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WHAT IS ATRIAL FIBRILLATION?

In Turkey, there are 800,000 people who suffer from atrial fibrillation (AF), which is the most common type characterized by palpitations, fainting, fatigue, and weakness. However, a significant number of patients are unaware of their condition, which increases the risk of stroke and death. One out of every four individuals over the age of 40 has a lifetime risk of developing AF, and this probability increases with aging. Atrial fibrillation is a rhythm disorder that will affect a considerable number of patients as life expectancy continues to increase. The problems it poses include palpitations, decreased exercise capacity, long-term heart failure, debilitating strokes, and unfortunately, shortened lifespan. However, recognizing AF, especially in patients without underlying structural heart problems that could cause rhythm disturbances, and planning individualized optimal treatment can prevent many short-term and long-term issues. Atrial fibrillation is a rhythm disorder originating from the heart's atria. It involves an acceleration and irregularity in the heart rhythm, causing discomfort for patients due to palpitations.

WHAT ARE THE SYMPTOMS OF ATRIAL FIBRILLATION?

Some individuals may not experience any symptoms, and they may learn about their atrial fibrillation issues after a medical examination. However, in some cases, the symptoms can be severe.

The possible symptoms include:

• Disturbing irregular heartbeat, sensation of palpitationsInability to exercise and feeling of weakness

• Fatigue

• Shortness of breath

• Chest pain

• Dizziness

These symptoms can last for a few minutes or sometimes extend up to several hours. Episodes can recur. Sometimes, the symptoms may resolve on their own. In some individuals, the heart rhythm may not return to normal spontaneously and become persistent.

WHAT CAUSES FOR ATRIAL FIBRILLATION?

The heart consists of four chambers. It is composed of two upper chambers called atria and two lower chambers called ventricles. In the right upper chamber of the heart, known as the right atrium, there is a group of cells called the sinus node. This can be referred to as the natural pacemaker of the heart. The sinus node generates the signal that initiates each heartbeat. Normally, this signal travels through the two upper heart chambers, then passes through a connection pathway between the upper and lower chambers called the atrioventricular node. The movement of the signal stimulates the contraction of the heart chambers, pumping blood throughout the body. In atrial fibrillation, the signals in the upper chambers become chaotic. The regular activity of the atria and sinus node is suppressed by the electrical activities in the heart, causing the atria to move randomly. In this condition, the atria do not contract effectively, leading to their enlargement in the long term. The most common cause of atrial fibrillation is high blood pressure. Prolonged hypertension can lead to thickening and enlargement of the heart's ventricular muscle. Heart vessel diseases, rheumatic conditions, mitral valve stenosis, and other conditions can also cause atrial fibrillation. Additionally, overactive thyroid gland, certain lung diseases, and specific medication types can contribute to the development of atrial fibrillation. Congenital heart problems, previous heart surgeries, viral infections, pneumonia, or stress related to different illnesses can also be causes of AF. Some individuals with atrial fibrillation may not have any underlying heart issues, and in some cases, the cause may not be identified.

HOW IS ATRIAL FIBRILLATION DIAGNOSED?

Atrial fibrillation is diagnosed by first obtaining a detailed medical history from the patient. Individuals experiencing atrial fibrillation often describe intense palpitations and other symptoms to their physicians. The most common diagnostic method is through an electrocardiogram (ECG). Atrial fibrillation can be diagnosed using the ECG method, which allows for clear visualization of any issues related to the heart rhythm. If no problems are detected, the physician may recommend wearing a rhythm holter device for 24 to 48 hours to monitor the heart's activity continuously. Echocardiography can be used to assess the structural condition of the heart. Additionally, a cardiologist may request further tests to identify potential triggers for atrial fibrillation. It's important to note that atrial fibrillation is a treatable condition.

HOW IS ATRIAL FIBRILLATION TREATED?

The treatment of atrial fibrillation (AF) varies according to the individual. For example, in patients with paroxysmal atrial fibrillation characterized by intermittent episodes, it is important to prevent the occurrence of palpitations, the main complaint. Treatment options for this purpose include antiarrhythmic medications, electrical cardioversion, and ablation. Rhythm control approaches are preferred in individuals who experience frequent symptoms due to episodes, have a low likelihood of recurrence, and do not have additional issues related to antiarrhythmic medications or approaches. In cases where rhythm control approaches are not successful or when there are minimal symptoms due to the rhythm disturbance, approaches that only slow down the heart rate without correcting the rhythm are preferred. In this case, medications that target the electrical connection between the atria and ventricles are used to maintain an appropriate heart rate. If medications fail, ablation of this connection node can be performed, and if necessary, pacemaker treatment is applied.

AF ablation treatment is a type of minimally invasive procedure. The procedure is performed on the patient through a groin route similar to angiography. The main aim of ablation is to interrupt the electrical connection between the pulmonary veins and the left atrium. For this purpose, burning (radiofrequency) or freezing with a balloon is used. Another goal in the treatment of atrial fibrillation is to prevent stroke caused by blood clots. For this purpose, anticoagulant medications are often used. An alternative method is the closure of the area in the left atrium where blood clots frequently form using occlusive devices. Some patients may be suitable for surgical interventions as well. In patients with AF requiring additional surgery, such as valve disease, surgical ablation is also possible. Innovations in the treatment of atrial fibrillation continue to emerge.