Symptoms and treatment of atrial fibrillation

  Atrial fibrillation is a disordered heart rhythm and is a common chronic arrhythmia. Recently, the Framingham Heart Study showed that men and women over the age of 40 have a lifetime risk of developing atrial fibrillation of approximately 1 in 4. The incidence of atrial fibrillation increases with age. Based on the mode and duration of AF episodes, AF is internationally classified into four major categories namely: primary AF, paroxysmal AF, persistent AF and permanent AF. Atrial fibrillation can be secondary to various organic heart diseases, hyperthyroidism, toxic reactions, etc. It can also occur without a clear cause, i.e., sudden onset atrial fibrillation.  The symptoms and prognosis of atrial fibrillation vary depending on the patient’s age, the presence or absence of co-morbid heart disease, and the speed of the ventricular rate. If the ventricular rate is between 60 and 100 beats/min, the patient only has palpitations; if the ventricular rate is greater than 100 beats/min, the patient may feel obvious palpitations, shortness of breath, dizziness, and in some cases, syncope may occur. Patients with chronic atrial fibrillation have a significantly reduced quality of life, and long-term attacks can lead to tachycardia cardiomyopathy and eventually heart failure, or even death.  A more common and serious complication of atrial fibrillation is thromboembolic events. Clinical epidemiological survey data show that about 2 out of every 10 ischemic stroke patients are caused by atrial fibrillation, and among them, 60% of stroke patients experience severe paralysis or die. It is clear that atrial fibrillation is a major risk to human life and health.  The principles of treatment for atrial fibrillation include: correction of the cause and triggers; treatment of the disease causing the arrhythmia and conversion to sinus rhythm; control of the ventricular rate; patients with atrial fibrillation usually also require anticoagulation to prevent thromboembolic complications. Treatment of the cause, such as treatment of hyperthyroidism, hypertensive patients, etc. Removal of causative factors such as quitting smoking, limiting alcohol, drinking less strong tea, and avoiding emotional excitement.  If atrial fibrillation is combined with acute heart failure and angina attack, synchronized electrical resuscitation therapy is required; some patients with persistent atrial fibrillation can use antiarrhythmic drugs, while for patients with permanent chronic atrial fibrillation or significantly enlarged heart, if the hemodynamics is stable, ventricular rate control therapy is preferred. Some patients with atrial fibrillation are at high risk (their chance of thromboembolism is more than 5 times that of the normal population), and their risk factors include advanced age (≥75 years), hypertension, cardiac enlargement, heart failure, diabetes mellitus, previous history of stroke or transient ischemic attack, etc., and the need for long-term anticoagulation with medication.  The application of drugs to control the ventricular rate of atrial fibrillation or drugs and electrical resuscitation to treat atrial fibrillation, although partially effective, still has many problems; while the surgical “maze surgery” is only suitable for a small number of patients because of the high trauma, high risk and pain.  In recent years, with the in-depth research on the mechanism of atrial fibrillation, experts at home and abroad have carried out catheter radiofrequency ablation of large veins or linear ablation around the pulmonary veins to treat atrial fibrillation, which can effectively cure atrial fibrillation, and tens of thousands of patients around the world have benefited from it in the past few years, which is a new breakthrough in the history of atrial fibrillation treatment. The Department of Cardiology of our hospital has carried out the new technology of catheter ablation for atrial fibrillation, treating nearly 100 patients with a success rate of nearly 80%.