Atrial fibrillation is a disease of the heart in which the heart muscle beats irregularly (cardiac arrhythmia). Typical symptoms of the disease are palpitations (excessively fast heartbeat) or palpitations. The disease mainly occurs in older patients. One in seven to ten 70 to 80-year-olds suffer from atrial fibrillation.
Further information on causes, diagnosis and treatment as well as selected specialists for atrial fibrillation can be found below.
Selected specialists for atrial fibrillation
Brief overview:
- What is atrial fibrillation? A disease of the heart in which the heart muscle of the atria does not contract regularly. It is therefore a cardiac arrhythmia.
- Causes: It is assumed that age-related scarring of the heart tissue leads to uncoordinated electrical signals that do not allow normal muscle contraction.
- Risk factors: Severe stress, certain heart conditions, high blood pressure, lung disease, diabetes, kidney disease, sleep apnea, hyperthyroidism, long-term alcohol abuse.
- Symptoms: General symptoms of cardiac arrhythmia: Dizziness and possibly fainting, heart pain, shortness of breath, palpitations, restlessness, severe anxiety.
- Diagnosis: A blood pressure measurement and an ECG clearly show irregular heartbeats. An event recorder and an echocardiogram can provide further information.
- Treatment: The pre-existing condition may need to be treated. Medication helps to normalize the heartbeat during attacks. Blood-thinning agents reduce the risk of stroke. Various further therapies are used depending on the individual situation.
- Prevention: A healthy diet, sufficient exercise and abstaining from smoking and alcohol can prevent the development of underlying diseases and thus also reduce the risk of atrial fibrillation.
Article overview
In contrast to ventricular fibrillation, atrial fibrillation is not life-threatening. However, those affected have an increased risk of suffering a stroke or heart attack or developing heart failure (cardiac insufficiency ). Untreated, prolonged atrial fibrillation often causes an enlargement of the heart's atria.
The earlier the heart disease is recognized and treated, the sooner the patient can regain normal sinus rhythm.
What are the symptoms of atrial fibrillation?
Paroxysmal atrial fibrillation often occurs without symptoms. Some sufferers only notice a slight drop in performance. Other patients with cardiac arrhythmia have the following symptoms:
- Dizziness or even fainting
- heart pain
- shortness of breath
- palpitations
- restlessness
- strong feelings of anxiety
Which symptoms occur depends on whether the heart beats
- too fast,
- rather normal or
- too slow
irregularly.
Rapid beats are experienced as a frightening racing heart, often accompanied by shortness of breath and severe pain in the chest area.
With normal speed, fatigue often occurs.
Slow heart arrhythmiasusually lead to dizziness. In the worst case, the person affected can faint.
Chronic atrial fibrillation is rarely noticed by the patient, as their heart muscle has already become accustomed to the irregular pumping.
Causes of atrial fibrillation
In healthy people, the sinus node in the right atrium sends out an electrical impulse that is transmitted to the ventricles. There it causes the heart muscle to contract. This is how the heartbeat is generated. This pumps the blood into the body.
Cross-section of the heart: In green at the top of the right ventricle is the sinus node, which sends impulses to the ventricles via the conduction system © lom123 | AdobeStock
In atrial fibrillation, an excessive number of circular electrical impulses are generated in both atria outside the sinus node. These uncoordinated signals are unable to cause normal muscle contraction. As a result, only a small proportion of the signals reach the ventricles, as conduction is also blocked.
The result is a slow arrhythmia. The atria and ventricles cannot fill with sufficient blood. If the patient also suffers from cardiac insufficiency, the heart muscle pumps even less blood through the body. As a result, blood pressure drops.
If the sinus node generates a high number of electrical impulses, they cause heart palpitations (too fast arrhythmia) in the underlying ventricles.
In the beginning, atrial fibrillation only occurs as an attack. After a few minutes or at most hours, the heart rhythm normalizes on its own.
There is still a considerable need for research into the exact causes of the cardiac arrhythmia. Doctors assume that the altered heartbeat is caused by age-related scarring of the heart tissue. It is no longer able to transmit the electrical impulses as required. The signals circulating in the atrium have a negative effect on normal cardiac activity.
In addition, the risk of developing atrial fibrillation at an advanced age appears to be genetically determined. However, it sometimes develops spontaneously without any other cause.
