Dr Aidin Rawshani

Atrial fibrillation

Contents

What is atrial fibrillation (cardiac fibrillation)?

Atrial fibrillation means that the rhythm of the heart is rapid and irregular. A rapid and irregular rhythm makes the heart less effective. The ability of the heart to pump blood around the body becomes worse and in the long run the heart function becomes worse. In addition, there is a risk of clots forming in the heart space and these clots can go out into the body and clog blood vessels. When blood vessels in the brain are clogged with such clots, you get a stroke. Atrial fibrillation is the most common cause of stroke.

There are several types of atrial fibrillation:

  • Permanent atrial fibrillation means that atrial fibrillation does not cess.
  • Attack-wise atrial fibrillation means having atrial fibrillation for periods, but the flicker passes by itself.

Atrial fibrillation and diabetes mellitus

  • People with type 2 diabetes have at least 2 times increased risk of atrial fibrillation.
  • People with type 1 diabetes probably have no increased risk of atrial fibrillation.

Symptoms of atrial fibrillation

The most common symptoms of atrial fibrillation are as follows:

  • Heart palpitation.
  • Irregular pulse.
  • Impaired physical ability (you can’t take as much as before)
  • Difficult breathing (you feel shortness of breath)
  • Feeling of discomfort in the chest.

After some time (which can vary from months to many years), the pumping function of the heart may be impaired and you have heart failure. In this case, a serious illness has developed, which gives symptoms in the form of shortness of breath (especially lying down), swelling of the legs and impaired physical ability.

When should I seek medical care?

If you suspect that you have atrial fibrillation, you can contact your caregiver. If you have previously been diagnosed with atrial fibrillation, you should contact your healthcare provider in the following situations:

  • If your atrial fibrillation has become clearly more difficult to live with.
  • If your heart rate is unusually high
  • If you have swollen legs or are inexplicably tired or shortness of breath.
  • You have difficulty breathing or chest pain (chest pain or discomfort)

Investigations and investigations for atrial fibrillation

To determine if you have atrial fibrillation and decide which treatments are appropriate, your doctor needs to know what your lifestyle is. The use of alcohol (beer, wine, spirits, etc.), smoking, snuffing, coffee and exercise habits are important. Alcohol can trigger atrial fibrillation, and coffee can also trigger atrial fibrillation. It is also important to identify what other diseases (especially cardiovascular diseases) and risk factors (e.g. high blood pressure, high cholesterol) you have to make an overall assessment of your future risks.

The diagnosis is made with ECG

The diagnosis of atrial fibrillation is made by a regular ECG examination. The examination maps the rhythm of the heart and is completely painless.

Other examinations in the investigation of atrial fibrillation

The doctor conducts a general examination to find more risk factors as well as signs of cardiovascular disease. Laboratory tests are also taken to investigate kidney function, cholesterol levels, salt balance, thyroid function and blood counts (among others). Most often, an ultrasound examination of the heart is also done to assess how the heart looks and how it works.

If you suspect that you have atrial fibrillation but the ECG does not show it, you can have a longer ECG record (e.g. over 24 hours). This can be done with a portable ECG apparatus.

When the examinations are completed

After the examinations are completed, you will be informed by the doctor whether the atrial fibrillation is caused by another heart disease or whether it is due to some other disease. You will also review the effects of atrial fibrillation on the body, especially the risks of developing heart failure and blood clotting. Next, you’ll talk about the advantages and disadvantages of all the different types of treatments available.

You have the right to understand

In order to be able to participate in your care and make decisions, it is important that you understand the information you receive from the healthcare staff. Ask questions if you don’t understand. You can also ask for information printed so that you can read it in peace. If you do not speak Swedish or have a hearing loss, you may be entitled to help from an interpreter.

Treatment

You will receive different types of treatment depending on how severe you have and how long you have experienced them. Most people who have permanent atrial fibrillation need to use medicines, often for life. Among other things, it is blood thinners, which reduce the risk of blood clotting.

In consultation with your doctor, you will decide which form of blood thinning treatment is best. There are a few people who cannot get blood thinners because they have bleeding much easier than others.

