Atrial Fibrillation and Atrial Flutter

Atrial Fibrillation and Atrial Flutter are extremely fast electronic discharge patterns that cause the heart’s atria (upper chambers within the heart) to contract extremely quickly and with some electrical impulses reaching the ventricles, occasionally causing them to contract more quickly and less effectively than they normally do.

• The majority of them are caused by circumstances that cause the atria to expand.
• The symptoms depend on the speed at which ventricles contract. Symptoms could include palpitations, weakness lightheadedness or dizziness, breathing problems, and chest discomfort.
• ECG (ECG) can confirm that the diagnosis is correct.
• Treatment may include drugs to reduce the heart’s contractions in the ventricles and occasionally, electric shocks (cardioversion) in order to restore the normal rhythm of the heart.

Atrial Fibrillation and Atrial Flutter

(See also What is Atrial Fibrillation.)

Atrial flutter and atrial fibrillation are more common in those who are older and suffer from heart conditions. Atrial fibrillation is more prevalent as is atrial flutter. A lot of people who have atrial flutter also experience instances of fibrillation atrial. Atrial fibrillation, as well as atrial flutter, could occur and disappear or last for a long time. The Conduction System

Atrial fibrillation

In the course of atrial fibrillation, electrical impulses are generated from a variety of areas within and around the atrium more than just one region (the sinoatrial nerve–see diagram Diagramming the Herz’s Electric Pathway). The resultant electrical activity is chaotic, not organized, and consequently, atrial walls begin to swell instead of contracting. Because the atria don’t expand normally and do not in pumping blood to the ventricles.

If the atria don’t aid in pumping blood into ventricles, the maximum quantity of blood that the heart pumps is decreased by approximately 10 percent. The slight decrease in the maximum output is generally not an issue, except for those with heart diseases in particular when they are exerting themselves.

A small portion of the unpredictable electrical impulses is transmitted through the atrioventricular junction to the ventricles. Therefore, the ventricles beat irregularly. In the majority of people who are not receiving treatment for atrial fibrillation, impulses are sent to ventricles at an increased rate (often 140-160 beats per minute in contrast to a normal heart rate of 60-100 beats per the minute). Even faster rates occur during exercise. Atrial Fibrillation

Fluttering of the atrial chambers

Atrial flutter is a condition that, unlike in atrial fibrillation where it is possible to coordinate electrical activities in the atria. Therefore, the atria contract, however at a high rate (250 or 350 times per minute). This is not enough for every impulse to travel through the atrioventricular node and to the ventricles. In the majority of patients who are not receiving treatment each second of atrial impulse is transferred into the ventricles, resulting in an atrioventricular rate of around 150 beats per min.

ECG: Reading the Waves

The electrocardiogram (ECG) depicts the electrical flow that flows through the heart in the heartbeat. The flow of current is split into components and each one is assigned an alphabetical designation within the ECG. Every heartbeat begins with an impulse coming from the cardiac pacemaker (sinus or sinoatrial nerve).

The impulse triggers the upper chambers of your heart (atria). The P wave is a signal for the activation of the heart’s Atria. Then, the electrical charge is then directed to the lower chambers in the heart (ventricles). The QRS complex is a signal to activate the ventricles.The ventricles will then undergo an electrical switch to prepare for the next heartbeat. This electrical activity is known as the recovery wave.

It is symbolized by the T-wave. Different kinds of abnormalities are often visible through an ECG. They can be caused by a previous heart attack (myocardial infarction) or an irregular heartbeat (arrhythmia) and a deficient supply of oxygen and blood for the heart (ischemia) and an the excessive swelling (hypertrophy) in the cardiac muscular walls. Certain irregularities that show up on an ECG may also be indicative of bulges (aneurysms) which develop in weaker parts of the heart’s wall.

Aneurysms can result from heart attacks. If the rhythm is irregular (too rapid, too slow or irregular) The ECG can also show the area in the heart where the abnormal rhythm begins. The information provided by doctors can help them to pinpoint the reason.

Atrial Flutter

Atrial flutter can be described as a typical rhythm that has distinctive “flutter” waves that form the sawtooth pattern.

Causes of Atrial Fibrillation and Atrial Flutter

Atrial fibrillation, also known as atrial flutter can occur even if there isn’t any other heart problem. More typically, these arrhythmias are caused by conditions such as

• High blood pressure
• Coronary arteriac disease
• Heart valve diseases that affect the mitral or tricuspid valves
• Alcohol abuse
• The condition is known as an excessively active thyroid gland (hyperthyroidism)
• It is birth defect that affects the heart

Heart valve problems along with high blood pressure can cause the atria to expand which makes atrial fibrillation also known as atrial fibrillation more probable.

Complications

The major issues are the following:

• The atria is a place where blood clots form.
• Heart rate increases rapidly, which results in lower heart rate and output.

Atrial fibrillation, also known as atrial Flutter, the atria do not fully empty into ventricles every time a beat is made. As time passes, blood within the atria can stagnate and blood clots could develop. The clots may split, usually when atrial fibrillation is converted to normal, whether by itself or due to treatment. The fragments of clot could enter the left ventricle and travel throughout the bloodstream (becoming emboli) and block the smaller artery. If clots made of blood block an artery inside the brain then it is possible that a stroke occurs. A stroke can be the first indication of atrial fibrillation, also known as atrial flutter.

