What is atrial fibrillation? Atrial fibrillation is the most common type of atrial arrhythmia. Atrial fibrillation is caused by abnormal rapid discharge of ectopic pacing points in the atrial tissue and uneven conduction of electrical signals in all directions. In normal sinus rhythm, the heart beats at 60-100 beats per minute with a regular frequency, so that the contractions of the atria are coordinated, whereas in atrial fibrillation, the atria contract very rapidly, usually at 300-600 beats per minute, with a highly irregular frequency, resulting in a highly uncoordinated contraction and diastole of the atria, resulting in atrial fibrillation. In atrial fibrillation, the rapid irregular rhythm of the atria is transmitted to the ventricles, causing rapid irregularities in the ventricular rate, so that patients with atrial fibrillation feel palpitations. The rapid irregular contraction of the ventricles also causes a significant decrease in ventricular pumping function. The reduced pumping of the heart can cause the brain and other organs of the body to be deprived of adequate blood supply. As a result, patients may experience shortness of breath, dizziness, fatigue and, in severe cases, fainting. When the ventricular rate is not fast, there are also some 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, atrial fibrillation should be treated despite the absence of symptoms because it can cause heart failure and stroke. Over time, atrial fibrillation can cause a decline in heart function, resulting in irreversible heart damage and heart failure. This is why the risk of death is twice as high in patients treated for atrial fibrillation than in people with normal hearts. Patients with atrial fibrillation should also be aware that during atrial fibrillation blood can pool in the atria (especially in the left auricle) and form blood clots, which, if partially dislodged, can potentially cause a stroke, which can be disabling in mild cases and life-threatening in severe cases. In fact, patients with untreated atrial fibrillation have a five-fold increase in the incidence of stroke compared to the general population. 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 people over the age of 80. What causes atrial fibrillation? Atrial fibrillation can occur independently, but there are a number of risk factors that do increase the development of atrial fibrillation. These factors include: 1) coronary artery disease, heart valve disease, and congestive heart failure; 2) hypertension and diabetes; 3) thyroid, lung, or neurological disease; 4) excessive caffeine or alcohol intake; Goals and strategies for treating atrial fibrillation: Treatment of atrial fibrillation involves three major goals and two major strategies. The three major goals are: prevention of thromboembolism, reduction of the ventricular rate to normal, and restoration of sinus rhythm. The most desirable goal of treatment is the restoration of sinus rhythm, but this goal is the most difficult to achieve. When sinus rhythm cannot be restored, control of the ventricular rate is an option. Therefore, two treatment strategies are currently available: the ventricular rate control strategy and the atrial fibrillation rhythm reversal strategy. The ventricular rate control strategy is chosen to be achieved primarily through pharmacological treatment. The atrial fibrillation rhythm reversal strategy is mainly achieved by: medical catheter ablation and surgical minimally invasive ablation. These two treatment strategies are not isolated, so medications can also be used clinically to redirect the rhythm, and medications are needed to control the heart rate before and after ablation therapy. The choice of strategy can be made by the patient in consultation with a medical professional. Regardless of the strategy chosen, it is important to make clear that pharmacological anticoagulation is the basis of all treatment. Specific treatment: 1. Anticoagulants Anticoagulants prevent the formation of blood clots that cause strokes and are therefore the basis of atrial fibrillation treatment. Anticoagulant drugs include: aspirin and warfarin. Aspirin is less effective than warfarin in anticoagulation. However, the application of warfarin anticoagulation requires strict testing of blood levels, and both low and high levels can cause serious complications. Whether to apply Warfarin anticoagulation is currently assessed according to the CHADS2 stroke risk stratification scheme. Consult your supervising physician to determine the best anticoagulation regimen for you. 2. Anti-arrhythmic drugs β-blockers and calcium channel blockers can control the ventricular rate in patients with atrial fibrillation; amiodarone can divert the rhythm in patients with atrial fibrillation but with a low success rate. Depending on your condition, your doctor may use a combination of medications. Please consult your supervising physician for specific dosing measures. It is important that you provide your doctor with as detailed a medical history as possible to avoid any side effects from the medication. Catheter ablation The mechanism of atrial fibrillation is currently thought to be a fast ectopic pacing signal in the atria caused by certain factors, and the electrical signal is conducted at different speeds in each direction in the diseased atria, resulting in a foldback. The ectopic electrical signals most often originate in the pulmonary veins, with about 10% originating from sites other than the pulmonary veins. The primary goal of catheter ablation is to isolate the pulmonary veins. The surgeon inserts a catheter from the femoral vein into the right atrium of the heart and makes a small hole in the septum to allow the catheter to enter the left atrium. Heat is then used to create scars (ablation lines) between the pulmonary veins and the left atrium. These scars block the propagation of the abnormal electrical signals that cause atrial fibrillation. Internal treatment is less painful for the patient, but it is not performed under direct vision, the ablation line is incomplete, and the success rate of a single ablation is low. Multiple ablations are usually required to achieve a satisfactory outcome. The cost of catheter ablation treatment is 60,000-80,000, and the patient needs to be exposed to radiation for a long time during the treatment period, and the intraoperative contrast agent will damage the kidney and may produce serious complications such as pulmonary vein stenosis and pulmonary vein rupture. 4. Minimally Invasive Cardiac Surgery Ablation In recent years, surgeons have developed a minimally invasive surgical technique for the treatment of atrial fibrillation, also known as Wolf Mini-Maze (Wolf Minimally Invasive Maze), a treatment that also targets the pulmonary veins for isolation. 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 surgery with minimal trauma. The surgical procedure is done under direct vision, no radiation is required, and the pulmonary vein isolation ablation line is precise and intact, so the success rate for a single surgical procedure is much higher than that for catheter ablation, which is 90%. In addition the surgical time is short and the cost is low by 50-60 thousand Yuan. It also allows simultaneous removal of the left heart ear, greatly reducing the risk of stroke in patients with atrial fibrillation.