Home DiseasesCardiac arrhythmias Atrial Fibrillation: Symptoms, Treatment, Causes

Atrial Fibrillation: Symptoms, Treatment, Causes

by Josephine Andrews
Published: Last Updated on 376 views

Atrial fibrillation is a cardiac arrhythmia in which the heart beats irregularly. It is the most common form of abnormal heart rhythm – in Europe over six million people suffer from it. Sometimes those affected do not even notice the atrial fibrillation. Others experience heart palpitations or tachycardia. The risk of stroke is increased. Learn all about the symptoms, diagnosis and therapy for atrial fibrillation.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

R00 I48 I46 I47 I49 I45 I44

quick overview

  • Symptoms: tachycardia, irregular pulse, dizziness, shortness of breath, chest pain, feeling anxious
  • Therapy: drug frequency or rhythm control, catheter ablation of the pathologically altered heart muscle cells, anticoagulant therapy for stroke prophylaxis
  • Causes and risk factors: Frequently other heart diseases and physical diseases (e.g. thyroid or kidney diseases), obesity, alcohol consumption, stress
  • Diagnosis: medical history, (long-term/stress) electrocardiogram ( ECG ), echocardiography, laboratory values
  • Course of the disease: Atrial fibrillation is not acutely life-threatening, but it can lead to complications such as strokes or heart failure.
  • Prognosis: The prognosis depends primarily on the underlying diseases and the success of the treatment.

What is atrial fibrillation?

Atrial fibrillation is the most common form of cardiac arrhythmia. Older people are mostly affected. Up to 15 percent of people over the age of 70 suffer from atrial fibrillation.

Normally, the sinus node in the right atrium generates an electrical signal that is conducted into the ventricles via a specialized conduction system. There it triggers a muscle contraction and thus a heartbeat. In atrial fibrillation, excitations also occur outside of the sinus node at various points in the heart atria. These locally circulating excitation waves disrupt the regular electrical impulses from the sinus node. Some of these are also passed on to the chambers via the pipe system.

This results in an irregular heart rhythm (arrhythmia). If the heart activity is completely irregular and the ECG no longer shows any regularity, it is an absolute arrhythmia (arrhythmia absoluta).

In addition, the pulse in atrial fibrillation is usually too fast (tachyarrhythmia) and is often more than 100 beats per minute at rest. Doctors then speak of absolute tachyarrhythmia (TAA). If a so-called conduction block occurs, the pulse is sometimes too slow (bradyarrhythmia). At a rate of less than 50 to 60 beats per minute, doctors speak of absolute bradyarrhythmia (BAA). If the pulse is only irregular, but neither too high nor too low, it is normal-frequency atrial fibrillation.

Due to the circulating electrical signals, the atria are unable to fill completely with blood. Therefore, the amount of blood ejected from the heart is reduced. If the heart is already weak, it pumps even less blood. The blood pressure drops.

Atrial fibrillation: forms

Doctors distinguish three different forms of atrial fibrillation:

  • Paroxysmal atrial fibrillation (also called intermittent atrial fibrillation) : Occurs spontaneously and in fits and starts, often lasting several minutes to hours but usually less than 24 hours. The maximum duration is seven days.
  • Persistent atrial fibrillation : The heartbeat does not find its way back to its usual rhythm on its own, the atrial fibrillation only ends with cardioversion .
  • Permanent atrial fibrillation : Chronic atrial fibrillation that should or can no longer be converted into a stable sinus rhythm.

Most often, atrial fibrillation develops over the course of life. In many cases, it begins in fits and starts (paroxysmal or intermittent) and then lasts for minutes, hours, or days. Eventually, this develops into chronic (permanent) atrial fibrillation, which may persist, even under drug treatment.

In addition to the three forms of atrial fibrillation, doctors distinguish between two types:

  • In the vagotonic type, the heart rate decreases. This type of atrial flutter usually occurs at night or at rest.
  • In the sympathicotonic type, the heart rate increases. It often occurs in the morning or during the day after stress or physical exertion.

Valvular and non-valvular atrial fibrillation

The terms non-valvular and valvular are used interchangeably in relation to atrial fibrillation, although this distinction is more historical today. Physicians understand valvular atrial fibrillation to mean atrial fibrillation that is due to a disease of the mitral valve or an artificial mitral valve replacement.

It is mainly characterized by an increased risk of blood clots forming compared to other forms of atrial fibrillation. The term non-valvular atrial fibrillation includes all other forms independent of the mitral valve.

Atrial Fibrillation or Atrial Flutter?

Another form of arrhythmia also originates in the atria and is treated in a similar way, but has a different cause. Read more about this in the article Atrial Flutter .

What are the symptoms of atrial fibrillation?