If you have a lot of symptoms from your atrial fibrillation but have only had it for a short time, you will often receive electrical therapy, called cardioversion. That means you’re anesthetized and you get an electric shock through your chest. The purpose of the electrical therapy is to restore the habitual rhythm of the heart. When atrial fibrillation has existed for more than a year, it is often very difficult to restore the heart rhythm. If you have had atrial fibrillation for a long time or if you don’t have much trouble, you may be given medicines that slow down the excessively rapid heart rate.

It may also happen that you do not feel your atrial fibrillation at all. Then you may not need medication, except for any blood-thinning drugs.

Two paths of treatment

When you have permanent atrial fibrillation, you can get two different types of treatments:

  • Treatment that involves restoring the heart rhythm and preventing atrial fibrillation from coming back.
  • Treatment that involves maintaining the atrial fibrillation itself, but helps to alleviate your symptoms with medicines. It is medicines that slow the heart so that it does not beat so fast, which also strengthens the heart muscle.

If you have symptoms of atrial fibrillation, it is usually necessary to try to restore the heart rhythm. Both treatments typically require you to receive treatment with blood thinners to reduce the risk of blood clotting.

When the heart rhythm should be restored

The heart rhythm can be restored with cardioversion. It’s a treatment that involves you getting anesthetized and getting an electric shock through your chest. It is also possible to get the right heart rhythm again with the help of medicines. Electric shock is the most effective method and allows most people with chronic atrial fibrillation to regain their usual heart rhythm for at least some time.

Electric shock treatment

In particular, electroshock treatment is caused by those people who have a lot of problems and who have not lasted for such a long time. It is a good and reliable method of treatment that has been used for a long time.

First you may need to prepare yourself with a drug treatment. This is true if you have had atrial fibrillation for more than two days, as blood clots may have started to form in the atria of the heart. To reduce the risk of blood clotting, you should take blood thinners for at least three weeks before the electrical treatment and at least four weeks after.

When the time comes for the actual electric shock treatment, you can come to the hospital, but you can go home again on the same day. First, you get anesthetized with an anesthetic drug given in a syringe. Then you get an electric shock through your chest. Often then the heart rhythm returns to a normal rhythm. After the electric shock, you may feel that it burns, or stings in the skin. It goes over after a couple of days.

One problem is that many people can get back their atrial fibrillation. Repeated electric shock may then be necessary. Between one third and half of the people treated to receive the flicker back within three months. After a year, the number of relapses has increased further.

Electric shock best in short-term atrial fibrillation

Electric shock treatment is most effective if you have had atrial fibrillation shortly before treatment. It rarely makes sense to get electroshock treatment if you have had atrial fibrillation for more than a year.

If atrial fibrillation returns, you may receive repeated electroshock treatments while taking medicines that stabilise the heart rhythm. If you experience this new relapse, it is doubtful whether you will benefit from continuing the electrical treatment.

Treatment with drugs for the right heart rhythm

As an alternative to electric shock, you can get medicines that restore the rhythm of the heart. The advantage of this is that you do not have to be anesthetized. The downside is that it is not so often possible to get back the usual heart rhythm. In addition, you can get side effects of the medicines. As with electric shock therapy, preliminary treatment with blood thinners is needed.

What happens in the body?

The heart has two atria and two chambers. The conduction system begins in the right atrium (sinus node), then the electrical signal spreads to the left atrium and descends into the ventricles (right- and left bundle branch).

Atrial fibrillation means that the heart beats with an irregular rhythm. You also usually get faster heart rate. This means that the heart cannot pump the blood around the body as effectively as it usually does. The fact that atrial fibrillation is chronic means that the symptoms are persistent.

The risk of getting permanent atrial fibrillation increases the older you become, but before the age of 50, the disease is rare. The reasons are only partially known. There is a connection with other cardiovascular diseases. If you have diabetes or hyperthyroidism, also called toxic goiter, the risk of permanent atrial fibrillation is also increased. You may also have atrial fibrillation that comes in attacks. The symptoms often pass by themselves.

