#长沙头条 ##湖南省第二人民医院#
Recently, Grandpa Liu (pseudonym), who lives in Changsha, always feels flustered, as if "his heart is about to jump to his throat", which makes him not eat and sleep well, so he came to the Department of Cardiovascular Medicine of the Second People's Hospital of Hunan Province (Hunan Provincial Brain Hospital) for treatment.
After a complete electrocardiogram examination, the attending doctor found that Grandpa Liu had "atrial fibrillation", and the ventricular rate reached about 110 beats per minute, and then arranged for Grandpa Liu to be hospitalized.
Atrial fibrillation (full name atrial fibrillation), as the name suggests, occurs in the atrium.
Atrial fibrillation is one of the most common arrhythmias in clinical practice, the normal heart sends electrical signals from the sinus node, causing the heart to contract and produce a pulse, when atrial fibrillation occurs, the electrical signal is abnormal, and the bilateral atria are irregularly tremor, there will be abnormal heartbeat and pulse, interfering with the normal heart rhythm, which forms atrial fibrillation. In atrial fibrillation, the frequency of atrial agitation is 300 to 600 beats per minute, and the heartbeat rate is often rapid and irregular, sometimes up to 100 to 160 beats per minute.
What are the dangers of atrial fibrillation?
You Sanli, chief physician of the Department of Cardiovascular Medicine of the Second People's Hospital of Hunan Province (Hunan Provincial Brain Hospital), introduced:
1. Thrombosis and stroke: Stroke is often referred to as stroke and is the most serious harm of atrial fibrillation. In atrial fibrillation, blood tends to stagnate in the atria and form a thrombus due to the loss of systolic function of the atrium. If the blood clot breaks off, it can travel with the blood to all parts of the body, resulting in cerebral embolism (stroke, hemiplegia), limb artery embolism (in severe cases, even amputation). The incidence of stroke in patients with atrial fibrillation is about 5 times that of normal people, and according to statistics, about 20% of strokes are caused by atrial fibrillation.
2. Aggravate the risk of dementia: Atrial fibrillation blocks the cerebral blood vessels through blood clots, directly damages the cranial nerves, or reduces the cerebral blood flow by reducing the cardiac blood flow, so that the cranial nerves are in a state of ischemia and hypoxia for a long time, thus causing dementia. The risk of dementia in patients with atrial fibrillation is 2 times higher than that of the general population.
3. Heart failure: The probability of heart failure in patients with atrial fibrillation is 3.4 times that of normal people, and long-term atrial fibrillation will increase the burden on the heart, which will lead to heart failure, and in severe cases, it will lead to death.
4. Serious impact on quality of life: patients with atrial fibrillation have palpitations, dyspnea, fatigue, reduced exercise tolerance, and bear mental and material burdens, which seriously affect their quality of life. Early detection, early diagnosis and early treatment can achieve satisfactory treatment results.
How is atrial fibrillation treated?
Chai Xiaoli, chief physician of the Department of Cardiovascular Medicine of Hunan Provincial Brain Hospital (Hunan Provincial Second People's Hospital), pointed out that there are many methods of atrial fibrillation treatment, which are divided into drug treatment and non-drug treatment.
1. Medication. It is mainly to restore and maintain sinus rhythm, control the ventricular rate, and prevent thromboembolic or stroke complications of atrial fibrillation. Including amiodarone, dronedarone, etc., as well as traditional Chinese medicines such as Wenxin Granules, Ginseng Song Yangxin Capsules, Chinese Medicine Decoctions, etc.
2. Non-pharmacological treatment. Non-pharmacological treatments for atrial fibrillation include electrical cardioversion (conversion to sinus rhythm), radiofrequency ablation and surgical maze surgery, left atrial appendage occlusion, etc. Currently, the mainstay of non-pharmacological treatment is radiofrequency ablation.
Transcatheter cardiac radiofrequency ablation is a minimally invasive interventional procedure with the advantages of less trauma and no need for general anesthesia. This surgery is an interventional technique that sends electrode catheters into the atrium through venous vessels, and releases radiofrequency current to cause local endocardial and subendocardial myocardial necrosis to the excitatory foci of ectopic in the atrium and pulmonary veins, so that the excitatory foci of ectopic in the pulmonary veins cannot be conducted, so as to treat atrial fibrillation.
