Atrial fibrillation

The causes are often pre-existing heart disease. There are various strategies for treating atrial fibrillation. Which ones are used depends on the duration of the cardiac arrhythmia, but also on the individual risk profile. Without treatment, a stroke can be the result.

Overview: What is atrial fibrillation?

Atrial fibrillation is one of the cardiac arrhythmias – it is the most common form. The heart beats irregularly and usually too fast. The reason is that the signals that normally determine the rhythm of the heart are disturbed. A kind of “electrical storm” occurs in the conduction system of the heart. The atria and ventricles then no longer pump in coordination with each other. The heart’s performance decreases and it can no longer pump as much blood through the body as usual.

Atrial fibrillation often manifests itself through symptoms such as palpitations, palpitations, a feeling of pressure and tightness in the chest or poor performance. However, quite a few patients experience no symptoms at all and doctors discover atrial fibrillation by chance. There are various causes of atrial fibrillation, for example coronary heart disease (CHD), in which the coronary arteries are narrowed. However, high blood pressure or a heart valve defect are also possible causes. Atrial fibrillation can be detected using electrocardiography (ECG).

We have various options for treating atrial fibrillation. Medication is used which only controls the heart rate. In cardioversion, on the other hand, we try to restore the normal heart rhythm with the help of medication or an electrical impulse. Various drugs and, above all, catheter ablation are available for permanent rhythm control. Surgery may also be an option if all other therapies have not been sufficiently successful.

Without treatment, atrial fibrillation can have further consequences, such as a stroke due to a blood clot being carried over. This develops particularly easily in the atria, can break away and enter the brain with the bloodstream.

Therefore, the most important therapy for patients with atrial fibrillation and additional risk factors is reliable blood thinning.

You can prevent atrial fibrillation to a certain extent by leading a heart-healthy lifestyle: a healthy diet, plenty of exercise, not being overweight and not smoking.

Atrial fibrillation – frequency and age

Atrial fibrillation is the most common cardiac arrhythmia. In Switzerland, around one percent of the population is affected. That is the equivalent of around 100,000 people. Heart disease is particularly common in older people. Around ten percent of people over the age of 75 suffer from atrial fibrillation.

Atrial fibrillation: Causes and risk factors

In atrial fibrillation, the normal heart rhythm is disturbed and the electrical signals no longer propagate properly in the heart. This is how a normal heartbeat develops: The “clock” for the normal heart rhythm is the so-called sinus node, which is considered the natural pacemaker. It is located in the wall of the right atrium and generates the electrical excitations. The AV node, which is located at the junction between the atria and the ventricles, then transmits the electrical impulses to the heart muscles. The muscles, which are excited one after the other, then contract – they contract and the normal heartbeat (sinus rhythm) is created in this way. A healthy heart beats about 60 to 100 times per minute (at rest).

What happens in atrial fibrillation

In atrial fibrillation, however, the electrical impulses circulate arrhythmically and rapidly in the atrium. They cannot spread normally. The atria are excited at a rate of more than 350 times per minute. They “tremble” or “flicker”. The sinus node itself is “overrun” during fibrillation and its function is no longer effective. The disruption can be compared to an “electrical storm”. The AV node in turn transmits these arrhythmic excitations to the ventricles. Because the atria do not provide sufficient pumping power, they no longer help to fill the ventricles with blood. Cardiac output therefore decreases (by approx. 20%). Nevertheless, the ventricles continue to pump blood into the body’s circulation, albeit more irregularly.

Atrial fibrillation: Causes are often other diseases

There are many causes of atrial fibrillation. Those affected usually have other diseases, either in the heart itself or in other organs. The most important are:

• Coronary heart disease (CHD): the coronary arteries narrow due to deposits (arteriosclerosis)
• High blood pressure
• Heart valve defects
• Enlarged atria
• Heart attack
• Heart failure (cardiac insufficiency) – it can also be the result of atrial fibrillation
• Heart muscle diseases, e.g. myocarditis

Possible risk factors for atrial fibrillation

Other diseases and factors can also promote atrial fibrillation. Examples are:

• Age – the risk of atrial fibrillation increases with age
• Diabetes mellitus – diabetes can also affect the heart
• Hyperthyroidism (overactive thyroid gland)
• Sleep apnea – breathing stops at night
• Overweight and obesity(adiposity)
• High alcohol consumption
• Smoking
• certain medications

However, we do not always find an organic cause for atrial fibrillation. Idiopathic or “lone atrial fibrillation” – i.e. without a recognizable cause – is the technical term for this.

Symptoms: Atrial fibrillation usually accelerates the heartbeat

Atrial fibrillation can be associated with various symptoms. The following symptoms may indicate atrial fibrillation:

• Palpitations, palpitations or palpitations – the pulse is faster and more irregular than normal; it can last for hours, days or longer.
• Feeling of tightness and pressure in the chest
• Shortness of breath, shortness of breath and rapid exhaustion, especially during physical exertion
• tiredness, fatigue, feeling of weakness
• Dizziness
• Drowsiness

However, up to 30 percent of those affected experience little or no discomfort. This is often the case if the atrial fibrillation has been present for a long time and is chronic. You have become accustomed to the cardiac arrhythmia. Doctors often only find out about the irregular heart rhythm by chance during another examination. However, it is extremely important to recognize atrial fibrillation, even if it does not cause symptoms, as it can cause a stroke. This can be prevented by blood thinning.

