What is atrial fibrillation (AF )
How to treat ?
atrial fibrillation, fibrillation, is the rule and orderly loss of atrial electrical activity (loss of normal sinus rhythm) and replace them with fast chaotic vibration wave, is one of the most common arrhythmia. When atrial fibrillation decrease or loss of pump function, easy to atrial thrombus formation, coupled with rapid atrial atrioventricular node of the decreasing conduction, ventricular arrhythmia so very irregular, thus affecting the ventricular pump function. Atrial fibrillation is a common disease, according to reports at home and abroad in recent years, atrial fibrillation in the general population prevalence rate of 0.4% to 1%, more men than women. With age, the prevalence of atrial fibrillation gradually increased in seven and 80 years old, the prevalence rate of 5% to 8%. In other words, this part of the elderly every 15 to 20 have a risk of atrial fibrillation. Department of Cardiology, Zhongshan Hospital, Shanghai, Cheng W
the occurrence of atrial fibrillation has many causes and incentives. Common diseases as hypertension, coronary heart disease, valvular heart disease, heart failure, various types of heart disease, congenital heart disease, pericarditis and other cardiovascular diseases. Other diseases can cause atrial fibrillation, such as chronic bronchitis and chronic obstructive pulmonary disease, sleep apnea syndrome, neurological disorders, obesity, hyperthyroidism. Some patients lack a clear basis for the disease, known as lone atrial fibrillation. The incidence of atrial fibrillation is also affected by familial factors, and autonomic (sympathetic and vagal) effects. Atrial fibrillation can also be a number of transient or acute illness induced by factors such as: alcohol, surgery, acute myocardial infarction, acute myocarditis, shock, electrolyte imbalance.
main clinical manifestations of atrial fibrillation is due to ventricular arrhythmia caused by irregular and rapid heart rate-related symptoms such as palpitation, chest tightness, decreased exercise tolerance. Symptoms may be due to heart rate, cardiac function, concomitant disease, atrial fibrillation duration and symptoms in patients with sensitivity and different. For the basis of heart disease patients, symptoms are often severe, even angina, acute heart failure. A few patients are less marked, was found only in the routine physical examination. Termination of atrial fibrillation can lead to patients with a transient ventricular asystole, resulting in dizziness, black mask, syncope, such as performance, some elderly people may be trauma or fractures have occurred. Susceptible to atrial fibrillation complicated by left atrial thrombus, thrombosis is caused by arterial thrombosis, cerebral embolism is the most common, the incidence of 5% per year, much higher than those without atrial fibrillation. Small number of patients due to medical neglect, and sometimes cerebral embolism as the initial presentation to medical treatment only to find atrial fibrillation, should be a warning.
physical examination in patients with atrial fibrillation in heart rate and pulse speed will find that different (in general too fast), absolutely irregular rhythm, pulse intensity ranging. Some patients have a family with the electronic device, a display function of the pulse, self-monitoring on behalf of the pulse frequency will find the number of constantly changing, such as 130 ~ 140 times / min between the fluctuation, reflecting atrial fibrillation and heart rate different pulse speed, rhythm is not the whole features, can be used as clues to prompt one of atrial fibrillation.
atrial fibrillation have a typical ECG. Recommended in patients with symptoms of sudden onset of palpitation or rapid or irregular pulse self-test, approaching the hospital due to diagnostic ECG recording. For paroxysmal episodes of atrial fibrillation, ECG (Holter) to help
based on clinical manifestations, physical examination and ECG, the diagnosis of atrial fibrillation can be clear. At present, the atrial fibrillation often divided into the following Ji categories: the first diagnosis of atrial fibrillation, paroxysmal atrial fibrillation, persistent atrial fibrillation, long-term persistent atrial fibrillation, permanent atrial fibrillation. Has been diagnosed, patients should be determined by further examination of the causes and incentives of atrial fibrillation, atrial fibrillation type, the size of thromboembolic wind Yan, a merger of the foundation of heart disease and heart function. Other commonly used method of thyroid function tests, echocardiography (echocardiography) and so on.
include the treatment of atrial fibrillation cardioversion in sinus rhythm (cardioversion), ventricular rate control, prevention of thromboembolic events in three areas. (1) For patients who want to maintain sinus rhythm, cardioversion may be considered for treatment, commonly used methods are anti-arrhythmic drugs, the rise of direct current cardioversion and in recent years has become mature and radiofrequency catheter ablation, according to patients with specific clinical use. If the duration of atrial fibrillation in patients with more than 2 days, left atrial thrombus may have formed, then before cardioversion, even after anticoagulant therapy treatment. (2) for cardioversion difficult or difficult to maintain sinus rhythm after cardioversion who can control the ventricular rate measures to reduce symptoms, improve heart function. Ventricular rate control method is the most commonly used medications, such as digitalis drugs, β-blockers, calcium channel blockers. (3) antithrombotic therapy to prevent and reduce the thrombotic events, but also increases bleeding (gastrointestinal bleeding, cerebral hemorrhage, etc.) air Xian, so is a . Antithrombotic drugs commonly used oral anti-platelet drugs (aspirin, clopidogrel) and anticoagulant (warfarin). The efficacy of warfarin is more accurate, but the wind Yan bleeding is relatively large, and therefore regular monitoring of international normalized ratio (INR) to evaluate. No contraindications in the case, the need for patients with atrial fibrillation and the use of antithrombotic therapy in which drug treatment, depending on the condition, advice and a professional clinician communication and consultation. Antithrombotic treatment in the process, but also on a regular basis to the hospital follow-up. Especially warfarin therapy need periodic monitoring INR, target range is 2 to 3. The beginning of week 1 or 2 times to monitor, due to its role may be the impact of a variety of food and drugs, even after compliance, should also monitor 1 month, not to be Patients whose condition requires the addition of other drugs, they should Dr. Xiang Chufang explain that you are using warfarin, if possible, avoid drug interactions. In order to facilitate monitoring of patients with INR, now also used in the home INR monitor, similar to the common use of blood glucose meter blood glucose test strips. However, the interpretation of the results for self-monitoring and follow-up treatment, or consultation with appropriate professional clinicians. (4) Others include atrioventricular node ablation of permanent pacemaker implantation, the left atrial appendage closure or occlusion, surgical minimally invasive surgery, such as the surgical maze procedure for treatment can be selected according to the patient’s specific condition .