The term fibrillation can be considered in two ways. If we are talking about a condition borderline for life, often leading to death, it is appropriate to talk about fibrillation of the ventricles of the heart. Doctors call atrial fibrillation atrial fibrillation, that is, a disease in which the patient's atrium muscle tissue contracts unevenly. This severe pathology requires regular monitoring by a cardiologist and adequate therapy. In the international classification of diseases, atrial fibrillation is presented in the section of circulatory diseases and other myocardial diseases. In medical documents, the code looks like this: atrial fibrillation (ICD-10 code - I48).
In medicine, fibrillation is a condition when individual muscle fibers of the heart muscle do not contract coherently, but chaotically, leading the organ to an unstable state. This is a dangerous variant of myocardial activity, leading to erratic contractions that provoke disturbances in cardiac activity and circulation.
Atrial fibrillation is a condition when the muscle fibers of the atria contract quickly and are not coordinated with each other. Due to incorrect contractions, the transmission of electrical impulses to the ventricles is disrupted - they become erratic.
Atrial fibrillation on an ECG looks like this:
- The R-R intervals are disrupted. If normally the distance between these teeth is always the same, then with atrial fibrillation the R-R intervals are different in all leads.
- Also, the P wave is always absent on the ECG. If cardioversion or RFA is used, and as a result the rhythm is restored, the P wave appears on the cardiogram in its usual place, before the QRS complex.
Treatment of atrial fibrillation requires an individual approach to each patient. It is not for nothing that cardiologists consider atrial fibrillation one of the most complex pathologies. And if today you are full of strength and vigor, have an absolutely healthy heart, pay attention to these statistics:
- The incidence of cardiac arrhythmias among men is 1.7 times higher than among women. Can you guess why? Yes, yes, smoking, alcohol, heavy physical labor, low stress tolerance. All these factors need to be eliminated if you want to be healthy.
- In the world, the diagnosis of atrial fibrillation occurs in every 200th person. Agree, this is a very high figure.
- Atrial fibrillation affects smokers 2 to 6 times more often than non-smokers. We strongly recommend breaking up with a bad habit.
- An attack of atrial fibrillation may occur without any symptoms for 48 hours. Therefore, always be extremely attentive to your well-being.
- Arrhythmias account for up to 15% of all heart diseases.
The statistics are disappointing. Even modern treatment methods are not always able to restore the “flickering” rhythm, and then the person develops a permanent form of atrial fibrillation.
Interesting: Atrial fibrillation has a very figurative synonym - delirium of the heart. This is what people call the disease.
Classification of the disease
Atrial fibrillation is classified according to several criteria. Based on heart rate, the following forms of the disease are distinguished:
- Tachysystolic form. In this case, the heart rate exceeds 90 beats per minute.
- Bradysystolic form. The myocardial contraction frequency does not reach 60 beats per minute.
- Normosystolic form. In this case, the contraction frequency fluctuates within normal limits, 70 – 80 beats per minute
According to the frequency of occurrence of attacks and their course, the classification is presented as follows:
As a type of atrial fibrillation, atrial flutter is classified as a separate group. This is a variant of very intense heart contractions, more than 400 per minute, provoking a high load on the myocardium.
Why does the heart “flicker”?
All causes of atrial fibrillation can be divided into congenital and acquired. Congenital causes include heart defects and other congenital myocardial anomalies. These factors provoke the occurrence of atrial fibrillation in the young population.
The disease occurs more often in the elderly population than in young people. This is explained by the fact that after 50 years a person already has chronic pathologies in his arsenal that can cause an imbalance in the functioning of the myocardium. Acquired causes include:
Special mention must be made about the low potassium content. Very rarely, a deficiency of this microelement is caused by a pathological reason. Diuretics if taken uncontrolled and serious dietary disturbances can remove potassium from the body. For patients with hypertension, potassium-sparing medications - diuretics - are recommended for continuous use. And uncontrolled use is possible among athletes who want to lose excess weight with the help of diuretic drugs, as well as among women who are actively losing weight, following a strict diet and striving for an ideal figure.
Clinical picture
We described above how to determine the presence of atrial fibrillation on an ECG. But a cardiogram is a diagnostic tool for specialists; it will not tell the patient anything. There are symptoms that may indicate that you have atrial fibrillation:
Separately, the clinic of paroxysm of atrial fibrillation should be considered.
Clinic and features of the paroxysmal form
With the paroxysmal form of fibrillation, patients complain of palpitations, general weakness, headache, and shortness of breath. Chest pain and fainting may occur. Compared to other forms of fibrillation, the symptoms are more pronounced and appear brighter. 
If the patient suffers from chronic heart failure, paroxysm provokes its intensification, up to an attack of cardiac asthma. During paroxysm, blood pressure numbers are unstable, the patient suffers from significant changes in blood pressure.
During percussion of the heart, the doctor notes an expansion of the left border of the relative dullness of the myocardium. If the patient has mitral stenosis, expansion is detected in the area of the upper border. During auscultation, the doctor hears chaotic arrhythmic activity of the heart (delirium cordis) with a constantly changing volume of 1 tone.
During rhythm restoration, the development of thromboembolism cannot be ruled out.
Important: A clear clinical sign of paroxysmal atrial fibrillation is a discrepancy between the heart rate and pulse rate. The heart rate is always higher than the number of pulse beats. The filling of the pulse is constantly changing, the waves appear randomly.
There is no P wave on the electrocardiogram, the difference between the R-R intervals is > 0.16 seconds. F fibrillation waves are up to 300-700 per minute and appear in standard leads - II, III, AVF, as well as in chest leads - V1, V2.
Diagnostic measures
Diagnosis of atrial fibrillation begins with examination of the patient. The doctor analyzes complaints and conducts a visual examination. It is mandatory to compare the number of heartbeats, which are determined in the neck veins, and the number of pulses on the periphery - in the area of the radius. The identified difference allows one to suspect arrhythmia in the patient.
Laboratory examination methods
Patients are required to undergo a biochemical blood test and a blood test for the normalized international ratio (INR). 
