Atrial fibrillation
Atrial fibrillation is the most common clinically significant arrhythmia. It occurs when the atria (the upper chambers of the heart) beat very fast and irregularly, which leads to an irregular and often fast heartbeat. Instead of contracting in an orderly, synchronised way, the atria ‘quiver’, which creates the conditions for slow, swirling blood flow and can encourage blood clots to form. This is why atrial fibrillation is dangerous not only because of its unpleasant symptoms, but also because of the increased risk of stroke.
The most common symptoms include palpitations and skipped heartbeats, shortness of breath, reduced exercise tolerance, fatigue, a feeling of weakness or chest discomfort. In some patients atrial fibrillation is completely asymptomatic and is discovered by chance, for example during an ECG, Holter monitoring or a routine check-up.
Atrial fibrillation can have various causes. The most common factors include arterial hypertension, heart valve disease, coronary artery disease, heart failure, thyroid disease, obesity and sleep apnoea. In older people, atrial fibrillation also often develops because of age-related changes in the heart, above all the replacement of normal heart muscle tissue in the atria by connective tissue, which disrupts the orderly conduction of electrical impulses.
The diagnosis is usually made with an ECG; if symptoms come and go, longer monitoring of the heart rhythm is needed, most often with a Holter ECG. Once the diagnosis is confirmed, the risk of stroke is assessed in order to decide whether anticoagulant therapy (medicines that prevent blood clotting) should be started.
Treatment of atrial fibrillation is tailored to each patient. It may include medicines that slow the heart rate, antiarrhythmic drugs that help maintain a normal rhythm, electrical cardioversion, catheter ablation, and the management of risk factors and treatment of associated conditions such as arterial hypertension, obesity, sleep apnoea and thyroid disease. An important part of treatment is a proper assessment of the need for anticoagulation to reduce the risk of stroke.
Although atrial fibrillation is a chronic condition, with timely diagnosis and appropriate treatment most patients can lead a normal, active life. An individually tailored treatment approach is key to controlling symptoms, preventing complications and maintaining quality of life.
