ภาวะหัวใจห้องบนเต้นระรัว (Atrial Fibrillation) อาการ สาเหตุ การตรวจวินิจฉัยและการรักษา

Atrial Fibrillation (AF)

Atrial fibrillation is an abnormal heartbeat of the upper two-chamber, pulsing, and beating inconsistently with the lower two chambers.

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Atrial Fibrillation (AF)

Atrial fibrillation is an abnormal heartbeat of the upper two-chamber, pulsing, and beating inconsistently with the lower two chambers. Patients with atrial fibrillation may experience palpitations and shortness of breath which may later disappear or recur. These raise the risk of developing blood clots in the heart which leads to paralysis if the clot slips into the bloodstream.

Symptoms

Atrial fibrillation may be temporary, frequent, or permanent. The symptoms and treatment may vary according to the severity of the individual patient's condition. Common symptoms seen in people with atrial fibrillation may include shortness of breath, palpitations, and dizziness. It was found that some patients may not have any symptoms and may not know that they have atrial fibrillation until receiving a diagnosis or physical examination. However, if you experience chest pain, it may be a warning sign of a heart attack. You should see a doctor or contact the emergency room urgently.

To prevent the higher level of the disease, see the doctor as any symptom above occurs. Electrocardiogram may be ordered purposely to find out the possibility of atrial fibrillation or other heart rhythm disorder.

Cause of Atrial Fibrillation

This abnormal and rapid heart rate occurs when two-upper chambers of the heart meet disordered electrical signals. There are groups of cells called the sinus node within the upper right chamber of your heart which produce the signal that operates the heartbeat. The movement of the signal that passes through the two champers results heart to squeeze and send blood to your heart and body. When the electrical signals operate irregularly, it leads to a rapid and abnormal heart system. The heart rate in atrial fibrillation may up to the range of 100 to 175 beats a minute while the normal one is 60 to 100.

Many factors increasing the risk of atrial fibrillation may include age, heart disease, high blood pressure, alcohol use, obesity, family history, and other chronic conditions.

Older people tend to have a higher risk of atrial fibrillation. It is also recorded that heart disease higher the tendency of developing atrial fibrillation. The risk is increased with people with high blood pressure and other chronic conditions such as diabetes, thyroid, and chronic kidney disease.  Developing of atrial fibrillation also relates to obesity and ones whose family has atrial fibrillation records.

Diagnosis

Normally, to evaluate the tendency of the disease, The doctor may review the patient's historical medications which may require a physical examination. Some tests are also required to diagnose the conditions including:

  • Electrocardiogram (ECG)
    This tool is used to sense and record electrical signals passing through your heart by attaching small sensors to your chest and arms.
  • Holter monitoring
    This portable ECG recording is intended to record the. To monitor the heartbeat for 24 hours a day or longer. This allows the doctors to monitor the heart's activity in cases where the heartbeat may show abnormal symptoms during the day.
  • Event recorder
    Event Recorder functions the same as the Holter monitoring portable ECG. This recorder focuses on the recording of multiple weeks of heartbeats or up to several months. In which the patient must press a button when the heartbeat occurs to record the frequency and number of times the anomaly has occurred. This allows the doctor to observe the abnormal heartbeat as well as abnormal rhythm disturbances.
  • Echocardiogram
    This method uses high-frequency waves to simulate images of the heart to show anomalies that may occur including the shape of the heart, the condition of the heart valve, and blood clots that may arise within.
  • Blood tests
    These procedures are used to look for other factors that may cause the development of atrial fibrillation such as thyroid and other substances in blood.
  • Stress test
    This exercise test is conducted to monitor your heart while exercising.
  • Chest X-ray
    Lungs and heart are observed to seek for other conditions besides atrial fibrillation that can describe your signs and symptoms


Treatment

Treatments for atrial fibrillation may vary on the severity and duration of the disease. The treatments aim to reset the rhythm or control the heart rate, and to prevent blood clots that may higher the risk of a stroke.