In biochemistry, the doctor is interested in the following indicators - creatinine, transaminases, CPK, LDH. Also, to identify potassium deficiency, the doctor may prescribe a test for electrolytes - potassium, magnesium, sodium.
The INR test reflects clotting capacity. At high values, the risk of thromboembolism increases, at low values, the risk of bleeding increases. For various forms of atrial fibrillation, it is advisable to maintain the INR level within 2.5. This is especially true in situations where the patient receives the anticoagulant drug Warfarin. During therapy with this drug, an INR test must be taken every 3 to 4 days in order to correctly adjust the dosage.
Please note: Warfarin is best absorbed by the body in the evening, after 18:00. Therefore, it is not prescribed during the daytime. Another expensive antithrombotic drug, Xarelta, is an analogue of Warfarin. Xarelta therapy does not require constant INR monitoring.
Instrumental diagnostic methods
To diagnose atrial fibrillation, the following is prescribed:
Treatment approaches for atrial fibrillation
There is a treatment algorithm that was developed by the World Association of Cardiologists. It helps eliminate the arrhythmia, its second task is to prevent complications that are dangerous for the patient.
Doctors do not always strive to restore sinus rhythm; sometimes it is enough to correct myocardial contractions to normal. When adjusting heart rate with medication or surgery, the patient's risk of thromboembolism increases, so long-term anticoagulant medications must be prescribed. If the patient suffers from a permanent form of arrhythmia, treatment is considered successful if it helps to achieve a heart rate of 90 beats per minute. With daily monitoring, this figure should not exceed 80 beats per minute.
Important: If the patient has no clinical manifestations of fibrillation and hemodynamics are not impaired, a wait-and-see approach is used. Doctors monitor the patient's condition for 72 hours. In half of the cases, relief of arrhythmia occurs independently.
For the chronic form of fibrillation, drug antiarrhythmic therapy and surgical treatment methods are used. According to clinical guidelines, there are 2 types of treatment for atrial fibrillation - electrical or drug cardioversion.
Drug therapy
Medicines that are used to restore heart rhythm are Amiodarone, Propanorm, Propranolol, Verapamil, Digoxin, Hindin, Novocainomide. Any antiarrhythmic medicine is prescribed only by a doctor; drug cardioversion is possible only in a hospital.
Surgery
In addition to drug therapy, surgical methods are used to restore rhythm:
Will folk remedies help?
Isolated traditional treatment will not give results in the presence of such a complex pathology as atrial fibrillation. But in combination with drug treatment, you can use some drugs, having previously agreed with your cardiologist. Rhythm disturbances caused by hypokalemia are corrected by replenishing potassium deficiency. Here are some recipes.
To prepare it, 700 grams of viburnum berries are covered with 300 grams of sugar and left for 3 to 5 days. The resulting juice is drained, 100 grams of vodka are added, and stored in the refrigerator. Take no more than 50 ml per day. 
Tincture of hawthorn and rosehip
Mix crushed hawthorn and rosehip berries in equal quantities, 1 tablespoon each. Pour 400 ml of boiling water, then simmer in a water bath for 20 minutes. Strain and take a third of a glass 2 – 3 times a day.
Delicious medicine
Take 0.5 kg of raisins, dried apricots, and figs. Scroll them through a meat grinder. Add 300 grams of chopped walnuts, 2 large lemons, minced with peel, and pour in 1 liter of liquid honey. Take this delicious medicine one tablespoon 1 to 2 times a day, always in the morning.
Calming fees
In some cases, calming preparations help restore heart rhythm. Tincture of valerian, motherwort, peony can have an excellent effect in case of an accidental paroxysm - the heart rhythm will be restored on its own.
What to eat to avoid getting sick?
The diet of a patient with heart “flicker” should be balanced and complete. The following products are prohibited:
You need to eat food often, in small portions. The habit of “overeating” significantly increases blood circulation, which is harmful for the diseased myocardium. Your daily diet should include fruits and vegetables, fresh herbs. Parsley deserves special attention because it can retain potassium throughout the year. Moreover, frozen parsley contains twice as much potassium as raw parsley. The menu must include cucumbers and tomatoes, paprika, apricots, pears, and grapes. During the berry season, be sure to eat raspberries, shadberry and currants. Raspberries and shadberry have anticoagulant properties, currants are an excellent antioxidant. Apples and pears should be on the table every day.
To prevent hypercholesterolemia, add flaxseed oil and boiled mackerel to your diet. There is an interesting recommendation from nutritionists regarding boiled fish - just 100 grams of boiled mackerel per day helps cope with excess cholesterol. Build your meals as follows: 2 vegetable days a week, 2 fish days, 2 days with dietary poultry and only 1 day with red meat. Your heart will be grateful to you.
Complications and prognosis
The main complication of atrial fibrillation is the high risk of sudden death of the patient. A lethal outcome is not excluded in any subsequent attack, especially in cases where emergency assistance is not provided in a timely manner. Also, against the background of atrial fibrillation, the following develop: chronic heart failure, thrombosis, strokes, and cardiomyopathies. Any complication is a severe pathology that worsens life and leads to disability. 
The prognosis of the disease is favorable with timely diagnosis and compliance with all recommendations of cardiologists, regular use of antiarrhythmic drugs, and lifestyle correction.
The life prognosis is worsened by late detection of the disease, the presence of chronic pathologies, old age and poor lifestyle.
Prevention is easy
In order to avoid fibrillation and all other cardiac pathologies, you need to lead a healthy lifestyle. This includes proper nutrition, reasonable physical activity, adequate rest and giving up bad habits. Annual medical examination is of great importance, which helps to identify and begin to treat asymptomatic diseases.
Changing your habits in a healthy direction is not very easy, but if you want to live long, it must be done. And let your heart tremble only with love.
Still have questions? Ask them in the comments! A cardiologist will answer them.
One of the most common rhythm disorders is atrial fibrillation, in particular atrial fibrillation (AF).
