Status: 02/27/2023 3:38 p.m
Atrial fibrillation is a common cardiac arrhythmia that promotes strokes. Timely treatment with medication, catheter ablation or atrial appendage occlusion increases life expectancy.
In Germany, around 1.8 million people are affected by atrial fibrillation. In the beginning, this cardiac arrhythmia usually occurs in attacks (paroxysmal atrial fibrillation). In the course of the disease, those affected often get permanent (persistent) atrial fibrillation. Typical symptoms include feeling weak, tachycardia or a pulse of 100 or more, severe palpitations, irregular heartbeat, heart pain, anxiety and, above all, shortness of breath during physical exertion and a fast heartbeat. However, it is treacherous: Those affected, especially older people, often do not notice any symptoms at all.
Severe consequences of the arrhythmia in the long term
The main problem is the great risk associated with atrial fibrillation: it is one of the most common causes of a stroke. In order to detect atrial fibrillation early and reduce the risk of a stroke, experts are calling for screening with heart rate measurement and an ECG for everyone over the age of 65. The second problem: the longer the atrial fibrillation lasts, the more likely it is that the heart will be damaged by the rapid heart rate and heart failure can occur.
Risk groups for atrial fibrillation
Atrial fibrillation mainly affects older people. Causes include:
- high blood pressure
- coronary heart disease
- heart valve defect
- myocardial insufficiency
- hyperthyroidism
- chronic inflammatory diseases such as rheumatism, lung diseases
- chronic renal dysfunction
- Diabetes mellitus
Women are affected slightly more often than men. Clear causes cannot always be found. Lifestyle factors such as smoking, alcohol consumption, but also stress and mental stress appear to increase the risk. Likewise, people who are overweight and sedentary are more likely to suffer from atrial fibrillation. While regular physical activity protects the heart, there are indications that extreme loads (such as marathons, major triathlons) can trigger atrial fibrillation. Massive disturbances in the electrolyte balance (potassium deficiency and magnesium deficiency) can also throw the heart rhythm out of rhythm.
Atrial fibrillation: causes and course
The atria are in front of the ventricles and support their pumping function by collecting blood in portions. When the atria contract, the blood surges into the ventricles, which immediately contract and pump it further in the direction of the lungs or systemic circulation. This coordinated process is controlled by electrical impulses from specialized heart cells.
Glitches caused by uncontrolled electrical activity in other heart cells can disrupt this process. The atria then fibrillate instead of contracting in a coordinated manner. The result: on the one hand, they can no longer fill the ventricles as well and therefore have to work harder to pump enough blood. On the other hand, flickering atria empty less easily, and the blood can accumulate there in the so-called atrial appendage or atrial appendage – a small appendix-like bulge. This increases the risk of a clot forming in the left atrial appendage, which will eventually be carried by the bloodstream to the brain and cause a serious stroke there.
End atrial fibrillation with cardioversion
If the heart does not find its way back into rhythm on its own, it can be brought back into the correct rhythm with medical help – this is called cardioversion. Synchronization is achieved either with medication (antiarrhythmics) or through a small intervention with electrical pulses (electric shocks). For this purpose, an electric shock is passed through the heart under brief anesthetic and ultrasound control.
Timely therapy increases life expectancy
Whether the atrial fibrillation stops on its own or is terminated by an intervention: in both cases there is a risk that it will recur and become chronic over time. In the case of atrial fibrillation, the first priority should therefore always be the risk assessment with regard to a stroke. The priority is then the optimal treatment of any underlying disease, such as high blood pressure. In order to reduce the risk of cardiac insufficiency and a stroke, the heart rhythm must also be stabilized (rhythm control) and the heart rate kept in the normal range (rate control). Another goal of therapy is to avoid clots in order to prevent a stroke in the event of a renewed arrhythmia.
Exercise helps against atrial fibrillation
Those who are overweight reduce their risk if they change their lifestyle and significantly reduce their body weight with a healthy diet and plenty of exercise. The results emphasize the particularly protective role of the movement a study: Accordingly, a special sports program consisting of strength and endurance training, similar to heart failure, significantly reduces the recurrence of atrial fibrillation.
