Causes, symptoms, complications.

What is atrial fibrillation?

Atrial fibrillation is the most common arrhythmia in the adult population, especially in people over 70 years of age. It is characterized by an irregular and often fast heartbeat, and is one of the most common causes of stroke.

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Electrocardiogram of a patient with atrial fibrillation:

How common is atrial fibrillation?

In 2016, more than 43.6 million people suffered from atrial fibrillation worldwide, while in Greece it is estimated that more than 250,000 people have experienced at least one episode of atrial fibrillation. We know that it occurs more often in men, with its frequency increasing exponentially with aging. It is estimated that one in three people over the age of 55 are at risk of developing atrial fibrillation during their lifetime.

What are the causes of atrial fibrillation?

Age, as aforementioned, constitutes itself a risk factor for atrial fibrillation.

Other common causes are:

• Unregulated blood pressure
• Diabetes mellitus
• Coronary artery disease
• Heart failure
• Valvular diseases
• Sleep apnea
• Lung diseases
• Chronic kidney disease
• Inflammatory diseases
• Obesity
• Alcohol consumption
• Smoking

However, atrial fibrillation can also occur in people without risk factors due to genetic predisposition.

What are the symptoms of atrial fibrillation?

In a large percentage of patients, atrial fibrillation can be completely asymptomatic and the first manifestation is a stroke or the onset of heart failure (also known as tachycardiomyopathy Video 1,2)

Video 1: Patient with atrial fibrillation and impaired left ventricular function (low ejection fraction).

Video 2: Improvement of left ventricular function after conversion to sinus rhythm. The most common symptoms are palpitations (fluttering), shortness of breath, chest tightness, dizziness, easy fatigue,cardiac arrest.

The most common symptoms are palpitations (fluttering), shortness of breath, chest tightness, dizziness, easy fatigue, cardiac arrest.

What are the effects of atrial fibrillation?

As we mentioned, stroke is the most common complication of atrial fibrillation.

Additionally, based on the international bibliography, it is recorded:

• 1.5 - 3.5 times increased risk of cardiovascular death
• 20-30% of patients will develop left ventricular dysfunction and heart failure
• 1.5 times greater risk for vascular dementia
• 20% of patients will likely experience depression
• 60% of patients will have their quality of life affected
• while 10-40% of patients will need hospitalization at least once a year due to complications or symptoms related to atrial fibrillation

Classification of atrial fibrillation

Atrial fibrillation, depending on its pattern of appearance, is characterized as newly diagnosed, paroxysmal, persistent, long-term persistent and permanent. It is common to switch from one type to another (paroxysmal to persistent). It has been shown that the transition from paroxysmal to persistent is related to deterioration of the cardiac substrate, specifically the appearance of atrial cardiomyopathy.

How is atrial fibrillation diagnosed?

To diagnose atrial fibrillation, a 12-lead ECG or heart rate recording with a Holter monitor or implantable Holter is required.

Periodic monitoring with pulse measurement, blood pressure measurement, or even more modern tools such as smart watches (Image 1) and mobile phone applications can increase the frequency of detection of atrial fibrillation episodes. However, it must be emphasized that the results should be evaluated by specialists before a diagnosis is made (Image 2).

Image 1: Smart watch recording of a symptomatic patient with atrial fibrillation.

Image 2: Electronic devices for recording the heart rate (European Society of Cardiology -2020 Guidelines for Management of Atrial Fibrillation)