Despite the fact that many patients live with this condition for many years and do not experience any subjective sensations, it can provoke such serious complications as tachyform fibrillation and thromboembolic syndrome.
The disease is treatable; several classes of antiarrhythmic drugs have been developed that are suitable for continuous use and rapid relief of a sudden attack.
Atrial fibrillation is the name given to uncoordinated excitation of atrial myocardial fibers. with a frequency of 350 to 600 per minute. In this case, a full atrial contraction does not occur.
The atrioventricular junction normally blocks excessive atrial activity and transmits a normal number of impulses to the ventricles. However, sometimes there is rapid contraction of the ventricles, perceived as tachycardia.
In the pathogenesis of AF, the main role is played by the micro-re-entry mechanism. The tachyform of the disease significantly reduces cardiac output, causing circulatory failure in the pulmonary and systemic circles.
Why is atrial fibrillation dangerous? Irregularity of atrial contractions dangerous due to the formation of blood clots, especially in the atrial appendages, and their separation.
Prevalence
The prevalence of atrial fibrillation is 0.4%. Among the group under 40 years old this figure is 0.1%, over 60 years old – up to 4%.
It is known that in patients over the age of 75 years, the probability of detecting AF is up to 9%. According to statistics, the disease occurs one and a half times more often in men than in women.
The disease is based on the mechanism of re-entry of excitation into the atrial structures. This is caused by myocardial heterogeneity, inflammatory diseases, fibrosis, stretching, and previous heart attacks.
Pathological substrate cannot carry out impulses normally, causing uneven contraction of the myocardium. Arrhythmia provokes expansion of the heart chambers and failure of function.
Classification and differences between species, stages
According to the clinical course, there are five types of atrial fibrillation. They are distinguished by the characteristics of their appearance, clinical course, and susceptibility to therapeutic influences.
- First identified form characterized by the first occurrence of atrial fibrillation in life. It is established regardless of the duration and severity of symptoms.
- For paroxysmal fibrillation duration is limited to 7 days. The episode usually stops on its own within the next two days.
- Persistent form does not spontaneously end within 7 days and requires drug treatment or electrical pulse cardioversion.
- Long-term persistent fibrillation diagnosed when the disease lasts more than one year and with the chosen method of rhythm correction.
- Permanent form characterized by the fact that attempts to restore sinus rhythm were unsuccessful, and a decision was made to maintain AF.
Based on the frequency of ventricular contraction, three forms of atrial fibrillation are distinguished:
- Bradysystolic, in which the heart rate is less than 60 per minute;
- at normosystolic the number of contractions is within normal limits;
- tachysystolic characterized by a frequency of 80 per minute.
Causes and risk factors
Various causes can contribute to the occurrence of rhythm disturbances, including non-cardiac diseases and congenital pathological syndromes. In addition, functional mechanisms and hereditary predisposition are possible.
The reasons are divided into the following groups:
- fickle reasons: low level of potassium in the blood, low hemoglobin content in red blood cells, open heart surgery;
- long acting: hypertension, coronary artery disease, heart and valve defects, cardiomyopathy, amyloidosis and hemochromatosis of the heart, inflammatory diseases of the muscular layer and pericardium, valvular structures, myxoma, Wolff-Parkinson-White syndrome;
- catecholamine-dependent fibrillation: provoke emotional overload, drinking strong coffee and alcohol;
- vagus-induced: occurs against a background of reduced heart rate, often at night;
- genetic forms.
Risk factors for young people include addiction to bad habits, excessive consumption of caffeine-containing drinks and alcohol, drugs; in older patients - previous myocardial infarction, a history of long-term arterial hypertension, and the presence of congenital heart diseases.
Symptoms and signs
The clinical picture of the disease is observed in 70% of cases. It is caused by insufficient blood supply, which accompanies dizziness and general weakness.
Tachyform Atrial fibrillation is characterized by rapid heartbeat and pulse, a feeling of interruptions in the functioning of the heart, and fear. When thrombotic masses occur in the atria, thromboembolic syndrome occurs.
The thrombus from the right atrium enters the right ventricle and pulmonary trunk, and accordingly enters the vessels supplying the lungs. When a large vessel is blocked shortness of breath and difficulty breathing occurs.
From the left atrium, a thrombus can travel through the systemic circulation to any organ, including the brain (in this case there will be a stroke clinic), lower extremities (intermittent claudication and acute thrombosis).
Paroxysmal form characterized by sudden onset, shortness of breath, rapid heartbeat intermittently, irregular heartbeat, and chest pain. Patients complain of acute lack of air.
Dizziness and a feeling of weakness often occur. Sometimes fainting occurs.
With permanent or persistent form symptoms (feeling of irregular heartbeat) occur or worsen when performing any physical activity. The clinical picture is accompanied by severe shortness of breath.
For more information about atrial fibrillation and the tactics for eliminating it, watch the video with a doctor:
Clinical and instrumental research
Upon examination and auscultation they find irregular pulse and heart rate. The difference between heart contractions and pulse is determined. Laboratory tests are necessary to determine the etiology of the disease.
The diagnosis is confirmed by the method.
ECG signs of atrial fibrillation: instead of P waves, f waves are recorded with a frequency of 350-600 per minute, which are especially clearly visible in lead II and the first two chest leads. With tachyform, along with waves, the distance between QRS complexes will be reduced.
This is what atrial fibrillation looks like on an ECG:
In case of unstable form, it is indicated, which will help identify attacks of atrial fibrillation.
To stimulate possible myocardial activity, use transesophageal stimulation, intracardiac EPS. All patients require echocardiography to establish hypertrophic processes in the heart chambers and identify the ejection fraction.
Differential diagnosis
In addition to atrial waves, AF is distinguished from sinus rhythm by different distances between the ventricular complexes and the absence of the P wave.
When intercalary complexes occur, diagnosis with ventricular extrasystoles is required. When the coupling intervals are equal to each other, there is an incomplete compensatory pause, against the background there is a normal sinus rhythm with P waves.