The RF current damage is small, so it does not pose a hazard to the body. At present, the success rate of ablation of paroxysmal atrial fibrillation can reach more than 80%. Three-dimensional mapping can intuitively display the intracardiac anatomy, abnormal excitation origin, electrical excitation conduction direction, etc., which can quickly map difficult tachyarrhythmias and analyze their mechanisms, and guide the formulation of ablation strategies, so as to improve the success rate of ablation, shorten the operation time, and reduce complications.
After a series of examinations and evaluations, the cardiovascular team finally decided to perform radiofrequency ablation of atrial fibrillation, and after a short two-hour operation, Grandpa Liu has successfully converted to sinus rhythm and has recently been discharged home.
How can we stay away from atrial fibrillation in our lives?
Hu Libo, attending physician of the Department of Cardiovascular Medicine of Hunan Provincial Brain Hospital (Hunan Provincial Second People's Hospital), warmly reminds that atrial fibrillation can be prevented through lifestyle interventions:
1. Weight control: Obesity increases the risk of atrial fibrillation and is closely related to the progression of atrial fibrillation, with evidence that people with a BMI of > 30kg/m2 (BMI: body mass index) have a 49% increased risk of atrial fibrillation. In the 2021 "Atrial Fibrillation: Current Knowledge and Treatment Recommendations", it is recommended that patients with atrial fibrillation control their weight, that is, BMI < 24kg/m2, and non-atrial fibrillation patients with BMI <28kg/m2, can reduce the risk of atrial fibrillation (I, A).
2. Alcohol and coffee: Evidence has shown that long-term alcohol consumption increases the risk of atrial fibrillation, and the benefits of abstaining from alcohol are immediate. Therefore, whether you are healthy or not, you can live a long life by abstaining from alcohol. In addition, studies have shown that coffee does not increase the risk of atrial fibrillation, and moderate coffee consumption can also help reduce the occurrence of atrial fibrillation.
3. Smoking: Some studies have shown that smoking increases the risk of atrial fibrillation, but there are also studies that show that there is no correlation between the two. Considering that smoking is closely related to coronary heart disease, heart failure, etc., and smoking itself is an unhealthy lifestyle, it is recommended that patients with atrial fibrillation should quit smoking.
4. Active exercise: The incidence of atrial fibrillation in athletes is higher than that of the normal population, and the risk of atrial fibrillation in lack of exercise is also significantly increased, so moderate exercise should be maintained and competitive and excessive endurance exercise should be avoided. Exercise methods such as yoga, tai chi, walking, or jogging are recommended.
5. Maintain good sleep: regular and high-quality sleep can help reduce the risk of atrial fibrillation, and sleeping too long (>8h) or too short (<6h) will increase the risk of atrial fibrillation, and long-term insomnia should be actively treated.
A variety of diseases are risk factors for the occurrence of atrial fibrillation, and we can reduce the risk of atrial fibrillation by controlling the disease factors:
1. Blood sugar control: diabetes mellitus is an independent risk factor for the occurrence of atrial fibrillation, and the incidence of atrial fibrillation in diabetic patients is more than 2 times that of non-diabetic patients, and increases with the progression of microvascular comorbidities, therefore, patients with atrial fibrillation should actively control blood sugar and reduce the risk of atrial fibrillation.
2. Control blood pressure: hypertension is the most common risk factor for the occurrence of atrial fibrillation, and the risk of atrial fibrillation in hypertensive patients is 1.7 times that of people with normal blood pressure. Blood pressure in hypertensive patients with atrial fibrillation should be reduced to less than 130/80 mmHg to reduce adverse events.
3. Prevention of heart failure: Atrial fibrillation and heart failure are cause and effect of each other, and the two are usually combined. Therefore, the prevention and management of cardiovascular disease is very important for the prevention of atrial fibrillation.
4. Sleep apnea syndrome (OSA): It often occurs in patients with atrial fibrillation, heart failure and hypertension, and significantly increases the incidence of all-cause mortality and adverse cardiovascular events. Patients with OSA should be actively managed to reduce the number of new episodes, progressions, recurrences, and symptoms of atrial fibrillation.
Hunan Medical Chat Special Author: Hu Libo, Department of Cardiovascular Medicine, Hunan Provincial Second People's Hospital (Hunan Provincial Brain Hospital).
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(Editor YH)