Atrial fibrillation, also known as atrial fibrillation, is progressive, it tends to get progressively more serious, and mainly affects people over 60. In its early stages, it is not particularly alarming (and often asymptomatic). On the other hand, it can have serious health consequences when episodes of irregular heartbeat are repeated (first referred to as paroxysmal atrial fibrillation, when attacks stop spontaneously after a few days, then persistent fibrillation and, finally, permanent fibrillation).
This heart disease needs to be treated as early as possible, not least to reduce the risk of stroke.
As a reminder, normal resting heart rate is between 60 and 100 regular beats per minute.
Symptoms of atrial fibrillation
Its main symptoms are:
- Rapid, irregular palpitations
- Unusual fatigue
- A feeling of faintness and vertigo
- Shortness of breath during exercise
- Reduced physical performance
- Excessive sweating
Some people experience chest pains. In rare cases, however, there are no symptoms to indicate the onset of atrial fibrillation. In such cases, the condition may be discovered by chance, during an electrocardiogram (ECG) for example.
Causes of atrial fibrillation
Atrial fibrillation may simply be a consequence of aging, the risk of suffering from this disease increases with age.
When it has no known specific cause, the disease is said to be primary. Secondary fibrillation can be caused by surgery, excessive alcohol consumption, inflammatory or autoimmune disease, high fever or hormonal disorders such as hyperthyroidism. In addition, there may be underlying cardiac abnormalities (e.g. in a valve or coronary artery, or in heart failure).
Risk factors of atrial fibrillation
The main risk factors for atrial fibrillation are high blood pressure, overweight and obesity, diabetes and sleep apnea. Overwork, sleep disorders and stress may also favour the development of atrial fibrillation, as well as smoking and alcohol.
Extremely intensive endurance sports can also lead to atrial fibrillation. Nevertheless, regular exercise is more than recommended to maintain a healthy lifestyle.
Diagnosis of atrial fibrillation
Diagnosis is confirmed by a resting ECG, then, if necessary, and particularly in the case of paroxysmal atrial fibrillation, by a long-term ECG. The latter increases the likelihood of detecting an intermittent problem. Connected devices (watch, smartphone, ring, etc.) can also be used to detect atrial fibrillation. A device that continuously monitors cardiac activity over a long period of time can be implanted under the skin.
Finally, an echocardiogram should be performed to assess cardiac morphology.
Treating atrial fibrillation
Treating or suppressing the initial cause can reverse secondary atrial fibrillation. Otherwise, there are various options for treating atrial fibrillation, including medication, electrical cardioversion or cardiological intervention.
Medications include antiarrhythmics, which help restore and/or maintain a normal heart rhythm. Beta-blockers are the most commonly used to slow the heartbeat.
If these are ineffective or poorly tolerated, another treatment may be considered, more effective if carried out early, when atrial fibrillation is not yet established or persistent.
Electrical cardioversion therapy is commonly used to restore a regular cardiac rhythm. It consists of administering electric shocks via two electrodes delivering a metered current that "resynchronizes" the heart's normal activity. This treatment, which does not address the cause of the arrhythmia, is generally only temporary, and antiarrhythmic medication is essential to minimize recurrence.
Radiofrequency ablation is sometimes necessary. By eliminating the heart cells responsible for the uncontrolled electrical discharges (located around the pulmonary veins), this procedure eliminates the focus of the atrial fibrillation, thereby reducing or even eliminating the atrial fibrillation itself.
Sometimes, a pacemaker is fitted when atrial fibrillation is permanent and the heart rate is difficult to control with medical treatment, always with the aim of regulating the heartbeat.
Progression and Possible Complications
Atrial fibrillation can lead to serious complications.
The two main complications are heart failure (the inability of the heart to provide sufficient blood flow) and stroke.
The link between stroke and atrial fibrillation lies in the fact that the latter can lead to a slowdown in blood flow, followed by stagnation of blood in the left atrium, encouraging the formation of a clot. This can then migrate into the bloodstream, usually reaching the brain, and occluding an artery. To limit this risk, and as a preventive measure, anticoagulants are used to thin the blood.
Preventing atrial fibrillation
High blood pressure, overweight, diabetes and sleep apnea are all risk factors to be monitored and, if necessary, treated. Just like any heart disease that may be associated with atrial fibrillation.
A healthy lifestyle also helps to protect the heart. It is therefore recommended to:
- Eating a healthy diet rich in fruit and vegetables;
- Practice an adapted and regular physical activity;
- Monitor the body's weight;
- Reduce salt, sugar and fat intake;
- Limit alcohol consumption and refrain from smoking, since both accelerate heart rate;
- Avoid stressful situations wherever possible.
When should you contact the Doctor
Palpitations, unusual shortness of breath, severe fatigue or night sweats should prompt medical attention, as should chest pains or an irregular pulse.
If symptoms of stroke appear, call 144 immediately.
Care at Hôpital de la Tour
Every medical consultation begins with a discussion, so that the care team can obtain a medical history of the person suffering from atrial fibrillation. The doctor measures the pulse and blood pressure and auscultates the heart and lungs. Blood tests and examinations, such as an electrocardiogram, are performed to confirm the diagnosis. An echocardiogram should be performed, and in some cases, a stress ECG or cardiac magnetic resonance imaging (MRI) may be requested. All patients with atrial fibrillation should be screened for sleep apnea.