Diagnosis of atrial fibrillation

The diagnosis of atrial fibrillation always begins with a discussion of your medical history, the anamnesis. For example, we ask the following questions:

• What symptoms do you have and since when?
• How pronounced are your complaints?
• Are there situations in which the symptoms intensify, for example during physical exertion?
• Do you have any known illnesses, e.g. cardiovascular diseases or other illnesses?
• Do you smoke? If yes: Since when and how much?
• What about your alcohol consumption?
• Are you taking any medications? If yes: Which and since when?

Based on your answers, we can already draw initial conclusions about the cause of your complaints. This is usually followed by a physical examination. Among other things, we measure blood pressure, feel the pulse and listen to the heart.

An electrocardiography (ECG) helps us to diagnose atrial fibrillation with certainty. A resting ECG is possible, but it only records the cardiac waveform over a short period of time. Sometimes a long-term ECG is necessary to record heart activity over 24 or 48 hours. You will receive a small, portable ECG device to take home with you and can and should go about your everyday life as normal during the recording. In both types of ECG, electrodes are attached to the chest to record the heart currents.

Imaging procedures are also used to detect other diseases of the heart or other organs. Examples are:

• Heart ultrasound (echocardiography): This examination can reveal heart valve defects, for example.
• Exercise ECG: We measure your heart activity under physical stress – you ride on an ergometer.
• Cardiac catheterization: We examine the condition of the coronary arteries
• Cardiac computed tomography (cardiac CT): We examine the condition of the coronary vessels and the heart chambers. Thrombi can be detected here.

In addition, a blood test with determination of blood biomarkers can be helpful. It provides indications of hyperthyroidism or anemia, for example, or of an underlying heart disease.

Atrial fibrillation – classification into three forms

Based on the frequency and duration of atrial fibrillation, we divide it into three forms:

• Paroxysmal atrial fibrillation: It occurs as an attack and usually disappears within 48 hours.
• Persistent atrial fibrillation: It lasts longer than seven days and does not stop on its own. Treatment can normalize the heart rhythm again.
• Long-term persistent atrial fibrillation: The condition persists for more than one year.
• Permanent atrial fibrillation: It remains permanent. A normal heart rhythm cannot be established.

Atrial fibrillation: Prevention, early detection, prognosis

There are several diseases that are associated with atrial fibrillation, for example coronary heart disease (CHD) or high blood pressure. To a certain extent, you can protect yourself from these and other risk factors: By leading a healthy lifestyle. These include the following measures:

• Eat a healthy and balanced diet: for example, eat plenty of fruit, vegetables and wholegrain products. You should also drink enough. We recommend 1.5 to two liters per day (as long as there is no heart failure).
• Move a lot in everyday life and do sports. 30 minutes of moderate physical activity is good – preferably every day of the week.
• Make sure you maintain a healthy weight – this can be achieved through a healthy diet and plenty of exercise. If you are overweight or obese, try to reduce your weight. Just a few kilos less often helps your heart a lot.
• Give up smoking and if you are a smoker: Try to stop smoking. Seek professional support if you can’t do it alone.
• Don’t drink too much alcohol and take regular alcohol breaks during the week.

If you have existing illnesses, such as coronary heart disease, cardiac insufficiency, high blood pressure or hyperthyroidism, make sure you receive adequate treatment. You can also achieve positive effects for many diseases with a healthy lifestyle. You should also always have high blood pressure or blood sugar levels treated.

There are no special measures for the early detection of atrial fibrillation. However, every doctor should take the pulse of patients over the age of 65. As a general rule, always consult your doctor promptly if you experience symptoms such as palpitations, shortness of breath or fatigue.

Course and prognosis of atrial fibrillation

Without adequate treatment, atrial fibrillation progresses further and further. At first it only occurs in attacks, then it lasts longer and finally persists permanently. Although atrial fibrillation is not life-threatening per se due to the arrhythmia, it can have a number of undesirable long-term consequences. One complication is heartfailure, because the heart has to work harder overall to supply the body with sufficient blood, oxygen and nutrients. Existing heart failure can also be worsened by atrial fibrillation.

Above all, however, the irregular heart rhythm can make it easier for a blood clot to form in the atria (usually in an area of the left atrium known as the atrial appendage). If it detaches and is carried away with the blood flow, an ischemic stroke can occur. stroke can be the result. The risk of stroke increases further if there are other risk factors, such as high blood pressure or coronary heart disease, but the risk is particularly high if there has already been a circulatory disorder in the brain (e.g. TIA). The aim here is to prevent another stroke. Interdisciplinary care is provided in cooperation with colleagues from the stroke center. With the right and sufficient treatment, the prognosis can be significantly improved.

Atrial fibrillation: Treatment varies from person to person

The treatment of atrial fibrillation always depends on the form, but also on other diseases and risk factors. We always work them out individually for each patient. Attack-like atrial fibrillation usually improves on its own within hours or days. If the flickering persists for a longer period of time, you should have it treated by us.

The therapy aims to control or normalize the heart rhythm, alleviate the symptoms and relieve the heart. In addition, specialists always treat any underlying diseases, for example cardiac insufficiency, high blood pressure, coronary heart disease or hyperthyroidism.