Atrial fibrillation: an arrhythmia not to be underestimated

  Atrial fibrillation is the abbreviation of atrial fibrillation, which refers to the uncoordinated and irregular fibrillation of 350-600 times per minute occurring in the atrial area, and the attack can be either paroxysmal or persistent, and the duration of persistent patients ranges from days to decades, and the longer the time, the more difficult it is to recover and the greater the danger, so atrial fibrillation is the most common persistent arrhythmia. In recent years, due to the aging of China, coupled with the increasing incidence of hypertension, coronary heart disease and heart failure, the number of patients with atrial fibrillation has also increased significantly. Currently, there are more than 13 million patients with atrial fibrillation nationwide, and there is one atrial fibrillation patient for about 12 over 80 years old. The main hazard of atrial fibrillation is that it significantly increases the chance of stroke and mortality, so it must be given high priority.  In normal atrial beats, the rate per minute is the same as that of the ventricles, but slightly earlier than the ventricles. This is the sequential nature of the work of the atria and ventricles so that the perfusion of blood from the atria to the ventricles is better accomplished. However, the atrial beats of 350-600 per minute in atrial fibrillation are very irregular. Such atrial beats cannot be completely transmitted to the ventricles, and the actual number of ventricular beats is only a few dozen to more than 100 per minute, which is of course also very irregular. Due to the uncoordinated activity between atria and ventricles, the atria cannot effectively perfuse blood to the ventricles, and blood stagnates in the atria, which leads to thrombus formation in the atria and The risk of stroke increases; at the same time, due to reduced blood perfusion, the output of the heart can be reduced by more than 30%, which adversely affects the blood supply to the heart itself and other organs of the body.  Symptoms of atrial fibrillation vary from person to person, as paroxysmal episodes can last only a few seconds, or persistent episodes are gradually tolerated, and some patients have no significant discomfort, but asymptomatic patients are at no less risk than symptomatic patients. The symptoms of paroxysmal atrial fibrillation are sudden onset, palpitations, shortness of breath, precordial discomfort, shortness of breath after activity, and anxiety. In elderly people with coronary artery disease, atrial fibrillation may begin with a rapid ventricular rate, angina pectoris, vertigo, or even syncope, and sometimes heart failure and shock. If other factors that cause tachycardia are present, sometimes the rapid heart rate can even lead to sudden death.  The risk of blood clots is one of the greatest dangers of atrial fibrillation. Once an atrial thrombus is dislodged and runs down an artery to the brain, a cerebral artery embolism can occur, leading to a stroke. Because thrombi of cardiac origin are often larger, strokes caused by atrial fibrillation are often more severe and more disabling and fatal than strokes originating in the cerebral vasculature. According to statistics, 20% of stroke events are related to atrial fibrillation, 35% of patients with atrial fibrillation will have one or more thromboembolic accidents in their lifetime, and the incidence of stroke in patients with atrial fibrillation is 5-17 times higher than normal, with a disability rate of 25% and a mortality rate of 25%. Other sites of embolism such as coronary embolism and renal artery embolism can also occur. In atrial fibrillation caused by rheumatic heart disease, there are often cases of amputation after the thrombus has dislodged and blocked an artery in a limb. Thrombotic events are an important factor in the overall survival of patients with atrial fibrillation, and studies have found that the mortality rate is 1.5 times higher in men with atrial fibrillation and 1.9 times higher in women with atrial fibrillation than in non-atrial fibrillation patients. Therefore, in recent years, professional organizations and institutions in both Europe and the United States, as well as in China, have paid increasing attention to the management of patients with atrial fibrillation.