Emergency care for paroxysmal atrial fibrillation consists of stopping the action and treating the cause of the disease and hospitalization in a cardiology hospital; to stop the attack, the tactics of medicinal rhythm restoration are used - 300 mg of cordarone intravenously.
Therapy tactics
How to treat atrial fibrillation? Indications for hospitalization are:
- first-time, paroxysmal form less than 48 hours;
- tachycardia more than 150 beats per minute, low blood pressure;
- left ventricular or coronary insufficiency;
- the presence of complications of thromboembolic syndrome.
Treatment tactics for different forms of atrial fibrillation - paroxysmal, persistent and constant (permanent):
Learn more about the disease and the common radiofrequency method of eliminating it from the video:
Rehabilitation
Depends on the disease that led to the occurrence of AF. After rhythm disturbances due to myocardial infarction after the inpatient stage follow-up treatment in cardiac sanatoriums is indicated lasting up to 21 days.
The most important thing is to maintain a normal heart rate and prevent thromboembolism.
Prognosis, complications and consequences
According to statistics, AF increases mortality by one and a half times. The risk of cardiovascular pathology against the background of an existing rhythm disturbance doubles.
To improve the forecast it is necessary to promptly identify and treat the disease, take maintenance therapy as prescribed by your doctor.
The most serious complications are thromboembolic, especially ischemic stroke. In the age group 50-60 years old, the risk is 1.5%, and over 80 years old it reaches 23%.
When AF is added to the patient’s existing ones, the risk of brain disorders increases 5 times.
Relapse prevention and prevention measures
Primary prevention of AF is used in cases of focal myocardial diseases and open heart surgery. Risk factors for cardiovascular disease need to be addressed: treat hypertension, lose weight, quit smoking, fatty foods. You should also limit your consumption of strong coffee and alcoholic beverages.
To prevent relapses and complications, prescribed antiarrhythmic therapy should be used daily and follow the doctor’s instructions. The INR level is very important.
Subject to compliance with all instructions and elimination of risk factors the prognosis is favorable. It is necessary to carefully prevent thromboembolic complications, take anticoagulants, and monitor the heart rate.
A permanent form of atrial fibrillation is a form of atrial fibrillation. With this rhythm disturbance, a chaotic contraction of the muscle fibers of the atria occurs. This is one of the most common heart disorders.
A permanent form of atrial fibrillation, which has an international classification code of ICD 10, can develop both at a young age and in adulthood. However, most often it is diagnosed in people after 40-60 years of age. This is due to the fact that a number of cardiac diseases contribute to its appearance.
With age, the risk of developing the disease increases. If at the age of 60 years this type of arrhythmia occurs in 1% of 100, then at 80 years it occurs in 6%.
Decoding the elements of the cardiogram
The contraction of the heart is determined by the work of the so-called sinus node. It generates impulses that cause the atria and ventricles to contract in the correct sequence and rhythm. Normally, the heart rate varies between 60-80 beats per minute. The atrioventricular node, in turn, is responsible for preventing the passage of impulses exceeding 180 per minute during contractions.
If the sinus node malfunctions for some reason, the atria begin to generate impulses with a frequency of up to 300 and higher. In this case, not the entire number of impulses enters the ventricles. As a result, they cannot work fully: the atria are not completely filled with blood, and its supply to the ventricles occurs unevenly and in small quantities. A decrease in the pumping function of the atria entails a gradual decrease in the pumping functions of the entire heart.
Atrial fibrillation can be paroxysmal (paroxysmal) or permanent. You can read more about this in a separate article on our website.
According to research, the development of a permanent form is preceded by a stage when the patient experiences attacks of atrial fibrillation from time to time.
An increase in symptoms may develop over a number of years.
The American Heart Association classifies all attacks that last more than one week as permanent. If an episode of sinus node dysfunction lasts up to 2 days, we are talking about a paroxysmal form. The duration of the attack from 2 to 7 days indicates the development of a persistent form of the disease.
In the paroxysmal form, normal activity of the sinus node is restored by itself.
However, it has already been proven that with frequent attacks over a long period of time, changes occur in the atria, as a result of which the paroxysmal form can eventually transform into persistent and then permanent. Therefore, the appearance of the first attacks of fibrillation requires contacting a cardiologist.
An important sign of persistent atrial fibrillation is the inability to maintain sinus rhythm without medical assistance. Also, this type of arrhythmia is extremely rare in healthy people. As a rule, it is accompanied by a number of diseases of the cardiovascular system.
Causes of atrial fibrillation
External and internal causes can provoke the development of the disease. External ones include:
- taking arrhythmogenic drugs;
- long-term alcohol consumption;
- long-term smoking;
- some types of surgery;
- exposure to vibrations in the workplace;
- intoxication with toxic substances;
- intense physical activity;
- hyper- and hypothermia.
It is important to note that these factors can provoke the development of atrial fibrillation, in particular permanent atrial fibrillation, in individuals predisposed to cardiac diseases and already having changes in the functioning of the heart, since in this case there is already a violation of the automatic regulation of the cardiovascular system.
Risk factors include:
- cardiac ischemia;
- arterial hypertension (high blood pressure);
- valve dysfunction and pathological changes;
- cardiomyopathies of various types;
- heart tumors;
- thyrotoxicosis (hyperfunction of the thyroid gland);
- chronic lung diseases;
- calculous cholecystitis;
- kidney disease;
- hiatal hernia;
- Diabetes mellitus is predominantly type II.
Various inflammatory diseases of the heart muscle can cause the development of atrial fibrillation:
- pericarditis;
- myocarditis.
It is believed that pathological changes in the nervous system can also be a trigger for the development of arrhythmia. Thus, persons with cardioneuroses and cardiophobia should be carefully examined and receive adequate treatment to prevent the development of the disease.
The disease develops in 5-10% of patients with arterial hypertension and in 25% of people with coronary artery disease and heart failure. At the same time, coronary artery disease and the permanent form of atrial fibrillation mutually aggravate each other.
There is a connection between the development of the disease and the presence of severe hypertrophy (enlargement) of the left ventricle and left ventricular dysfunction of the diastolic type. Mitral valve defects dramatically increase the likelihood of developing the disease.