Antiarrhythmetika (“Pill in the pocket”)
Antiarrhythmic drugs, drugs that control the rhythm, help some people. They can bring the heart back into the correct rhythm if necessary in the case of attacks of atrial fibrillation. This therapy is called “pill in the pocket” because you should always carry the pill with you. Sometimes antiarrhythmics are prescribed for long-term stabilization even after successful cardioversion. The intake of antiarrhythmics must be closely monitored, as various side effects are known and the effectiveness of the tablets also decreases over time.
Destroy heart cells with catheter ablation
Catheter ablation can help when drug therapy and lifestyle changes aren’t enough and AF attacks become more frequent or last for a long time. The sources of electrical interference in the heart are obliterated in order to significantly reduce the frequency of atrial fibrillation or to eliminate it completely.
This procedure is most likely to succeed when the atrial fibrillation is still coming and going on its own (paroxysmal atrial fibrillation) and lasting a week or less. Then the success rate is over 80 percent. On the other hand, if the atrial fibrillation is present around the clock and the heart no longer beats at a normal rhythm, the chance of success is significantly lower. Even if the ablation is repeated several times, the success rate is less than 50 percent.
This is how the ablation works
During ablation, a special catheter is inserted through the groin vein into the heart. With the help of heat (high-frequency current ablation) or cold (cryoballoon ablation), the cardiologist tries to destroy heart muscle cells in the transition area between the pulmonary veins and the left atrium, because this is where the source of the interference impulses is usually located. In this way, the atrial fibrillation should, in the best case, be permanently ended.
When an ablation makes sense
In every third case, the atrial fibrillation returns after some time and the ablation may have to be repeated several times until the seizures stop completely. Whether an ablation makes sense must be decided individually. The chance of success of this procedure also depends on the experience of the attending physician. Those affected should therefore contact a heart center where catheter ablation is part of the routine procedure. In the search for suitable specialists, for example, the German Heart Foundation.
Long-term therapy with blood-thinning drugs
Even after successful treatment of atrial fibrillation with medication, cardioversion or ablation, the risk of a stroke remains. Depending on the risk associated with age and previous illnesses, those affected usually have to take blood thinning tablets for the rest of their lives. These anticoagulants effectively protect against thrombus formation and prevent a stroke.
However, the dosage must be well adjusted, also to minimize the risk of possible internal bleeding from the medication. There are also people who don’t tolerate blood thinners well. In the case of advanced age, weight loss or damaged kidneys, the dose must be reduced or another therapy sought.
Determine individual risk of stroke
The individual stroke risk in atrial fibrillation can be estimated by calculating the so-called CHA2DS2-VASc score. The value provides information about the probability of suffering a stroke within a year. It is determined by adding up points for different risk factors:
- Age between 65 and 74 years: 1 point
- Age 75 and over: 2 points
- Stroke in the past: 2 points
- Diabetes mellitus: 1 Point
- Hypertension: 1 point
- pronounced cardiac insufficiency: 1 point
- female gender: 1 point
- Narrowing of blood vessels as a result of arteriosclerosis (coronary heart disease, peripheral occlusive disease): 1 point
Adding the points gives a value between 0 and 9, which corresponds to the individual risk. The “0” stands for “no other risk factors” and the “9” for “maximum risk factors”.
With a total value of “5”, according to statistics, 84 out of 1,000 people with this risk will have a stroke within one year. Conversely, if 1,000 people at risk take blood-thinning medication, only 29 of them will have a stroke.
If there are no other risk factors apart from atrial fibrillation, statistically two out of every 1,000 people affected will have a stroke within one year. In this case, the doctor must weigh up whether it makes sense to take a blood thinner to prevent a stroke. However, the therapy increases the risk of bleeding.
Stroke prophylaxis by atrial appendage occlusion
According to current knowledge, a stroke can be prevented with a new method just as well as with blood thinners.
It is closed to prevent a dangerous blood clot from forming in the atrial appendage. A special catheter is pushed into the right atrium for this purpose. This pierces the septum between the auricles and thus creates access to the atrial appendage in the left atrium. The umbrella is then inserted into the atrial appendage via a guide wire and unfolded. It is fixed by small barbs and closes the protuberance. The shield remains permanently in the heart. Over time, the inner skin of the heart then grows over the umbrella.
This new method could mean that many of those affected will be able to do without blood thinners in the future. However, it is also an intervention with corresponding risks. Those affected should seek comprehensive advice
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