Factors that promote a disturbed heart rhythm are, for example
- severe stress
- certain heart diseases(coronary artery disease, inflammation of the heart muscle, heart valve defects)
- prolonged high blood pressure
- lung diseases
- Diabetes mellitus (diabetes)
- kidney disease
- Sleep apnoea (breathing stops briefly during sleep)
- Hyperthyroidism
- Long-term alcohol abuse
Diagnosis of atrial fibrillation
People who experience one or more of the above symptoms should contact a specialist as soon as possible. Suitable contacts are specialists in internal medicine or cardiologists. The same applies if the atrial fibrillation does not disappear on its own within two days at the latest.
The irregular heartbeat can be diagnosed with the help of a blood pressure measurement and an ECG (electrocardiogram). The doctor attaches electrodes to the patient's chest to measure their heartbeat. If atrial fibrillation is suspected, an exercise ECG or a long-term ECG is usually used.
The exercise ECG is used to measure the heart rate under physical stress, i.e. increased pumping activity of the heart. The patient sits on an exercise bike and pedals hard.
The long-term ECG involves measuring the heart rate over 24-48 hours. To do this, the patient carries a small mobile ECG device with them. It records the patient's everyday heart activity.
The doctor evaluates the data after the measurements have been completed.
Paroxysmal atrial fibrillation can be easily recorded with an event recorder. The patient only activates the device when the atrial fibrillation becomes noticeable. The doctor then analyzes the data on a PC.
The echocardiogram (ultrasound image of the heart) provides detailed information about the condition of the heart muscle and its pumping behavior. The examining specialist can also easily identify any blood clots.
An ultrasound probe connected to a narrow tube is used to perform an echocardiography. The doctor pushes this through the mouth and throat to the middle of the patient's esophagus. From there, he can take a close look at the right atrium of the heart. The patient is given a mild sedative beforehand.
Treatment of atrial fibrillation
If the cardiac arrhythmia is caused by a thyroid disorder, the specialist will initially only treat this. After that, the atrial fibrillation usually improves all by itself.
In the case of paroxysmal atrial fibrillation, the doctor prescribes special medication, so-called antiarrhythmic drugs. The patient takes them as soon as they feel an attack coming on. Antiarrhythmic drugs reduce the heartbeat to a resting pulse rate of around 70 beats per minute within a short period of time.
However, the patient must take care to take the medication exactly as instructed: Accidental overdoses can slow down the heartbeat considerably. Atrial fibrillation accompanied by palpitations can also be effectively treated with medication.
To minimize the increased risk of stroke, the patient is also given blood-thinning medication such as Marcumar or Xarelto. They prevent the blood circulating in the atrium from clotting and forming blood clots. These could then travel to the brain and block an important blood vessel there.
Drug therapy does not always work. If the heart patient still has symptoms, electrocardioversion (electroshock treatment) is recommended. For this, the patient is connected to various devices under short-acting anesthesia. They control the blood pressure and oxygen supply. Two applied electrodes then conduct electricity through the heart muscle for fractions of a second. This causes the heartbeat to normalize.
In most cases, the connection points between the pulmonary veins and the heart trigger the disease in the patient. In this case, the patient can also be treated with pulmonary vein isolation(catheter ablation).
To do this, the doctor inserts a catheter (thin plastic tube) through a small incision from the inguinal vein through the great vena cava to the left atrium. There he obliterates the muscle tissue causing the arrhythmia using high-frequency electricity or cold.
6 to 8 out of 10 patients become permanently symptom-free as a result of catheter ablation. Repeating the procedure further increases the patient's chances of recovery.
The German Heart Foundation advises that this operation should only be performed in a special heart center. This reduces the risk of complications due to the extensive experience of the doctors involved. In addition, an inserted pacemaker can significantly improve the patient's heart function.
Patients with heart disease who also suffer from atrial fibrillation sometimes suffer relapses after successful treatment. People with heart failure who develop atrial fibrillation in the course of their lives generally die earlier than patients who only have cardiac arrhythmias.
Prevention of atrial fibrillation
The occurrence of atrial fibrillation cannot be prevented. However, it is possible to prevent the development of underlying diseases, the direct consequence of which is cardiac arrhythmia.
As narrowed coronary arteries are the main cause of the disease, it is advisable to
- eat a healthy diet,
- exercise sufficiently and
- avoid smoking and
- excessive alcohol consumption
alcohol if possible.