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The Dance of the Heart: What's the Mystery of Atrial Fibrillation?
Atrial fibrillation, or AF for short, is an abnormal heart rhythm characterized by the heart's atria beating in a rapid and irregular rhythm. This condition often begins with a brief abnormal beat that may become longer or constant over time. It is worth noting that it may sometimes be accompanied by asymptomatic attacks.
According to statistics, more than 33 million people worldwide are affected by atrial fibrillation, and in Europe and North America, the incidence of atrial fibrillation has increased from approximately 0.4% in 2005 to 2-3% in 2014.
The condition may begin as another type of arrhythmia, such as atrial flutter, and turn into atrial fibrillation. Patients experiencing atrial fibrillation may experience discomfort such as palpitations, fainting, dizziness, shortness of breath, or chest pain. For these patients, atrial fibrillation is more than just an uncomfortable feeling; it can be associated with a higher risk of heart failure, dementia, and stroke.
Atrial fibrillation is usually caused by episodes of rapid heartbeats that are triggered by bundles of muscle that extend from the atria to the pulmonary veins. Isolation of the pulmonary veins has been shown to restore normal heart rhythm. In addition, the autonomic ganglia of the atria can also be a source of atrial fibrillation and are therefore sometimes removed.
As atrial fibrillation becomes more persistent, the boundary between the pulmonary veins and the left atrium ceases to be the starting point of the episode, and the left atrium becomes an independent source of the rhythm.
Some modifiable risk factors include high blood pressure and valvular heart disease. Other heart-related risk factors include heart failure, coronary artery disease, cardiomyopathy, and congenital heart disease. In developing countries, valvular heart disease is often caused by rheumatic fever. In addition to the above factors, chronic obstructive pulmonary disease (COPD), obesity and sleep apnea are also risk factors associated with atrial fibrillation.
Stress biomarkers, such as cortisol, vasopressin, and heat shock proteins, may also be involved in the etiology of atrial fibrillation. In addition, risk factors such as excessive alcohol intake, smoking, diabetes and thyrotoxicosis should not be ignored. Still, about half of cases are not linked to any known risk factors.
A medical professional may confirm atrial fibrillation by checking your pulse or interpreting an electrocardiogram (ECG). A typical ECG image shows an irregular QRS complex and no P waves.
Healthy lifestyle changes, such as losing weight, increasing physical activity, and reducing alcohol consumption, can reduce the risk of atrial fibrillation.
Treatment for atrial fibrillation usually involves medication to adjust the heart rate to a closer to normal range or to change the heart rhythm to normal sinus rhythm. Electrical cardioversion is often necessary when the patient is unstable in an emergency setting, and ablation can help prevent recurrence.
For patients at low risk of stroke, atrial fibrillation does not mandate the use of anticoagulants, although some providers may prescribe them; however, most patients with atrial fibrillation have a high risk of stroke, so Experts generally recommend the use of anticoagulants.
Anticoagulant drugs such as warfarin and direct oral anticoagulants reduce the risk of stroke but also increase the risk of major bleeding.
Symptoms of atrial fibrillation are usually related to a rapid heart rate. The rapid and irregular heartbeats may be felt as rapid, irregular or skipped heartbeats (palpitations), or may manifest as a decreased tolerance for exercise. Sometimes it can even cause angina. These discomforts can be very distressing, especially if the heartbeat is noticeably irregular.
Initially, atrial fibrillation may be first detected during a routine physical exam or electrocardiogram (ECG) because it sometimes causes no obvious symptoms. In some cases, the abnormal heart rhythm of atrial fibrillation may not be detected until a stroke or transient ischemic attack occurs.
All of these situations point to one question: What unsolved mysteries are hidden behind atrial fibrillation, a rare yet common heart rhythm disorder?