Symptoms of a constant form
25% of patients may not feel any symptoms of rhythm disturbance. However, most often this is a consequence of the fact that a person does not pay attention to a number of changes in well-being, considering them a sign of age, vitamin deficiency or fatigue.
The presence of persistent atrial fibrillation can be indicated by:
- weakness and fatigue;
- frequent dizziness and fainting;
- feeling of heart failure;
- feeling of heartbeat;
- chest pain;
- cough.
As a rule, such symptoms occur after physical activity. The degree of it does not matter - even small physical efforts can cause similar symptoms.
During attacks, a feeling of panic may appear. Atrial fibrillation differs from vegetative disorders with panic attacks and hypertensive crisis of the vegetative type in that at the time of the attack there is not a rise, but a fall in blood pressure.
A distinctive sign of constant fibrillation is an irregular pulse with different contents. In this case, there is a pulse deficiency when its frequency is less than the heart rate.
Hypertension, coronary artery disease, angina pectoris, and valve defects aggravate the symptoms of the disease.
Diagnostic methods
Main research methods:
- personal examination;
- electrocardiogram;
- ECG-Holter monitoring.
It is important to differentiate the disease from diseases with similar symptoms, such as:
- various forms of tachycardia;
- atrial extrasystoles;
- with panic attacks.
From this point of view, the most informative method is the ECG, which is specific for each type of arrhythmia.
The permanent form on the ECG is manifested by irregular rhythm and irregular R-R intervals, absence of P waves, and the presence of erratic F waves with a frequency of up to 200-400. The ventricular rhythm may or may not be regular.
Holter monitoring is a valuable research method because it allows you to identify all rhythm fluctuations during the day, while a regular ECG study may not provide a complete picture.
During a personal examination, the doctor reveals the irregularity of the pulse and interruptions in its filling. An irregular heartbeat can also be heard.
Treatment methods
With this type of arrhythmia, the doctor rarely has the goal of normalizing sinus rhythm. Although with an unsevere form of the disease, you can try to restore normal sinus rhythm with the help of drug treatment or electrocardioversion. If it is impossible to achieve this, the task is to normalize the heart rate (HR) in the range of 60-80 beats per minute at rest and up to 120 beats during physical activity. It is also important to reduce the risk of blood clots and thromboembolism.
Contraindications to restoring sinus rhythm are:
- the presence of intracardiac thrombi,
- weakness of the sinus node and bradycardic form of atrial fibrillation, when the heart rate is reduced;
- heart defects requiring surgical intervention;
- rheumatic diseases in the active stage;
- severe arterial hypertension 3 degrees;
- thyrotoxicosis;
- age over 65 years in patients with heart disease and 75 years in patients with coronary heart disease;
- dilated cardiomyopathy;
- left ventricular aneurysm;
- frequent attacks of atrial fibrillation, requiring intravenous administration of antiarrhythmics.
Rhythm restoration is carried out with the help of antiarrhythmic drugs such as Dofetilide, Quinidine, as well as with the help of electrical pulse therapy.
In the case of persistent atrial fibrillation, the effectiveness of medications in restoring rhythm is 40-50%. The chances of success when using electropulse therapy increase to 90% if the disease lasts no more than 2 years and are the same 50% if the disease lasts more than 5 years.
Recent studies have shown that antiarrhythmic drugs in people with cardiovascular diseases can have the opposite effect and worsen the arrhythmia and even cause life-threatening side effects.
The doctor may refuse to restore rhythm if there is doubt that sinus rhythm can be maintained for a long time in the future. As a rule, patients tolerate the permanent form of atrial fibrillation more easily than the return from sinus rhythm to atrial fibrillation.
Therefore, the first choice is drugs that reduce heart rate.
β-blockers (drugs for the treatment of permanent atrial fibrillation - metoprolol) and calcium antagonists (verapamil) in combination can help reduce heart rate to the required limits. These drugs are often combined with cardiac glycosides (). Periodically, the patient must undergo monitoring of the effectiveness of treatment. For this purpose, Holter ECG monitoring and bicycle ergometry are used. If it is not possible to achieve normalization of the heart rate with medication, then the question arises of surgical treatment, which involves isolating the atria and ventricles.
Since the formation of blood clots is one of the most serious and frequent complications of permanent atrial fibrillation, treatment involves the parallel administration of anticoagulants and aspirin. As a rule, such treatment is prescribed to patients over 65 years of age with a history of stroke, high blood pressure, heart failure, diabetes mellitus, thyroid dysfunction, and coronary heart disease.
For people over 75 years of age, anticoagulant therapy is prescribed for life. Also, such drugs are prescribed on an ongoing basis to those who have a high risk of developing stroke and thromboembolism. The only absolute contraindication to the use of anticoagulants is an increased tendency to bleed.
In the brady form (sparse pulse) of the disease, electrical cardiac stimulation has shown high effectiveness. Stimulation of the ventricles with electrical impulses can reduce rhythm irregularity in patients with a tendency to bradycardia at rest when taking drugs to lower heart rate.
Simultaneous ablation of the atrioventricular node and installation of a pacemaker can improve the quality of life of patients who do not respond to antiarrhythmic drugs, as well as those who have a combination of left ventricular systolic dysfunction in combination with high heart rate.
It should be borne in mind that after installation of a pacemaker, mortality from ventricular arrhythmias reaches 6-7%, the risk of sudden death varies around 2%. Programming the pacemaker to a base rate of 80-90 beats per minute 1 month after installation allows you to reduce the indicators.
Treatment with folk remedies
Traditional methods should be used in parallel with medications prescribed by a doctor. This significantly alleviates the patient’s condition and reduces the risk of side effects. Also, herbal medicine will help reduce the dose of medications taken or gradually abandon them.
First of all, decoctions and tinctures of plants that normalize heart rhythm are used. These include hawthorn, calendula, and motherwort. The effects of mixtures are most effective.
