Atrial fibrillation is a very common arrhythmia. According to statistics, the incidence of atrial fibrillation in people over 60 years old is 65438 0%, and it increases with age.

aetiology

The onset of atrial fibrillation is paroxysmal or persistent. Paroxysmal atrial fibrillation can be seen in normal people, occurring during emotional excitement, after surgery, after exercise or acute alcoholism. When acute hypoxia, hypercapnia, metabolic disorder or hemodynamic disorder occur, patients with cardiopulmonary diseases can also have atrial fibrillation. Persistent atrial fibrillation occurs in patients with original cardiovascular diseases, and is common in rheumatic valvular heart disease, coronary heart disease, hypertensive heart disease, hyperthyroidism, constrictive pericarditis, cardiomyopathy, infective endocarditis, heart failure and chronic pulmonary heart disease. Atrial fibrillation occurs in people with no known heart disease basis, which is called solitary atrial fibrillation.

clinical picture

The severity of atrial fibrillation symptoms is affected by ventricular rate. When the ventricular rate exceeds 150 beats per minute, patients may have angina pectoris and congestive heart failure. When the ventricular rate is slow, patients don't even realize it exists. Atrial contraction disappears and cardiac output decreases by 25% or more during atrial fibrillation.

Atrial fibrillation has a high risk of systemic embolism. Embolus comes from left atrium or left ear, which is caused by blood stasis and atrial loss of contractility. Patients without valvular heart disease are complicated with atrial fibrillation, and the probability of stroke is 5 ~ 7 times higher than those without atrial fibrillation. The incidence of cerebral embolism is high when mitral stenosis or mitral prolapse complicated with atrial fibrillation.

Three therapies

1. Etiological treatment: We should try our best to find the primary disease and inducing factors and carry out etiological treatment.

2. Acute attack: If the patient has a rapid ventricular rate and symptoms and signs of acute cardiovascular insufficiency, synchronous cardioversion should be the first choice. For patients with good cardiovascular function, the initial treatment goal is to slow down the ventricular rate. Use digitalis, beta blockers or verapamil to keep the ventricular rate at rest at 60-80 beats per minute, and the heart rate will not increase more than 0/00 beats per minute/kloc after light exercise. Digitalis can be used alone or in combination with beta blockers or calcium antagonists as needed. Beta blockers and verapamil should not be used in patients with heart failure and hypotension, and digitalis and verapamil should not be used in patients with preexcitation syndrome complicated with atrial fibrillation.

3. Paroxysmal atrial fibrillation: Paroxysmal atrial fibrillation is called when the duration of atrial fibrillation is shorter than 12 months, and the probability of successful cardioversion is greater, and the probability of maintaining sinus rhythm after cardioversion is greater. Quinidine is the most commonly used and effective class IA drug, but it may lead to fatal ventricular arrhythmia. Procaine amine is also very effective. Before cardioversion with class IA drugs, beta blockers should be given to slow down the conduction of atrioventricular node to prevent the drugs from antagonizing vagus nerve. Otherwise, when atrial fibrillation turns into atrial flutter, the hidden conduction of atrioventricular node will be weakened, leading to an increase in ventricular rate. The efficacy of class Ⅰ C drugs, such as flucaine and propafenone, in converting atrial fibrillation is similar to that of class Ⅰ A, but it can also lead to ventricular arrhythmia. Amiodarone can also effectively convert atrial fibrillation. When drug cardioversion is ineffective, try synchronous electrical cardioversion. In order to prevent left ventricular thrombosis, warfarin should be given for 3 weeks before cardioversion (to prolong the thromboplastin time to 1.3 ~ 1.5 times of the control value) and continue for 2 ~ 4 weeks after cardioversion.

Before deciding on cardioversion therapy for patients with chronic atrial fibrillation, we should fully consider whether atrial fibrillation can last for a long time after it turns into sinus rhythm. The duration of atrial fibrillation (the longer the course of the disease, the more difficult it is to maintain after cardioversion), the degree of atrial dilation (the larger the atrium, the lower the success rate) and the patient's age (the lower the success rate of elderly patients) are all important factors affecting the maintenance of sinus rhythm after cardioversion.

To prevent the recurrence of atrial fibrillation, quinidine, propafenone or amiodarone can be used.

At present, it has been reported that radiofrequency ablation has successfully treated paroxysmal atrial fibrillation.

4. Persistent atrial fibrillation: those whose atrial fibrillation lasts more than 12 months are called persistent atrial fibrillation. Generally, cardioversion is no longer used, but medication is used.

For rapid atrial fibrillation, digoxin is a commonly used oral drug. Excessive digoxin is toxic to the heart. Patients and their families must learn to listen to the ventricular rate with a stethoscope (be careful not to count the pulse) and adjust the dose according to the heart rate. If the heart rate is fast, the dosage will be increased, and if the heart rate is slow, the dosage will be reduced to keep the heart rate at 70-90 beats/min. Digoxin should be used for a long time. Digoxin poisoning patients can continue to use it as long as their condition requires after the poisoning is completely recovered.

Patients with chronic persistent atrial fibrillation have a high incidence of embolism, especially those with a history of embolism, left atrial thrombosis diagnosed by ultrasound, severe mitral stenosis and artificial heart valve replacement. People under 60 years old who have no history of heart disease are low-risk patients. For high-risk patients, it is generally advocated that long-term anticoagulants (long-acting aspirin 325mg per day or warfarin) should be given, and low-risk patients do not need long-term application. It should be pointed out that there is no consensus on long-term anticoagulation treatment of atrial fibrillation. Even patients who need long-term anticoagulation therapy should pay attention to the different situations of individuals, weigh the advantages and disadvantages, and fully consider that drugs may increase the risk of potential bleeding.

For patients with frequent attacks, rapid ventricular rate and ineffective drug treatment, healthy bundle ablation of atrioventricular node can be performed and frequency-adaptive ventricular pacemakers can be implanted at the same time.

Is the doctor's statement correct that atrial fibrillation is now under control and arrhythmia is normal?

The more you used to be a cardiologist, the above statement is basically correct. Because there is a process of drug defibrillation, namely: atrial fibrillation-paroxysmal and short-term atrial fibrillation-atrial premature beat-sinus rhythm-sinus rhythm. In this process, the heartbeat and pulse are regular and only the last step, and the middle third gear is irregular!