one during a lifetime to several during a day. Sometimes this form eventually becomes permanent.

With this variant of arrhythmia outside the attack, due to the normal functioning of the heart, the person feels as usual. During a sharp arrhythmia of the type of atrial fibrillation, the condition deteriorates sharply. With self- or medication restoration of a normal heartbeat, the state of health again becomes normal.

When an attack (paroxysm) of atrial fibrillation occurs, the heart begins to contract inefficiently and quickly. As a result, there is insufficient pumping of blood and its delivery to vital organs. This leads to ischemia of tissues and body systems.

With frequent paroxysms or long periods (episodes) of abnormal heartbeat, the whole body gradually adapts to such work of the heart. Subjectively, the state of health worsens at the time of transition to arrhythmia from normal sinus rhythm. During an already disturbed rhythm, a person’s condition and his sensations improve slightly.

Atrial fibrillation can manifest itself with completely different symptoms. The common ones are:

• an attack of a sharp rapid heartbeat;
• discomfort in the region of the heart;
• severe weakness, malaise;
• increased sweating, cold extremities;
• feeling of fear;
• dizziness up to loss of consciousness.

The above symptoms can disturb a person not only with atrial fibrillation. Almost all types of cardiac arrhythmias are accompanied by similar manifestations.

permanent form
This course of atrial fibrillation is characterized by the absence of impulse generation in the sinus node. All idiopathic sources of rhythm are located in the atrial myocardium. Often the paroxysmal form becomes permanent. This happens either when it is impossible to restore sinus rhythm, or when paroxysms are too frequent, when restoring a normal heartbeat is not justified.

The condition and well-being of patients with this variant of the course is determined by the heart rate (HR). If it is as close as possible to 80 beats per minute, then a person may not feel this disease at all. With a significantly increased or decreased heart rate, the state of health worsens.

The concept of "heart rate with atrial fibrillation" includes the number of ventricular contractions per minute. With this pathology, it is not possible to change the number of atrial contractions.

Diagnosis of atrial fibrillation

Normal sinus rhythm and atrial fibrillation on the ECG The main methods for determining atrial fibrillation is an ECG study and Holter monitoring. An important criterion for diagnosing and prescribing further treatment is the heart rate at rest. This value is the starting point for choosing the dosage of the drug. Sometimes it is important to know how fast the heart beats during exercise. For this, stress tests are additionally assigned.

By interpreting the ECG, the diagnosis of atrial fibrillation can be made based on the following changes:

1. There is not a single P wave.
2. Instead, fibrillation waves f are recorded.
3. Different amplitude and shape of ventricular QRS complexes.
4. QRS complexes are located at different distances from each other (unequal R-R distances).

All these data indicate an inferior contraction and relaxation of individual atrial myocardial fibers.

Treatment

The treatment option for the disease depends on the course and degree of developing complications. The permanent form does not require the restoration of a normal heartbeat, but implies a correction of the heart rate and an increase in the contractile function of the ventricles. The paroxysmal form requires the restoration of sinus rhythm as soon as possible.

Treatment of paroxysm of atrial fibrillation(stopping an attack in a paroxysmal form):

• Provide access to fresh air.
• Take a horizontal position of the body.
• Take Corvalol. If the attack has not developed for the first time, take the antiarrhythmic drug recommended by the doctor.
• In case of a sharp deterioration in well-being or no effect within a few hours, it is necessary to seek qualified medical help.

When providing assistance in a hospital, the rhythm is restored in two main ways:

• The introduction of an antiarrhythmic drug intravenously.
• The use of electropulse therapy (the use of an electric discharge).

To the choice of tactics treatment of a permanent form of atrial fibrillation must be approached with extreme caution. In some cases, we can still talk about restoring normal sinus rhythm.

The main task of treating persistent arrhythmia is to ensure adequate blood supply to all organs of the body. To do this, you need to create the optimal number of heartbeats. At an increased frequency, drugs are used that help the atrioventricular node to pass a smaller number of nerve impulses to the ventricles. With a ventricular contraction rate of less than 40 beats per minute, drug treatment is practically useless. In this case, surgical intervention is necessary. In view of the increased risk of thrombus formation in the atrial cavities, additional therapy is aimed at preventing their occurrence.

Main drugs used for atrial fibrillation:

• Antiarrhythmic drugs (Novocainamide, Amiodarone).
• Beta-blockers (Anaprilin, Metoprolol).
• Calcium channel blockers (verapamil).
• Antiplatelet agents (Aspirin, Polocard).
• Minerals and trace elements - preparations containing potassium and magnesium (Asparkam, Magnevit, Panangin).
• Cardiac glycosides (prescribed with the addition of heart failure - Digoxin, Strofantin).

Surgical treatment of the disease

In view of the active development of science and medicine, the surgical method for the treatment of arrhythmias is very promising. There are several different approaches:

• Physical destruction of an element of an atrioventricular node or a pathological bundle of conduction of a nerve impulse to the ventricles from the atrium. This option is resorted to in the absence of the effect of drug treatment. As a result of the operation, a decrease in heart rate is achieved by normalizing the number of signals conducted to the ventricles. In this case, quite often the atrioventricular connection is completely blocked, and for normal contraction of the ventricles, a pacemaker (IVR - artificial pacemaker) is implanted in them.
• Implantation of a mini cardioverter defibrillator. This treatment option is more suitable for people who have paroxysms of atrial fibrillation infrequently. Such a device automatically recognizes a violation of the rhythm and produces an electrical impulse that can restore normal cardiac activity.

Prevention of atrial fibrillation

If there is a history of at least one episode of paroxysmal atrial fibrillation, it is important to identify its cause. This is necessary to prevent their recurrence. The general plan of measures aimed at preventing arrhythmia attacks:

1. Treatment of the disease that caused the rhythm disorder.
2. Taking magnesium and potassium supplements. Eating foods rich in them (pumpkin, watermelon, bananas).
3. Continuous intake of small doses of antiarrhythmic substances (only on the recommendation of a cardiologist).
4. Exclusion of the influence of increased tone of the nervous system.

The last point of prevention is effective in the presence of evidence of a vagal or hyperadrenergic form of arrhythmia.

Prevention of attacks of the vagal type of atrial fibrillation:

• reduction of excess body weight;
• avoid constipation and bloating;
• exclusion of the horizontal position of the body after eating. Exclusion of excessive eating at night;
• avoidance of sharp bends of the body.

Prevention of the hyperadrenergic type:

• increase in rest and sleep time;
• avoidance of stress and strong physical exertion;
• the maximum possible reduction in the use of coffee, strong tea, nicotine;
• taking sedative herbal preparations (tincture of motherwort or valerian).

Possible Complications

Speaking about the possible complications of atrial fibrillation, it is necessary to understand that they are divided into two types:

1. Developing with paroxysm.
2. Developing with a long course of constant arrhythmia.

The first group includes:

• OLZHN - acute left ventricular failure (cardiogenic pulmonary edema);
• ONMK - an acute violation of cerebral circulation due to a lack of oxygen and nutrients;
• violations of the blood supply to any organ of the body.

The second group includes the so-called. late complications:

• chronic heart failure with all its manifestations;
• increased thrombosis and thrombosis of various organs (myocardial infarction, thromboembolic strokes).

Forecast of atrial fibrillation

The prognosis of the disease depends entirely on the timely diagnosis and treatment of pathology. Adequate treatment, which contributes to the normalization of heart rate and full blood supply to the organs of the body, leads to complications to the least extent. However, even with proper treatment, there is an increased risk of thrombosis and its complications.
Thus, with atrial fibrillation, it is quite possible to maintain a normal lifestyle for a long time.