Atrial fibrillation is often asymptomatic. About two-thirds of those affected feel nothing or only a small drop in performance from paroxysmal atrial fibrillation. In others, the symptoms are severe enough to interfere with normal, daily activities.

Typical symptoms of atrial fibrillation include:

  • tachycardia, palpitations
  • Irregular pulse
  • dizziness
  • shortness of breath
  • pain or pressure in your chest
  • feelings of anxiety
  • Frequent urge to urinate

The symptoms depend on the speed of the heartbeat. If the heart beats normally despite the atrial fibrillation, those affected may only feel tired and dizzy. If the heart beats too fast (often more than 100 beats per minute), those affected usually feel an uncomfortable racing heart, often chest pain and shortness of breath. If the heart beats too slowly, they suffer from dizziness or even faint.

If the atrial fibrillation becomes chronic, the organism sometimes gets used to the arrhythmia and those affected no longer have any pronounced symptoms.

How is atrial fibrillation treated?

If the atrial fibrillation developed due to another condition, such as an overactive thyroid, it is important to treat that condition first. In many cases, the arrhythmia then improves on its own.

Two strategies are available for the treatment of atrial fibrillation itself, which do not differ in terms of the prognosis of those affected: normalization of the heart rate (rate control) or control of the heart rhythm.

frequency control

In atrial fibrillation, the heartbeat is usually too fast. Depending on the cause of the atrial fibrillation and concomitant diseases, various active substances are used to lower the heart rate, in particular beta-blockers, calcium channel blockers (calcium antagonists) and digitalis. Guidelines recommend aiming for a resting heart rate of less than 80 beats per minute.

Drug rhythm control

In most people, atrial fibrillation initially occurs in fits and starts (paroxysmal atrial fibrillation). Affected people are often given medication to control the rhythm, which usually brings the heart rhythm back to normal. Doctors speak of drug cardioversion.

For example, the following active ingredients are used:

  • Vernakalant (antiarrhythmic)
  • Flecainide (antiarrhythmic)
  • Propafenone (antiarrhythmic drug)
  • amiodarone (potassium channel blockers)

In some cases, a single dose is enough to bring the heart’s rhythm back under control. If the person concerned has been trained accordingly, a doctor’s visit is not always necessary: ​​in this case, he carries the drug with him and takes it when an atrial fibrillation episode occurs.

In the case of long-term use, however, it is important that a doctor regularly checks and monitors the treatment. Even if it sounds like a contradiction at first, in some cases the drugs used to treat atrial fibrillation trigger other, potentially dangerous, arrhythmias. The treatment is therefore often initially carried out in the hospital. This enables doctors to react quickly to side effects.

electrocardioversion

Sometimes atrial fibrillation is very persistent and does not go away on its own or with medication. The doctor then tries to normalize the heart’s rhythm with external electrical currents. Doctors refer to this therapeutic measure as electrocardioversion.

Compared to medical cardioversion, electrocardioversion, which has an immediate effect, is particularly recommended for those affected whose circulation is impaired by atrial fibrillation (hemodynamic instability). These include, for example, people with fainting spells, symptoms caused by low blood pressure or acute heart failure.

Electrocardioversion works similarly to defibrillation during resuscitation. During the procedure, the patient is connected to various monitoring devices that monitor blood pressure and oxygen supply. Under a brief anesthetic , the doctor conducts electricity into the heart for a fraction of a second via two electrodes. This often falls back into its normal rhythm due to the electric shock.

Although electrocardioversion is almost always successful, atrial fibrillation often returns after some time.

catheter ablation

Catheter ablation makes it possible to cure many affected people from atrial fibrillation in the long term. Under certain circumstances, current guidelines even recommend considering ablation as the first therapeutic option for rhythm control.

First, the doctor guides a thin tube (catheter) through the groin veins into the heart. There he uses cold or electricity to destroy the pathologically altered heart muscle tissue. This is often in the area of ​​the pulmonary vein, which is why the procedure is also called “pulmonary vein isolation”. The chance of recovery with this procedure is up to 80 percent, but several interventions are often required.

pacemaker implantation

Sufferers who experience a heartbeat that is too slow sometimes need a pacemaker . This ensures a faster and stable heartbeat.

Protection against stroke

If people suffer from paroxysmal or chronic atrial fibrillation, there is sometimes a risk of blood clots forming in the atrium because the blood is no longer circulating properly. These blood clots can cause a stroke if they get into the bloodstream and from there into the vessels in the brain. However, the risk of stroke in atrial fibrillation is not increased in everyone affected.

If there is an increased risk of a stroke, this can be reduced by taking blood-thinning and anticoagulant medication (anticoagulants). In addition to the so-called vitamin K antagonists (e.g. warfarin and phenprocoumon), the available active ingredients include the new oral anticoagulants (NOAC) with the active ingredients apixaban, dabigatran, edoxaban and rivaroxaban.