To treat arrhythmia, you can prepare infusions from the above-mentioned plants, taken in equal proportions. You should drink the infusion three times a day, a quarter glass. Treatment is long-term, over several years.
You can mix ready-made tinctures of hawthorn, calendula and motherwort. Drink the mixture three times a day, 30 drops.
Decoctions and infusions of yarrow and mint have proven themselves well. Yarrow, mint, calendula are brewed with boiling water and mixed with honey. The mixture is taken 150 mg 3-4 times a day. Tea made from viburnum, cranberries and lemon mixed with honey has a beneficial effect on well-being.
Lifestyle with permanent atrial fibrillation
If you have arrhythmia, it is extremely important to start leading a healthy lifestyle. You should stop eating fatty, spicy, smoked foods and increase the amount of grains, vegetables and fruits in your diet. Preference should be given to those that are healthy for the heart: figs, dried apricots, persimmons, apples, bananas.
Atrial fibrillation is not an absolute contraindication for physical activity. It is important to choose the most optimal degree of load for yourself.
Gymnastics, daily walks, walking, swimming will help train the heart muscle and lower blood pressure. However, patients will have to give up high-impact sports, as they can cause a worsening of the condition.
It is necessary to constantly monitor your condition and regularly visit your doctor. During drug treatment with anticoagulants, if bruising occurs, you should immediately stop the drug and consult a doctor to eliminate the risk of internal bleeding.
It is important to inform your doctors about the medications you are taking, especially if you are undergoing dental surgery.
Possible complications
Atrial fibrillation is not considered a life-threatening disease, although it can significantly reduce its quality. However, it aggravates the course of existing concomitant diseases of the cardiovascular system. This is the main danger of the disease.
Persistent atrial fibrillation causes persistent circulatory disorders and chronic oxygen starvation of tissues, which can negatively affect myocardial and brain tissue.
The vast majority of patients experience a gradual decrease in tolerance (tolerance) to physical activity. In some cases, a detailed picture of heart failure may appear.
The presence of this form of arrhythmia increases the risk of developing heart failure to 20% in men and 26% in women from the population average values of 3.2% and 2.9%, respectively.
Coronary and cerebral reserve is reduced, which means the risk of development and stroke. Today, persistent atrial fibrillation is considered one of the main causes of ischemic strokes in older people. According to statistics, the incidence of strokes in patients with permanent atrial fibrillation is 2-7 times higher than in others. Every sixth case of stroke occurs in a patient with atrial fibrillation.
Life forecast
If you receive constant adequate treatment, it is quite favorable. The patient’s standard of living at the desired quality can be maintained with medication for a long time. The most favorable prognosis is for patients who do not have significant cardiac or pulmonary diseases. In this case, the risk of thromboembolism is minimized.
With age, as symptoms of heart disease increase, the size of the left atrium may increase. This increases the risk of thromboembolism and death. Among people of the same age, mortality in the group with atrial fibrillation is twice as high as in those with sinus rhythm.
Useful video
What atrial febrillation is is shown very clearly and in detail in the following video:
Persistent atrial fibrillation is a disease that requires regular monitoring by a cardiologist and ongoing treatment. Moreover, in each specific case, treatment is selected by the doctor based on the individual characteristics of the patient. Only in this case can the development of life-threatening complications be prevented.
When receiving a document from a doctor with a difficult-to-pronounce, incomprehensible diagnosis, the patient has the right and even the obligation to receive complete information about his disease.
This knowledge will enable a person to understand what is happening in his body, how dangerous it is, how he can be helped, what should be avoided and why it is necessary to adhere to certain treatment tactics.
The patient’s attitude towards the diagnosis largely determines the success of therapeutic measures, which is why it is so important for the patient to realize that his illness is not a death sentence. It is for this purpose that information will be provided below about such a concept as the classification of atrial fibrillation.
The term “atrial fibrillation” (AF) worldwide refers to a condition that in the CIS countries until recently was called atrial fibrillation. Many experts, despite the provisions of the classification of atrial fibrillation, even today consider this name (MA) to be more successful in the sense of reflecting the essence of the disease. What is it? Let us consider, as an example, the normal functioning of the heart and its parts.
Principles of normal heart function
The heart rate is set by the heart rhythm generator - the sinus node, located at the junction of the superior vena cava with the right atrium.
The impulse generated by the sinus node is transmitted to the atria, which as a result contract and pump blood down into the ventricles. Continuing the movement, the impulse causes the ventricles themselves to contract, as a result of which the blood is expelled into the vessels and distributed further throughout the body.
Between the ventricles and the supraventricular cavity there is a “checkpoint” in the form of the atrioventricular node (AV), which does not allow an impulse to pass into the ventricles with a frequency of more than 180 beats per minute. Such coordinated operation of the mechanisms is the norm, but in case of arrhythmia the system does not work.
The classification of atrial fibrillation divides arrhythmias according to the degree and nature of the rhythmic system failure.
What happens during fibrillation
In a state of arrhythmia, the sinus node generates impulses, but they are distorted, looped, and multiplied. 
At the same time, the contractions they cause are chaotic (flickering) and gain a frequency of more than 300 per minute.
Of course, such a high frequency does not allow the atria to make full contractions capable of capturing the required amount of blood and pumping it into the ventricles.
If it were not for the atrioventricular node, such an ultra-high frequency would be deadly for the ventricles and would lead to the death of the patient in 5-10 minutes. The AV node “extinguishes” excessive impulses, but even despite this fuse, the frequency of ventricular contractions can exceed 90-100 beats per minute. And this factor causes the appearance of symptoms of heart failure. This is one of the dangers of MA.
Forms of atrial fibrillation
To denote the condition of atrial fibrillation in modern medicine, it is customary to use the term atrial fibrillation. The classification of this pathology involves the division of various similar conditions into separate groups with certain characteristic features.
Depending on these characteristic features, the forms of AF are determined. What it is? Just as many diseases with the same name can have different forms, for example, tonsillitis - follicular, lacunar, fungal, and so on, MA can also have different forms. The forms of atrial fibrillation, designated in the classification of atrial fibrillation, have names:
- paroxysmal;
- persistent;
- permanent;
- tachysystolic;
- normosystolic;
- Bradysystolic atrial fibrillation.
