Paroxysmal, persistent and permanent forms of atrial fibrillation and their treatment

One of the most common disorders of rhythm 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 tachyforms of fibrillation and thromboembolic syndrome.

The disease is treatable, several classes of antiarrhythmic drugs have been developed that are suitable for the constant reception and rapid relief of a sudden attack.

What it is

Atrial fibrillation refers to uncoordinated excitation of atrial myocardial fiberswith a frequency of 350 to 600 per minute. At the same time, there is no full atrial contraction.

The atrioventricular junction normally blocks excessive atrial activity and passes a normal number of pulses to the ventricles. However,rapid contraction of the ventricles, perceived as tachycardia.

In the pathogenesis of AF, the main role is assigned to the mechanism of micro-re-entry. Tachiform of the disease significantly reduces cardiac output, causing circulatory failure along a small and large circle.

What is dangerous atrial fibrillation? Uneven atrial contractionsis dangerous for the formation of thrombi, especially in the ears of the atria, and their separation.

Prevalence

The prevalence of atrial fibrillation is 0.4%.Among the group under the age of 40 this figure is 0.1%, over 60 years - up to 4%.

At the heart of the disease is the mechanism of re-entry of excitation into the atrial structures. This is caused by the heterogeneity of the myocardium, inflammatory diseases, fibrosis, stretching, and myocardial infarction.

Pathological Substratecan not normally conduct an impulse, causing uneven myocardial contractions. Arrhythmia provokes an enlargement of the chambers of the heart and a deficiency of function.

Classification and differences of species, stages

Five types of atrial fibrillation are distinguished in the clinical course. They are distinguished by features of appearance, clinical course, compliance with therapeutic effects.

1. The newly discovered formcharacterized by the first-ever occurrence of atrial fibrillation. It is established irrespective of the duration and severity of the symptoms.
2. With paroxysmal fibrillationduration is limited to 7 days. The episode itself stops most often in the next two days.
3. Persistent formspontaneously does not end within 7 days, requires medical treatment or electropulse cardioversion.
4. Persistently persistent fibrillationdiagnosed with a duration of the disease for more than one year and with the chosen method of rhythm correction.
5. Constant formcharacterized by the fact that attempts to restore the sinus rhythm were unsuccessful, and it was decided to keep the AF.

The frequency of contraction of the ventricles distinguishes three forms of atrial fibrillation:

• bradysystolic, at which the heart rate is less than 60 per minute;
• atnormosystolicthe number of abbreviations is within the norm;
• tachysystoliccharacterized by a frequency of 80 per minute.

Causes and risk factors

The occurrence of rhythm disturbances can contribute to various causes, including non-cardiac diseases, inflammation of the heart layers, congenital pathological syndromes. In addition, functional mechanisms and hereditary predisposition are possible.

The causes are divided into the following groups:

• non-permanent reasons: a low level of potassium in the blood, a low hemoglobin content in the erythrocyte, open heart surgery;
• long-term: hypertension, coronary heart disease, heart disease and valves, cardiomyopathy, amyloidosis and hemochromatosis of the heart, inflammatory diseases of the muscular membrane and pericardium, valve structures, myxoma, Wolff-Parkinson-White syndrome;
• catecholamine-dependent fibrillation: provoke emotional overload, reception of strong coffee and alcohol;
• vagusinduced: occurs against the background of a decreased heart rate, often at night;
• genetic forms.

Symptoms and signs

Clinic of the disease is observed in 70% of cases. It is caused by a lack of blood supply, which accompanies dizziness, general weakness.

TachiformeAtrial fibrillation is characterized by a rapid heart rate and pulse, a sense of disruption in the heart, fear. When thrombotic masses occur in the atria, thromboembolic cider occurs.

The right atrial thrombus enters the right ventricle and pulmonary trunk, respectively, enters the vessels that feed the lungs. When a large vessel is cloggedthere is shortness of breath and difficulty breathing.

From the left atrium, a thrombus can get into any organ, including the brain (in this case there will be a stroke clinic), lower limbs (intermittent claudication and acute thromboses).

Paroxysmal formcharacterized by the sudden appearance, dyspnoea, palpitations with irregularities, irregular heart function, chest pain. Patients complain of acute shortage of air.

With a constant or persistent formSymptoms (sensation of a wrong palpitation) arise or are aggravated at performance of any physical activity. The clinical picture is accompanied by pronounced dyspnea.

More on atrial fibrillation and tactics for its elimination, see the video with your doctor:

Clinical and instrumental research

When examined and auscultation is detectedirregular pulse and heart rate. The difference between cardiac contractions and pulse is determined. Laboratory tests are needed to establish the etiology of the disease.

The diagnosis is confirmed by electrocardiography.