A muscle that is constantly working

An illustration of the heart with the atriums and ventricles

The heart is a muscle that pumps blood around the body so that all organs receive their vital oxygen. The heart consists of two atria and two chambers. Between the atria and ventricles of the heart and at the exit from the ventricles there are heart valves. The heart valves function as check valves, which prevent blood from flowing back when the atria or ventricles contract.

Blood that left oxygen in the body comes back to the right atrium of the heart. The atria contract and the blood then flows into the right ventricle. In turn, the chamber collapses and sends the blood into the lungs for it to be oxygenated again. The oxygenated blood then flows from the lungs onto the left atrium and left ventricle of the heart and then through the large body artery into the body. The blood then has a high pressure to reach out to all parts of the body and leave oxygen. Then the blood flows back to the right half of the heart again in a constant cycle.

Pulse shows the pace

Any contraction of the left ventricle increases blood pressure. You can feel the pulse beating in the various arteries of the heart, arteries. Most often, the pulse ranges from 60 to 90 beats per minute when you are not straining. That means almost 100,000 beats per day.

The heart is controlled by electrical signals

The rhythm of the heart is controlled by electrical impulses from the so-called sinus node of the right atrium. It provides a regular rhythm of contraction of the heart muscle. From the sinus node, the signals first spread to both atria of the heart, which contract and squeeze the blood into the ventricles. The signals then pass through the electrical system of the heart, the so-called conduction system, to the chambers that are about to contract.

It is important that the atria and ventricles contract in turn, because then the heart fills properly and every heartbeat brings maximum benefit. If the normal conduction system of the heart works poorly or completely stops working, other parts of the heart muscle cells can enter instead and form electrical signals that take over the control of the heart rhythm. But such a rhythm makes the heart pump out the blood less efficiently.

Atrial fibrillation disrupts the work of the heart

In atrial fibrillation, the heart’s signaling system has partly come into disarray. The electrical signal of the atria is then not started from the sinus node. Instead, electrical signals occur in several places of the atria without coordination. This electrical disorder results in the atria contract independently of the ventricles, in addition very quickly, often more than 300 times per minute. The atria do not have time to fill or empty effectively of blood between contractions. Only some signals from the atria are transmitted to the ventricles. Therefore, the contractions of the ventricles, and hence the pulse, become irregular and often faster than usual. The effect of poor coordination between the atria and ventricles, irregular rhythm and rapid pulse is that the heart gets less ability to pump around the blood, one of the causes of so-called heart failure.

Common disease in the elderly

Atrial fibrillation is the most common form of rhythm disturbance of the heart in adults. The disease is rare in people under 50 years of age. The risk increases with increasing age and every tenth person over 80 years of age has atrial fibrillation.

Associations with other diseases

The causes of atrial fibrillation are only partially known. Over six out of ten people with atrial fibrillation have some other cardiovascular disease such as high blood pressure, heart valve disease, heart failure or heart muscle inflammation. The risk of developing atrial fibrillation increases if you have diabetes or thyrotoxicosis, which is also called a toxic goiter. But just over three out of ten people with atrial fibrillation have no heart disease or other diseases that is behind.

How to reduce the risk of flicker

By quitting smoking, starting to eat less fatty foods and exercising more, you reduce the risk of cardiovascular disease, which in turn can reduce the risk of atrial fibrillation. However, if you have permanent atrial fibrillation, you can’t influence by changing your lifestyle.

Atrial fibrillation increases the risk of blood clotting

Permanent atrial fibrillation is the most common cause of a blood clot in the brain and, accordingly, to a stroke. Every year, 6,000 Swedes suffer strokes as a result of atrial fibrillation. The increased risk of blood clots is due to poor blood flow and occasionally standing still in the atria of the heart. The blood then has easier to lump together. If you have atrial fibrillation, you can often reduce the risk of having a stroke by taking medicines against blood clotting. It is the doctor who must determine whether you can take such medication

More information

Patient version of the National Board of Health and Welfare Guidelines for Care in Atrial Fibrillation

The Swedish National Board of Health and Welfare has developed national guidelines on how atrial fibrillation and a number of other diseases should be investigated and treated. The guidelines provide health care recommendations on certain examinations and treatments that may be relevant to care for those who have atrial fibrillation.

In the area there are also examinations and treatments that are done more routinely. They are not in the guidelines.

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