Different forms of atrial fibrillation are characterized by different duration of fibrillation and heart rate.
Classification of AF by duration
Cardiologists still do not have a consensus on which form of atrial fibrillation poses the greatest danger or, on the contrary, has the best prognosis. Let us consider each of the forms in the classification of atrial fibrillation in more detail.
The paroxysmal form of MA, or AF, is characterized by frequent, paroxysmal (up to an innumerable number of times a day) occurrence and independent disappearance of “flickering” contractions. During the intervals between paroxysms, the patient's heart works normally.
The patient’s reaction to attacks of AF can be radically opposite - the arrhythmia can go completely unnoticed or, on the contrary, cause quite severe conditions that significantly impair a person’s quality of life.
With persistent fibrillation, the arrhythmia lasts more than a week or does not resolve on its own for a long time, requiring medication to restore the rhythm. The patient's condition with this form of rhythm disturbance can be corrected not only with medication, but also through the use of electrical pulse therapy.
As can be understood from the name, permanent (or constant) arrhythmia is characterized by a constant flow and cannot be eliminated by medications and other methods known today. Failure to restore sinus rhythm becomes the reason for diagnosing permanent AF.
Classification of AF proposed by the European Society of Cardiology
According to the latest classification of atrial fibrillation, supported by the All-Russian Scientific Society of Cardiology, there is another form of atrial fibrillation - isolated. It designates a type of fibrillation in individuals with a negligible risk of thromboembolism and without structural heart disease. This term is usually used to describe arrhythmia in patients under the age of 60 years.
In addition, in 2010, the European Society of Cardiology (EHRA) proposed a clinical classification of atrial fibrillation based on the symptomatic severity of the disease. According to this classification, 4 forms are distinguished - from the asymptomatic mild form I to the disabling form IV. 
Classification of AF by heart rate
In accordance with the classification of atrial fibrillation, forms of atrial fibrillation are distinguished not only by the duration of the course, but also by the heart rate during atrial fibrillation:
- tachistole form (or atrial fibrillation) - heart rate more than 90 beats per minute;
- normosystolic (or eusystolic) form of AF - heart rate ranging from 60 to 90;
- bradyform AF - heart rate below 60.
Treatment of all of the above forms of AF is based on the same principles and means and pursues the same goal - restoration of the normal sinus impulse.
Difference between AF and atrial flutter
A condition symptomatically similar to AF, but characterized by less chaotic supraventricular contractions, is called atrial flutter. The classification of these conditions defines 2 types of flutter depending on the directions of depolarization waves in the atria. These varieties are determined by electrocardiogram and endoelectrophysiological studies and differ little in symptomatic manifestations.
Despite the fact that atrial flutter is characterized by a more rhythmic pulse, this condition often develops into one of the forms of AF - most often into the tachysystolic form of atrial fibrillation.
Treatment of tachyform atrial fibrillation, unlike therapy for flutter, does not involve the use of TEE technology (transesophageal pacing). And this is one of the few indicators that distinguishes flutter from fibrillation.
Useful video
The following video explains what atrial fibrillation is and why it occurs:
Conclusion
As a rule, the diagnostic determination of arrhythmia is not difficult. Patients themselves are able to feel the irregularity of the heartbeat, and when determining the pulse, feel for a chaotic rhythm with different beat strengths.
If such phenomena are detected, you must immediately consult a doctor and undergo. Sometimes additional examinations may be required to clarify the diagnosis, and this should not be neglected.
Only a timely diagnosis, and most importantly, a diagnosis made in accordance with the classification of atrial fibrillation, will help you choose an effective treatment regimen.
The group of rhythm disorders includes atrial fibrillation. This pathology develops against the background of a variety of cardiac diseases. Otherwise it is called atrial fibrillation. The frequency of atrial contractions reaches 350 per minute or more. The myocardium cannot work at this rhythm for a long time, and complications arise.
- cardiac ischemia;
- rheumatism;
- congenital and acquired defects;
- valve pathology;
- diseases of the coronary arteries;
- cardiomyopathy;
- heart failure;
- pathology of the sinus node;
- pericarditis;
- performing surgical interventions;
- severe form of hypertension;
- myocarditis.
- overdose of glycosides;
- intoxication with adrenergic agonists;
- hyperfunction of the thyroid gland;
- acute alcohol poisoning;
- decreased potassium levels in the blood;
- viral infections;
- chronic lung diseases (COPD);
- electrolyte disturbances.
- feeling of heartbeat in the chest;
- pulsation of veins in the neck;
- periodic fainting;
- dizziness;
- unsteadiness of gait;
- difficulty breathing;
- weakness;
- fatigue during work;
- pressing or squeezing pain in the chest.
- physical examination;
- patient interview;
- daily monitoring;
- registration of cardiac activity in real time;
- conducting functional tests with physical activity;
- multislice computed tomography;
- echocardiography;
- Magnetic resonance imaging.
- lead an active and healthy lifestyle;
- promptly treat arterial hypertension;
- enrich your diet with fresh fruits and vegetables;
- eat less fatty and spicy foods;
- drink more fluids;
- do not take everything to heart;
- exercise;
- quit smoking and alcohol;
- take medications only according to the regimen prescribed by your doctor;
- Avoid contact with chemicals.
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Development of atrial fibrillation in adults and children
Every person's heart beats at a certain frequency. The intervals are the same. With atrial fibrillation, the atrial fibrillation contracts very quickly. This leads to myocardial exhaustion. Flickering occurs, which is chaotic vibrations. It is in the right atrium that the sinus node is located. This is the main section of the conduction system of the heart, on which heart rate depends.
With this pathology, muscle fibers can contract at a frequency of up to 600 per minute. Such work of the heart cannot meet the needs of other organs for blood and oxygen. There is a classification of AF based on the course of this pathology. According to it, persistent, chronic and transient forms of atrial fibrillation are distinguished.
