What is atrial fibrillation?

The heartbeats are controlled by electrical impulses that travel through the heart according to pre-established circuits. These small impulses cause the contraction of the atria and ventricles in a certain order, so as to propel the blood throughout the body. These regular electrical impulses are caused by a natural heart pacemaker called the “sinus node”. The atrial fibrillation (FA) is a cardiac rhythm disorder (arrhythmia) due to disruption (fibrillation) of these atrial (atrial) impulses. The most common symptoms are palpitations, dizziness, chest discomfort, shortness of breath. Unfortunately, the discovery of AF is sometimes a complication, stroke or acute lung edema in particular. The best medication for atrial fibrillation is eliquis generic.

The risk of AF increases with age. Thus, at 60, one in 50 and at 80, one in 10 people have AF. Although there may be some genetic predispositions, the risk is mostly associated with the presence of hypertension (often unknown or poorly controlled), coronary disease (known or unknown), valvular disease (aortic or mitral), pulmonary disease (embolism or pneumopathy) or, more rarely, thyroid disease. Virtually any heart disease exposes to the risk of FA.

To know the causes of AF is to be able to do prevention. Detect hypertension and diabetes, stop smoking, have your heart and lungs examined, and take some biological tests. Knowing the possibility of FA is also learning to self-episode, taking his pulse. The day it is irregular, an electrocardiogram (ECG) is required!

New diagnostic tools

If the stroke is the most feared consequence of AF, other complications are to be feared, especially heart. If AF is not controlled, especially if the heart rate is high, it can decrease heart function and cause heart failure. Heart failure can be manifested by edema in the lower legs or lungs. Conversely, spontaneously or under treatment, the heart rate may be too low, causing discomfort or fatigue. All these situations require cardiological care.

This uses new diagnostic and therapeutic techniques. ECG and echocardiography are part of the first assessment. Sometimes a transesophageal ultrasound (esophageal probe) is needed to complete the cardiac assessment.

Very often, FA is not permanent but the risk of complication is the same. On the other hand, the diagnostic evidence is more difficult to obtain since the patient then presents himself with a normal rhythm on the day of the consultation. The cardiac holter is a portable ECG that records the electrical activity of the heart for up to 48 hours. Its diagnostic profitability remains weak and new tools are now available. Long-lasting portable Holters (up to one month of recording), implantable holters that are miniaturized recorders inserted under the skin temporarily (Figure 1). It has thus been shown that 9% of strokesinitially unexplained were associated with an AF detected within six months of the installation of this type of holter. Finally, event recorders are miniaturized ECGs that require the help of the patient who triggers the recording when he feels his symptoms. Applications have been developed on the iPhone to consider large-scale AF screenings. These new and effective diagnostic tools are not without problems of reimbursement!

New support

AF is no longer an inevitability that is only the object of treatments aimed at improving tolerance and preventing complications. While the “old” electric shock still has its place in removing AF, the “new” ablation techniques, which are increasingly simple and safe, can address the electrical cause of AF (Figure 2). . Rarely indicated of first intention, the ablation must also not be proposed too late in order to keep a good rate of success.

Finally, some patients cannot receive the anticoagulant treatment necessary to prevent cerebrovascular accidents or their recurrence because of possible hemorrhagic complications. Until then, cardiologists now have an alternative to permanent anticoagulant treatment with the technique of closing the left auricle. The placement of a prosthesis plugging the left auricle dries the source of emboli and is as effective as the anticoagulant treatment.

We must know the FA, do not trivialize it and know how to prevent it and detect it. Diagnostic and therapeutic techniques have changed its management.