However, bleeding complications, which are sometimes life-threatening, occur more easily as a result of the treatment. A newer procedure to protect against a stroke is the closure of the so-called atrial appendage. The atrial appendage is a sac of the atrium where clots form most commonly. However, this procedure carries the risk of complications, sometimes serious.

The benefit of such a therapy compared to drug therapy cannot be conclusively evaluated at the moment, as too little study data is available to date.

prevent relapses

Antiarrhythmic drugs are not only important for the treatment of an acute episode of atrial fibrillation. They also serve to prevent further episodes. Other medications and measures also reduce the risk of a relapse. These include, for example, ACE inhibitors and AT1 blockers for the treatment of high blood pressure and heart failure, as well as weight loss if you are overweight.

Sport in atrial fibrillation

Many people with heart disease question whether they can continue to exercise. In fact, the health-promoting effect of moderate endurance sports in cardiac arrhythmia has been scientifically proven. Exercise even reduces the risk of recurrences of atrial fibrillation. With the right training and weight reduction, the frequency of atrial fibrillation episodes can be reduced noticeably in some cases.

However, it is advisable not to exercise too much. High-performance athletes in endurance sports (marathons, cross-country skiing) in particular have an up to eight times higher risk of experiencing an episode of atrial fibrillation.

Beginning of training with atrial fibrillation

It is also recommended that patients with atrial fibrillation always discuss the appropriate training dose (intensity and duration) with their doctor before starting training. He determines the performance of the person concerned with various tests and, based on this, makes an individual recommendation for the training.

Which sport for cardiac arrhythmia?

Low to moderate endurance training is advisable for people with atrial fibrillation. Three to five training units per week of 20 to 30 minutes if possible are good for the heart. The guideline for those affected is a total of 60 to 120 minutes of exercise per week.

If an affected person increases their exercise capacity by more than 50 watts, which corresponds to walking faster, the risk of renewed atrial fibrillation is reduced by more than a third over a period of five years. If he also loses a few extra pounds, the risk of renewed atrial fibrillation falls by as much as three quarters. Sport and weight loss have a similar effect as medication.

The following endurance sports are good for atrial fibrillation:

  • (Fast) walking
  • Jog
  • Walking/Nordic walking
  • rowing
  • Cycling or ergometer training
  • Dance

Strength training prevents falls

In addition to endurance training, heart patients benefit from low-dose strength training . Older people in particular are affected by cardiac arrhythmias such as atrial fibrillation. Strength training gives them more security in everyday life and may help to prevent falls.

The following exercises are particularly gentle on the legs:

  • Strengthening the abductors (extensor muscles): Sit upright in a chair and press your hands against the outside of your knees. The legs work against the hands. Hold the pressure for a few seconds and then relax.
  • Adductor (flexor) muscle strengthening: Sit upright in a chair with your hands between your knees. Push outwards with your hands. The legs work against the hands. Hold the tension for a few seconds and then relax completely.

Walking or jogging on uneven ground helps to improve balance. For example, sand or a soft floor mat for indoor sports is suitable. The underground also trains the muscles in the legs and torso.

Since muscle mass consumes more energy than fat , muscle increases the basal metabolic rate and helps with weight loss. This is why heart patients benefit twice over from light strength exercises: the muscles become stronger, the gait more secure and the fat deposits disappear faster.

These sports are not suitable for atrial fibrillation

Atrial fibrillation often occurs suddenly and is accompanied by side effects such as weakness, dizziness or shortness of breath. Therefore, sport in the water is only suitable to a limited extent. However, supervised aqua aerobics is less risky than swimming in open water.

Climbing or mountain hiking or other sports with an acute risk of falling are also not suitable for people with atrial fibrillation.

Sports with a low risk of injury are recommended for those affected who take anticoagulants for stroke prophylaxis. Injuries cause internal or external bleeding, which is difficult to stop with the medication you are taking.

Unsuitable sports for cardiac arrhythmias such as atrial fibrillation are therefore:

  • mountain biking
  • snowboarding
  • Alpine skiing
  • boxing
  • karate
  • Full contact sports (e.g. handball, football, ice hockey)

Self-help for atrial fibrillation

The most effective self-help for atrial fibrillation is to remain on the medication prescribed, have regular check-ups with your doctor, and make lifestyle changes as necessary. Since stress is a possible trigger for atrial fibrillation, it is advisable to reduce constant time pressure and psychological stress if possible.