ECG signs of atrial fibrillation: instead of the P wave, waves of frequency 350-600 per minute are recorded, which are especially well seen in the II lead and the first two thoracic. With the tachyform, along with the waves, the distance between the QRS complexes will be reduced.

Here is what atrial fibrillation looks like on an ECG:

In the non-permanent form, 24-hour monitoring is shown, which will allow to detect attacks of atrial fibrillation.

To stimulate the possible activity of the myocardium,transesophageal stimulation, intracardiac EFI. All patients need to carry out echocardiography to establish the hypertrophic processes of the heart chambers, identify the ejection fraction.

Differential diagnostics

AF from sinus rhythm apart from atrial waves distinguish different distances between ventricular complexes, the absence of a tooth R.

If there are intercalary complexes, diagnostics with ventricular extrasystoles is required. With ventricular extrasystole, the cohesion intervals are equal, there is an incomplete compensatory pause, against the background - a normal sinus rhythm with teeth.

Tactics of therapy

How to treat atrial fibrillation?Indications for hospitalization are:

• first appeared, paroxysmal form less than 48 hours;
• tachycardia more than 150 beats per minute, lowering blood pressure;
• left ventricular or coronary insufficiency;
• presence of complications of thromboembolic syndrome.

Tactics of treatment of different forms of atrial fibrillation - paroxysmal, persistent and permanent (permanent):

• Paroxysmal form of atrial fibrillation and the first to arise.

  An attempt is made to restore the rhythm. Medication cardioversion is performed with amiodarone 300 mg or propafenone. ECG monitoring is mandatory. As antiarrhythmics apply procainamide intravenously struino 1 g for 10 minutes.

  If the duration of the disease is less than 48 hours, it is advisable to administer 4000-5000 U of sodium heparin to prevent thrombus formation. If the AF appeared more than 48 hours ago, warfarin is used before restoring the rhythm.

  With severe symptoms, a significant decrease in blood pressure, symptoms of pulmonary edema, electropulse therapy is used.
  

  For preventive antiarrhythmic treatment use:

  • propafenone 0.15 g 3 times a day;
  • ethatzin 0.05 g 3 times a day;
  • allapinin in the same dosage;
  • Amiodarone 0.2 g per day.

  With bradycardia, the drug of choice for atrial fibrillation is allapinin. Control of the effectiveness of treatment is carried out by means of daily monitoring, repeated transesophageal stimulation. If it is impossible to restore the sinus rhythm, it is sufficient to reduce the frequency of paroxysms and improve the patient's condition.

• Persistent forms of atrial fibrillation.

  Patients of young and middle age, as well as in the subjective state, it is necessary to attempt a medical or electropulse cardioversion.

  Before restoring the rhythm, it is necessary to check the INR level (the target value is 2-3 within three weeks).

  Electrical cardioversion is performed in the intensive care unit, before the intervention, 1 ml of 0.1% atropine solution is premedicated. For drug cardioversion, 15 mg of nibentane or 450 mg of propafenone are used.

• Constant form of atrial fibrillation

  To reduce the rhythm used digoxin, diltiazem 120-480 mg per day. It is possible to combine with beta blockers.

  For the prevention of thromboembolism, acetylsalicylic acid is prescribed in a dosage of up to 300 mg, with a risk factor for stroke-warfarin (with INR control), with numerous risk factors for atrial fibrillation (elderly age, hypertension, diabetes), indirect anticoagulant therapy.

Learn more about the disease and the widespread radio frequency method for its elimination from the video:

Rehabilitation

Depends on the disease that caused the onset of AF. After rhythm disturbances against a background of myocardial infarction after a stationary stageThe treatment in cardiological sanatoria is shownup to 21 days.

Prognosis, complications and consequences

According to statistical data, AFincreases mortality by one and a half times. Risk of occurrence of cardiovascular pathology against the background of the existing rhythm disturbance doubles.

To improve the forecastIt is necessary to identify and treat the disease in a timely manner, take maintenance therapy as directed by a doctor.

The most serious complications are thromboembolic, especially - ischemic stroke. In the age group of 50-60 years, the risk is 1.5%, and over 80 years, it reaches 23%.

When AF is added to the patient's rheumatic malformations, the risk of brain damage increases fivefold.

Prevention of relapse and prevention measures

Primary prophylaxis of AF is used for the transfer of focal diseases of the myocardium and with open heart surgery.It is necessary to eliminate risk factors for cardiovascular disease: treat hypertension, reduce weight, give up smoking, fatty foods. Also, you should limit the consumption of strong coffee, alcoholic beverages.

If all the requirements are met and risk factors eliminatedprognosis. It is necessary to thoroughly prevent thromboembolic complications, take anticoagulants, monitor heart rate.