In the latter case, symptoms last less than 1 week. It is rare for an attack to last for more than a day. The greatest danger is the chronic form. Depending on the frequency of occurrence, this pathology can be primary, frequently or rarely recurring. The permanent form of atrial fibrillation can be normosystolic, tachysystolic, or bradycardia. It is based on the frequency of ventricular contractions.
There are 4 degrees of severity of this pathology. At grade 1 there are no symptoms. Type 2 atrial fibrillation is characterized by a poor clinical picture. The person retains the ability to perform work. At grade 3, human activity is limited. The most dangerous type 4 atrial fibrillation. Such people become disabled and need help.
Main etiological factors
You need to know not only the forms of atrial fibrillation, but also the reasons for its development. According to scientists, the prevalence of fibrillation among the population is about 1%. Every year the number of patients increases several times. Cardiac causes of arrhythmia include:
Paroxysmal atrial fibrillation often develops in people who have suffered an acute myocardial infarction. Causes include sclerosis of the heart muscle. Arrhythmia is often associated with pathology of other organs. Other reasons are:
Less commonly, atrial fibrillation develops against the background of anemia, blockage of a pulmonary artery by a blood clot, food poisoning, diabetes mellitus, tumor of the adrenal medulla, or cerebral hemorrhage. Paroxysmal atrial fibrillation often accompanies Wolff-Parkinson-White syndrome and sinus node weakness. Predisposing factors include emotional experiences, alcohol dependence, smoking, atherosclerosis, sports, physical inactivity, and abuse of strong tea and coffee.
How does fibrillation manifest?
The persistent form of atrial fibrillation manifests itself with scant symptoms. With this pathology, the following clinical signs are possible:
The tachysystolic form of atrial fibrillation is characterized by rapid ventricular contractions. Most often, this disease manifests itself as a feeling of interruptions in the functioning of the heart. In most cases, heart rate is increased. Symptoms largely depend on the underlying cause of the rhythm disorder. With ischemic disease, shortness of breath is often observed.
During an attack of fibrillation, the ventricles are poorly filled with blood. The atria contract weakly. All this causes low blood output. Other symptoms of atrial fibrillation include sweating and a feeling of fear. The duration of attacks ranges from several hours to a week or more. Complaints disappear when normal sinus rhythm is restored.
If the paroxysm of atrial fibrillation is often repeated, then this pathology becomes chronic. Other people rarely experience seizures. They can be triggered by external and internal factors: sudden climate change, stress, intestinal dysfunction, and alcohol consumption.
In severe cases, permanent atrial fibrillation is characterized by periodic attacks of Morgagni-Adams-Stokes. They manifest themselves as sudden loss of consciousness and fainting. During an attack the person turns red. Loss of consciousness is short-term. The attack lasts a couple of minutes. With constant atrial fibrillation, patients stop complaining. They do not notice the symptoms of atrial fibrillation.
This cardiac pathology can cause dangerous complications. These include heart failure, thromboembolism, ventricular tachyarrhythmia, stroke, renal infarction, ventricular fibrillation, and vascular occlusion. Possible cardiac arrest. Similar consequences are observed if treatment is not carried out.
Patient examination plan
You need to know not only the causes of atrial fibrillation, what it is, but also how to identify this cardiac pathology. The main diagnostic method is electrocardiography. It allows you to assess the condition of individual chambers and the functioning of the organ as a whole. The main signs are loss of P waves and chaotic arrangement of ventricular QRS complexes. If a person has flutter, the P wave is replaced by atrial waves.
Other diagnostic methods are:
Transesophageal examination is often performed. Atrial fibrillation can be suspected already in the process of assessing the pulse. It is disordered, of varying tension and content. Auscultation allows you to detect irregular heart sounds. Additionally, the blood vessels of the heart can be examined. For this purpose, coronary angiography is organized. Laboratory testing methods include blood tests. The presence of rheumatoid factor must be determined.
Treatment tactics
Treatment of patients with atrial fibrillation is predominantly medicinal. With a permanent form of atrial fibrillation, medications must be taken for life. This allows you to maintain optimal heart function and rhythm. With a paroxysmal form of fibrillation, a drop in pressure, pronounced signs of heart failure and the duration of this pathology for less than a year, attacks can be eliminated using conservative methods.
Often, treatment of such patients is carried out in stages. First, preparation is required. For fibrillation lasting less than 2 days, medications based on unfractionated heparin are used. If the attack drags on for more than 2 days, then Warfarin Nycomed is used. The medicine is prescribed before and after normalization of the rhythm.
The main treatment for atrial fibrillation involves the use of Amiodarone or Novocainamide. These are antiarrhythmic drugs. Cardiac glycosides and calcium channel blockers are less effective. Propanorm and Cordarone are often included in the treatment regimen. All these medications have strict indications and contraindications. The advantage of Amiodarone is that it is suitable for the treatment of patients with heart failure.
It is recommended to stop the attack in the first 2 days. Restoring the correct heart rhythm is called cardioversion. It can be not only medicinal, but also electrical. In the latter case, a shock is passed through the person. Such treatment is carried out only if drug therapy is ineffective.
Chronic atrial fibrillation is an indication for the prescription of anticoagulants, cardiac glycosides, calcium channel blockers and adrenergic blockers. In severe cases, radical treatment is required. Radio frequency isolation is the most effective. Ablation is often performed. With complete heart block, patients need a pacemaker installed. Catheter operations are performed successfully.
Prevention measures and prognosis
Unlike ventricular fibrillation, this pathology poses much less danger to humans. Despite this, ignoring the problem often causes complications. The prognosis largely depends on the underlying disease. It worsens with a history of heart attack and severe heart defects.
Poor prognosis for atrial fibrillation due to thromboembolism. Primary prevention is aimed at preventing diseases that may cause fibrillation. To do this, you must adhere to the following recommendations:
If the heart rhythm is disturbed, then you should contact a cardiologist at the first complaints. Thus, atrial fibrillation is a dangerous pathology that over the years can lead to heart failure.