1. To reset the heart rhythm or to control the heart rate

Cardioversion is the most common method used to reset the heart rhythm.  The methods vary from the severity and duration of atrial fibrillation in each individual, with two main methods:

  • Electrical cardioversion
    This electrical shock is sent to your heart through paddles or patches attached to your chest. This method will stop the heart’s activity for a short period of time to reset the heart to a normal system. A sedative will be given before the procedure. In some cases, other medication may be used along with the procedure to reset the heartbeat.
  • Cardioversion with drug
    The medication called antiarrhythmics may be required to restore regular sinus rhythm. Taken by mouth or IV, your heart rate will be monitored in the hospital and evaluated for further treatments. Normally, if your heart rhythms have gotten back to normal, the same or similar antiarrhythmics will be continued to prevent the development of atrial fibrillation.
    Several weeks before this treatment, warfarin and some kinds of blood-thinning medications will be prescribed to prevent the risk of blood clots and stroke. These medications may be continued for at least a month after the treatment.
  • To maintain a normal heart rhythm
    After the procedure of electrical cardioversion, some antiarrhythmic medications may be prescribed to prevent future atrial fibrillation and to maintain a normal heart rhythm such as:
    • Amiodarone
    • Flecainide
    • Propafenone
    • Sotalol
    • Dofetilide

The patients may experience some side effects such as nausea, dizziness, and fatigue after the use of the medications. In some cases, severe rhythm disturbances in the heart’s lower chambers may occur. The use of these medications may lead to more severity of atrial fibrillation as well.

  • To control the heart rate
    There are some kinds of medications that may be used to control the rapid heart rate and to restore it to its normal rate including:
    • Digoxin. This medication controls the heart rate during rest. The doctor may prescribe some additional medications such as calcium channel blockers or beta blockers while using this medication.
    • Beta-blockers. Beta-blockers help regulate the heart rate either at rest or during physical activity. The side effects of the drug may lower blood and may cause hypotension.
    • Calcium channel blockers. Anti-calcium drugs affect regulating the heart rate. However, it should be avoided because it can cause low blood pressure and may lead to heart failure. The doctor may suggest other procedures to control the heart rate including:
  • Catheter and surgical procedures
    If other treatments do not achieve, catheter and surgical procedures may be recommended as alternative treatments. The procedure's purpose to destroy a part of heart tissue that results in abnormal electrical signals to bring back normal heart rhythms.
    • Catheter ablation This treatment aims to destroy a part of heart tissue that causes atrial fibrillation. by using high-frequency electric waves or radiofrequency energy through a catheter into the heart to destroy the underlying tissue. This will create a scar to help the heart rhythm return to normal.  This procedure is occasionally used in patients with congestive heart failure or those who are unresponsive to antiarrhythmic drugs.
    • Maze procedure is a surgical procedure that aims to destroy a part of heart tissue that causes atrial fibrillation. The surgery is performed by opening the heart before destroying the underlying tissue. The procedure will leave a scar that does not conduct electricity and helps the heart rhythm return to normal. However, this surgery is only used to treat patients who have not responded to other treatments because open-heart surgery is complicated. This procedure may be performed during other open-heart surgeries such as coronary bypass surgery.
    • Atrioventricular (AV) node ablation This is an alternative procedure for those patients who do not respond to any of the other procedures. The procedure implicates a catheter to send radiofrequency energy to the pathway joining the upper and lower heart chambers. This therapy will destroy a small area of heart tissue to prevent irregular signaling. A pacemaker implanted is needed to keep the lower heart chambers beating properly. The patients will be required to take blood thinner medications after the therapy to prevent the formation of blood clots that may cause a stroke.

    2. To prevent blood clot

    Patients with atrial fibrillation have a high risk of blood clots that lead to a stroke. The risk is even higher with people who are involved with other heart disease. The doctor may prescribe some medications to prevent blood clots such as the two main kinds of medications below:

    • Anticoagulants
      • Warfarin This severe anticoagulant is intended to prevent the formation of blood clots. Patients receiving this drug must strictly follow the doctor's instructions and must have regular blood tests to monitor the effect of the drug on the blood to prevent bleeding that can be dangerous.
      • Newer anticoagulants These anticoagulants are often used in patients with atrial fibrillation to prevent a stroke. Newer anticoagulants are shorter-acting than Warfarin and therefore do not need a blood test to monitor the effects of the drug. However, consult a doctor and follow the advice strictly.


    Left atrial appendage closure

    Left atrial appendage closure is an option for patients with a high risk of blood clot formation or easy bleeding without heart valve problems, and people who cannot use the anticoagulants.

    The procedure starts with the insertion of a small tube through a vein in the thigh to insert a small umbrella-like appendage to seal the left atrial appendage (left atrial) and allow the tissue to wrap over time. This treatment can help prevent the formation of blood clots and replace the use of anticoagulants.

    Preparing for an appointment

    Before your appointment, you are advised to be aware of restrictions prior the appointment and you may prepare some information including:

    • your experienced symptoms
    • your key personal information
    • all medications you are taking
    • questions that you want to ask the doctor

    During the consulting, the doctor may ask some questions including information such as:

    • the beginning of your symptoms
    • whether your symptoms are continuous or occasional
    • the severity of your symptoms
    • whether anything improves or worsens your symptoms

    Published: 26 Oct 2020

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