There are many doubts that arise when diagnosing atrial fibrillation. This type of arrhythmia can generate concern and, in some cases, fear. In this second part of the Rithmi Expert Corner, we want to help to solve some of these doubts, in a very interesting talk with Doctor Joaquín Oscà.
Dr. Joaquín Oscà is a cardiologist at the Hospital Universitario la Fe in Valencia, specialized in Electrophysiology and Cardiac Arrhythmias. He was the president of the Arrhythmia Section of the Valencian Society of Cardiology until 2011, he is responsible for the Arrhythmia Unit at Vithas Hospital in Valencia and the author of many scientific publications and presentations at national and international congresses.
What is atrial fibrillation?
Atrial fibrillation is a heart disease that affects the heart rhythm (cardiac arrhythmia) in which a very irregular and usually fast rhythm appears. It can accompany other heart diseases such as: myocardial infarction or diseases of the heart valves. However, most of the time it appears in people who do not suffer from other heart diseases.
What are the most common symptoms of atrial fibrillation?
The symptoms of atrial fibrillation are palpitations, sensation of an irregular pulse (more or less rapid), feeling of suffocation, dizziness or loss of consciousness and a decrease in effort capacity.
However, atrial fibrillation can appear without symptoms in a significant percentage of people and manifest for the first time with any of its complications such as stroke or heart failure. For this reason, different cardiological scientific societies (Spanish, European and American) have emphasized the importance of atrial fibrillation early detection to prevent complications derived from it.
How prevalent is atrial fibrillation in society? Which sector does it particularly affect?
In Spain it is estimated that around one million citizens suffer from this heart disease in some of its varieties. Recent calculations suggest that these figures may reach up to two million.
Atrial fibrillation is related to age and cardiovascular risk factors such as high blood pressure, diabetes, obesity, sedentary lifestyle, and other heart diseases. The relationship with age is very important: 5% of people between 60 and 69 years old suffer from atrial fibrillation, 12% of people between 70 and 79 years old and over 17% of people with age over 80 years. This relationship allows predicting a rise in atrial fibrillation numbers in the coming years in parallel with the aging of the Spanish population.
Incidence of atrial fibrillation according to age
5% of people between 60 and 90 years
12% of people between 70 and 79 years old
17% of people over 80 years old
Is it dangerous to have atrial fibrillation?
Untreated atrial fibrillation increases the risk of suffering a stroke, especially in people suffering from high blood pressure, diabetes with other heart diseases or over 65 years. Also, atrial fibrillation increases the risk of heart failure. Consequently, the presence of atrial fibrillation doubles the risk of death of the person suffering from it.
What controls should people diagnosed with atrial fibrillation follow?
Patients with atrial fibrillation should undergo a cardiac evaluation in which the personal history and symptoms related to the arrhythmia are determined, and a physical examination is performed. Likewise, an electrocardiogram will be performed to confirm the presence of the arrhythmia and various factors such as heart rate. Finally, echocardiography is common. In patients with atrial fibrillation, other diagnostic tests such as cardiac MRI or catheterization can be performed, but it is limited to specific cases with a very specific indication.
Once this cardiological evaluation has been done, patients will undergo periodic controls by Cardiology, in many cases by specialists in cardiac arrhythmias or electrophysiologists, or by specialized doctors in Primary Care.
These reviews will analyze the patient’s situation, control their symptoms or certain risk factors such as hypertension (HT) and confirm that the patient receives adequate treatment.
“Atrial fibrillation can appear without symptoms and manifest for the first time
with some of its complications such as stroke”
Can a person with atrial fibrillation lead a normal life?
Patients with atrial fibrillation can lead a normal life with a series of recommendations such as following correct lifestyle habits that include physical exercise, proper nutrition, avoiding alcohol, tobacco or other toxins, as well as following the treatment prescribed by the responsible doctor.
Is it possible to make this type of arrhythmia disappear?
The only treatment that has been shown to be able to eliminate – cure – atrial fibrillation is catheter ablation of this arrhythmia. Atrial fibrillation ablation is especially effective in people with paroxysmal atrial fibrillation, that is, those people who suffer episodes of said arrhythmia that are spontaneously interrupted, and to a lesser degree in cases of permanent atrial fibrillation. In addition, some studies have shown that ablation can improve the prognosis and survival of the patient.
What are the treatments for atrial fibrillation?
The main treatment for atrial fibrillation is oral anticoagulant treatment (acenocoumarol or any of the modern oral anticoagulants) which is especially indicated in people over 65 years of age. In fact, the main objective of the early detection of atrial fibrillation would be the initiation of this treatment, with the aim of avoiding the appearance of a stroke and its consequences.
Treatment for atrial fibrillation also includes treatments to control the heart rate and prevent people from experiencing an abnormal increase in heart rate.
Finally, patients with atrial fibrillation can receive antiarrhythmic pharmacological treatment whose objective is preventing the person from suffering new episodes of atrial fibrillation or from interrupting them in cases where the arrhythmia is present. Electrical cardioversion is a treatment that is given to people with atrial fibrillation that is not interrupted with drugs.
Finally and as previously mentioned, the most effective antiarrhythmic treatment is catheter ablation of atrial fibrillation.
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