Atrial fibrillation: classification, symptoms, causes and treatment

By Cristiano Antonino On Feb 6, 2023

Atrial fibrillation occurs when the atria, from which the heart rhythm originates, do not contract in a synchronous manner and therefore ‘quiver’ or fibrillate, i.e. beat very rapidly and irregularly

The blood is not pumped efficiently to the rest of the body, as a result of which one may feel very weak or tired or experience uncomfortable cardiac sensations such as an accelerated or irregular heartbeat.

Atrial fibrillation can be:

Paroxysmal (occasional) – lasting from a few minutes to several days, but resolving spontaneously.
Persistent – does not resolve spontaneously but with the administration of drug therapy or the delivery of a particular electrical shock (cardioversion) to restore normal heart rhythm
Permanent – continuously present and does not resolve with either drug therapy or cardioversion

Atrial Fibrillation (AF) is the most frequent heart rhythm disorder.

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Atrial Fibrillation is defined as a heartbeat that becomes irregular and accelerated (tachyarrhythmia)

Among people over the age of 40, one in four may have an episode of atrial fibrillation during their remaining lifetime.

Sometimes this remains the only event, while in other cases the arrhythmia tends to recur.

Especially in the early stages, episodes tend to stop spontaneously, usually within a couple of days; later on, their duration increases and interventions will be required to bring them to a halt.

The characteristics of atrial fibrillation vary from individual to individual

Some people experience no symptoms at all, often for years, while for others symptoms change from day to day, which is why treating symptoms and atrial fibrillation together is far from straightforward.

A continuous monitoring device can provide the physician with a more complete clinical picture, enabling him or her to implement a more targeted treatment.

Causes of atrial fibrillation

The causes of atrial fibrillation are often unclear.

In some cases, atrial fibrillation is due to congenital heart abnormalities or damage to the heart structure following a heart attack or valvular heart disease.

Even individuals without heart problems can develop atrial fibrillation.

Age (the risk increases with age; after the age of 40, one in four individuals may have an arrhythmic episode)
Heart disease (previous heart attack, heart failure, valvular disease, etc.)
Arterial hypertension
Extra-cardiac diseases (lung, thyroid)
Alcohol abuse
Family history (rarely)

In a small number of cases (approximately one in ten), the arrhythmia occurs without an apparent cause and is therefore defined as ‘isolated’ (halo).

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Symptoms of atrial fibrillation

Atrial fibrillation can manifest itself with these symptoms:

Sensation of an accelerated heartbeat
Sensations of ‘fluttering’, often called palpitations, which may include irregular, pounding or very intense heartbeats
Loss of consciousness, light-headedness or dizziness
Fatigue, breathlessness or weakness
Discomfort or pain in the chest

In some individuals, the complaints may be very mild or even absent and the arrhythmia is occasionally discovered during a medical examination performed for other reasons.

In the presence of symptoms or signs suggestive of atrial fibrillation, it is advisable for the family doctor to send the patient for a consultation with an electrophysiologist (a cardiologist who deals with cardiac arrhythmias); in more serious cases, rapid access to the emergency department is required.

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Risk factors and consequences of atrial fibrillation

Controllable risk factors

High cholesterol
High blood pressure
Heart disease
Smoking
Overweight
Caffeine
Alcohol abuse
Sedentary lifestyle
Certain medications
Sleep apnoea

Uncontrollable risk factors

Family history
Ageing
Congenital heart defects

One stroke in 4 is caused by atrial fibrillation and is much more severe than a stroke caused by other causes

The risk of suffering a stroke is not the same in all individuals and increases with advanced age, the presence of diabetes mellitus, high blood pressure, reduced pumping function of the heart, arterial disease or in those who have already suffered cerebral ischaemia.

Another possible negative consequence of atrial fibrillation is a more or less severe reduction in the pumping function of the heart (heart failure).

This usually occurs in predisposed individuals and especially when the heart’s contraction frequency remains very high for a long time.

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Diagnosis

Detecting and quantifying atrial fibrillation can be a complex operation.

The doctor may use one or more of the following tests to determine whether or not the patient has atrial fibrillation:

Electrocardiogram (ECG)
Stress test
Long-term monitoring devices
Event recorder
Holter
Implantable cardiac monitor

Diagnosing an atrial fibrillation condition is important because this heart problem can contribute not only to the onset of a stroke but also to the development of a heart attack.

Diagnosis, however, can be difficult as Atrial Fibrillation is an unpredictable event and the symptoms are not always obvious.

This is why the collaboration of the subject is important. The doctor or team following the case will need detailed indications of the symptoms as well as data on cardiac electrical activity.

If the doctor has reason to suspect that atrial fibrillation is related to a cardiac condition, diagnostic tests will be needed to gather information on organ activity.

The social impact of stroke is enormous, being the leading cause of disability in the world.

Nevertheless, available data in Italy indicate an under-treatment of people with atrial fibrillation, even in those at high risk.

A high percentage (about 50 per cent), especially the elderly, despite a clear indication for treatment with anticoagulants, are not receiving any specific treatment, or are on antiplatelet drugs whose effectiveness is limited.

To these must be added the people currently being treated with the oral anticoagulant walfarin who, despite frequent monitoring and dose adjustments, have values outside the therapeutic range in a proportion ranging from 30 to 50 per cent.

Since the availability of NAOs, which do not require monitoring of blood coagulability in the laboratory, with significant management advantages for both the individual and the health system, another barrier has fallen towards the goal of optimising the proportion of people with atrial fibrillation who are correctly scoagulated.

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