What is atrial fibrillation?
Atrial fibrillation is a common cardiac arrhythmia. Atrial fibrillation is caused by abnormal electrical signals and conduction in the atrial tissue, resulting in a significantly faster and more regular heartbeat. Atrial fibrillation affects the pumping function of the heart, which means that the human brain and other organs do not receive enough blood supply. Dong Nianguo, Department of Cardiac Surgery, Wuhan Union Medical College Hospital
Although atrial fibrillation does not cause pain, it can cause chest discomfort. It can also cause dizziness, light-headedness, shortness of breath and fatigue due to the reduced pumping function of the heart. However, there are also patients who have no symptoms and do not even know they have atrial fibrillation.
Why does atrial fibrillation need to be treated?
Many patients with atrial fibrillation seek treatment because their symptoms are obvious. However, despite the absence of symptoms, AF should be treated because it can have many serious consequences. Over time, atrial fibrillation can cause a decline in new function and irreversible heart damage. This is why the risk of death is twice as high in patients with untreated atrial fibrillation than in those with normal hearts.
Patients with atrial fibrillation should also be aware that atrial fibrillation causes the heart to under-pump and that blood can pool in the atria to form blood clots, which, if partially dislodged, can potentially cause a stroke. In fact, the incidence of stroke increases fivefold in patients with untreated atrial fibrillation.
Is atrial fibrillation common?
A recent study by the Mayo Clinic in the United States showed that more than 5,000,000 people in the United States have atrial fibrillation. In our country, studies show that more than 9,000,000 people have atrial fibrillation. The incidence of atrial fibrillation increases with age. It is estimated that atrial fibrillation can occur in up to 4% of people over the age of 60 and up to 9% of patients over the age of 80.
What causes atrial fibrillation?
It can be difficult for your doctor to determine exactly what is causing your atrial fibrillation, but there are certainly risk factors that can increase the development of atrial fibrillation. These factors include.
・Having had a heart attack or angina attack, congestive heart failure, valve closure insufficiency, arterial disease
・High blood pressure or diabetes
・Thyroid, lung, or neurological disorders
Excessive intake of caffeine or alcohol
Other causes
How is atrial fibrillation treated?
There is no single treatment that is suitable for all patients with atrial fibrillation. Treatment for atrial fibrillation should be based on the type of atrial fibrillation, which treatment is likely to be most effective for you, and consideration of the risks and efficacy of a particular treatment. Your doctor will advise you on your specific condition.
There are many different approaches available for the treatment of atrial fibrillation. This brochure highlights only a few of the most commonly used treatments. They are divided into three categories depending on the purpose of the treatment.
1. risk of stroke
2.Control of atrial fibrillation
3.Cure atrial fibrillation
(i) Drug therapy
Anticoagulant drugs can prevent the formation of blood clots that cause strokes. Warfarin is the most commonly used drug and has been shown to reduce the risk of stroke by 68% compared to patients without any treatment. However, to achieve such a therapeutic effect, it is important to control the concentration of warfarin in the blood: too low and there will be thrombosis, too high and serious bleeding complications will result. Like other drugs, diet can affect its blood levels. That’s why it’s important to take your medication exactly as prescribed, as well as to have your blood levels tested regularly.
Heart rate control medications are used to control the rate of your heartbeat, while rhythm control medications (or antiarrhythmics) are used to try to keep your heart rhythm in a normal rhythm. These drugs can achieve some degree of therapeutic benefit, but some patients cannot tolerate them or have contraindications to their use because of their side effects.
(ii) Treatment of atrial fibrillation
Because it is difficult to control atrial fibrillation, your doctor may recommend treatment measures that may cure atrial fibrillation. Three “ablative treatments” are discussed below that may offer you the opportunity to cure AF. Three types of ablation treatments can achieve different cure rates. The type of atrial fibrillation you have determines which treatment is better for you.
Like all other treatments for heart disease, they come with varying degrees of risk. Your doctor will tell you what these risks are. How your general health and age relate to these risks.
1. Catheter ablation
The purpose of this treatment is to eliminate the main cause of atrial fibrillation. A catheter is inserted from the femoral vein into the right atrium of the heart, and a small hole is made in the septum to allow the catheter to enter the left atrium.
Electrodes at the end of the catheter allow the physician to detect abnormal potential points in the atrial wall that are responsible for the irregular and increased beating of the atria. Heat or freezing is then used to scar (ablate) these areas. These scars block the propagation of the abnormal electrical signals that cause atrial fibrillation. The cure rate fluctuates widely and some doctors may feel the need to re-treat or treat multiple times. Catheter ablation treatment can take up to 6 hours or more, and there is radiological damage.
2. Open heart surgical ablation
It is often referred to as the “maze procedure”. More than 80,000 people worldwide have undergone this treatment. To date, hundreds of hospitals in China have used this method to treat thousands of patients with atrial fibrillation. It has been proven to have a high cure rate for all types of atrial fibrillation, especially chronic atrial fibrillation.
This method can cure atrial fibrillation, but it requires open-heart surgery, which is more invasive and often requires surgery under extracorporeal circulation. Patients who have atrial fibrillation and other heart conditions that require open-heart surgery such as valve replacement or bypass are more likely to be treated in 15 to 25 minutes. In addition, many cardiac surgeons also remove or close the left heart ear during surgery. It is generally believed that the left heart ear is the main site of thrombosis.
3. Minimally invasive cardiac surgical ablation
In recent years, surgeons have developed a minimally invasive surgical technique for the treatment of atrial fibrillation, known as the Wolf Mini-Maze procedure. This treatment is based on the same treatment principle as open-heart surgical ablation and has a similarly high cure rate, while avoiding the need for highly invasive and risky open-heart surgery. The procedure involves making two small holes and a small 3-5 cm incision in each side of the chest wall, through which the surgeon performs the procedure.
The procedure usually takes 2-4 hours and uses the same ablation energy as in an open heart ablation procedure to make precise and effective ablation lines in the beating heart. These ablation lines create scars that block the transmission of the abnormal electrical signals that cause atrial fibrillation.
Likewise, many surgeons remove the left ear of the heart.
Because the heart does not beat without opening the chest and does not require extracorporeal circulation, postoperative recovery is faster than with open-heart surgical ablation. The average postoperative hospital stay can be reduced to 4-7 days.