According to recent study results, yoga may help relieve symptoms of atrial fibrillation and reduce the number of episodes of atrial fibrillation. In addition, the effectiveness of home remedies or alternative medical concepts for atrial fibrillation has not been scientifically proven.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

cause and risk factors

Atrial fibrillation usually develops in old age. The causes of atrial fibrillation cannot always be clearly clarified. However, the structure of the heart changes with age and the heart tissue increasingly scars. As a result, electrical signals in the atrium are mistransmitted. They then circulate through the atrial tissue and disrupt normal heart activity. If no cause is found in people who otherwise have a healthy heart, doctors also speak of primary or idiopathic atrial fibrillation.

However, there are some risk factors that favor atrial fibrillation. Such risk factors are found in about 85 percent of those affected. In addition to certain medications that trigger atrial fibrillation, there are many chronic diseases, such as:

  • high blood pressure
  • Heart diseases (e.g. heart valve defects, myocardial insufficiency, coronary artery disease)
  • heart surgeries
  • diabetes mellitus
  • thyroid disorders
  • lung diseases
  • sleep apnea
  • kidney diseases

But lifestyle also has an influence on the development of atrial fibrillation. The following factors trigger atrial fibrillation in some cases:

  • Significant alcohol consumption
  • overweight
  • Stress and other psychological burdens

Researchers found that the risk of atrial fibrillation also has a genetic component.

diagnosis and examination

The atrial fibrillation specialist is a cardiologist. First, the doctor asks about the medical history. For example, it is important:

  • How often and how long the tachycardia lasts
  • Whether certain factors such as alcohol consumption or a lack of sleep trigger the tachycardia
  • Whether the tachycardia was preceded by a surgical intervention on the heart
  • Whether the person has heart disease or another physical condition
  • Whether other symptoms occur during the tachycardia

This is followed by a physical examination and a pulse and blood pressure check.

Electrocardiogram (ECG)

The most important test to diagnose atrial fibrillation is the electrocardiogram (ECG). The doctor measures the electrical heart currents using electrodes that are stuck to the chest.

Sometimes it is necessary to write an ECG over several days. Doctors then speak of a long-term ECG . For this purpose, small ECG devices are available, which those affected wear on their bodies. The ECG can also be recorded during physical exercise, usually on a type of home trainer ( exercise ECG ).

echocardiography

An ultrasound examination of the heart (echocardiography) can be used to examine its structure and pumping behavior. Especially if the doctor has already diagnosed atrial fibrillation, it is important to check for blood clots in the heart.

In order to examine the atria more closely and to detect any blood clots that may have formed, the doctor sometimes performs an ultrasound scan of the esophagus. To do this, he pushes the ultrasound head with a tube into the esophagus , as in a gastroscopy . Doctors refer to this procedure as transesophageal echocardiography. The right atrium is located in the middle of the esophagus, very close to the ultrasound head. He is particularly easy to judge from this position. Patients are usually given a light anesthetic for the procedure.

laboratory values

To find out the cause of the atrial fibrillation, the doctor may do some blood tests. This includes, for example, the determination of:

  • Blood salts (electrolytes), especially potassium and magnesium
  • thyroid levels
  • coagulation values
  • Infection parameters (possibly)

When it comes to coagulation values, the so-called INR value (International Normalized Ratio) records various blood coagulation factors. It has replaced the Quick value, which was frequently measured in the past, as it is less dependent on the measurement method.

Living with atrial fibrillation

Atrial fibrillation can be treated in different ways, but even after successful therapy it is always possible for atrial fibrillation to recur. Relapses are common, especially in people with heart disease.

Untreated paroxysmal atrial fibrillation may develop into permanent atrial fibrillation over the course of the disease. The longer the arrhythmia has existed, the more difficult it is to treat it. If it has occurred due to other diseases, for example an overactive thyroid gland, the arrhythmia often disappears on its own after treatment.

The prognosis of atrial fibrillation depends particularly on accompanying cardiac diseases. If the heart is already weak, atrial fibrillation can significantly increase mortality and reduce life expectancy. How high the life expectancy is in atrial fibrillation, however, cannot be answered in general.

In contrast to ventricular fibrillation, atrial fibrillation is not acutely life-threatening, but it does carry some risks, such as cardiac insufficiency or an increased risk of stroke. This can usually be contained well with anticoagulant medication. The risk of an overdose is particularly high in older people because their liver is no longer working as well, they sometimes take many other medications, drink too little or fall more often. In these cases, the doctor sometimes advises against anticoagulant medication.

While it is not possible to prevent atrial fibrillation, it is possible to prevent the diseases that cause it. A healthy diet, regular exercise and avoiding stimulants reduce the risk of coronary heart disease – the main cause of atrial fibrillation.

Sexuality in atrial fibrillation?

People with heart conditions such as atrial fibrillation often wonder if they can still have sex despite their condition. However, the fear of overloading the heart is usually unfounded. There are usually no medical concerns, particularly in people with well-controlled arrhythmias who do not experience problems with moderate physical exertion.

If in doubt, consult a doctor. This is able to assess or test physical resilience.

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