Atrial flutter causes the heartbeat too quickly that the ventricles don’t provide enough space to be filled with blood. Since they aren’t filled completely with blood, the volume of blood that is pumped out by the heart reduces. This can cause blood pressure to drop to a point where an insufficiency of the heart could be a possibility.

Did You Know…

Because blood can build up within the heart’s atria, and form clots, atrial fibrosis is a significant risk cause of stroke.

Symptoms of Atrial Fibrillation and Atrial Flutter

The signs of atrial fibrillation or atrial flutter rely largely on the speed at which ventricles beat. If the rate of ventricular beats is at a normal level or barely elevated (less than 120 beats per min) the majority of people have no signs. A higher rate can trigger a feeling of heartbeats ( palpitations) or shortness of breath. They can also cause chest discomfort.

If you suffer from atrial fibrillation the pulse is generally quick and often irregular. If you have atrial flutter the pulse tends to be rapid, but it can be irregular or regular.

The decreased pumping capability of the heart can cause weakness, apathy, or shortness in breath. If the rate of ventricular contraction is extremely fast, a few individuals, particularly older ones and those suffering from heart problems may develop heart failure or chest discomfort. In rare cases, individuals may experience the condition of shock (very very low blood pressure).

Diagnosis of Atrial Fibrillation and Atrial Flutter

• Electrocardiography

The symptoms suggest that you have an atrial flutter or atrial fibrillation The diagnosis is made when Electrocardiography (ECG) proves this.

The heart is examined using ultrasound ( echocardiography) is carried out. It allows doctors to assess the heart valves as well as look for blood clots within the atria.

Doctors typically also conduct tests on the blood to check for an overactive thyroid gland.

Treatment of Atrial Fibrillation and Atrial Flutter

• The heart’s rate is lowered.
• Anticoagulants
• Restoring the normal heartbeat
• Ablation

The treatment of atrial fibrillation, also known as atrial flutter is intended to limit how fast ventricles contract, in order to bring back the normal rhythm of the heart, and also to treat the disorder that is causing the arrhythmia. Treatments that prevent the development of emboli and blood clots (anticoagulants and aspirin) are generally prescribed.

The treatment of the root cause is crucial, but it does not necessarily eliminate arrhythmias in the atrial region. However, treating a thyroid gland that is too active or surgery to rectify a heart valve issue or defect in the birth to the heart might assist.

A slowing of the heart rate

The first stage in treating atrial fibrillation, also known as atrial flutter, is to slow down the beat of the ventricles to ensure that the heart can pump blood more effectively. Most often, drugs slow the heart’s ventricle. Most often, the first medication that is tried will be one that blocks calcium channels like diltiazem and verapamil which can slow down the transmission of impulses into ventricles (see the table The following list of drugs used to treat arrhythmias). Beta-blockers, like propranolol or atenolol could be prescribed. If you suffer from heart problems, digoxin could be considered.

Restoring the normal heartbeat

Atrial flutter or atrial fibrillation could spontaneously transform into a normal heartbeat. In certain people, the arrhythmias have to be converted into a normal heartbeat ( cardioversion). These include people in who atrial fibrillation or atrial flutter triggers heart failure or other signs of low output from the heart.

In order to restore normal rhythm, because there is a possibility of a blood clot may rupture and trigger a stroke during the transition, precautions are required to avoid blood clots from occurring.

If atrial fibrillation or atrial flutter was present for longer than 48 hours physicians recommend an anticoagulant, such as warfarin for 3-4 weeks prior to trying the conversion. In addition, doctors can prescribe an anticoagulant with a short-acting effect like heparin and also perform echocardiography. If the echocardiogram does not reveal an artery clot it is possible to undergo a conversion process immediately. If the heart’s rhythm has clearly occurred for less than hours, the patient does not require an anticoagulant prior to the conversion. But, the majority of people require an anticoagulant for a minimum of 4 weeks following conversion.

Methods for conversion include

• Electric shocked (synchronized cardioversion)
• Drugs

Electroshock at the heart can be the best method. This electrical stimulation is timed to only be administered at a specific point in the electrical activity of the heart (synchronized cardioversion) to ensure that it doesn’t trigger ventricular fibrillation. Cardioversion can be effective for up to 75 percent of the population.

Certain antiarrhythmic medicines (most often such as amiodarone, flecainide propafenone or procainamide) sotalol – see the table below for Certain Drugs used to treat arrhythmias) could also aid in restoring normal rhythm. But, they can only be effective in 50% to 60% of patients and frequently cause adverse consequences.

The conversion to normal heart rhythm via any means is less likely the longer the arrhythmia is occurred (especially after six months and more) and the bigger the atria get more extensive, and the more severe the heart disease that is underlying. When conversion is successful the likelihood of recurrence becomes extremely high, even when people are taking medication to avoid the recurrence (typically the same drugs that convert the arrhythmia back to regular heartbeat).

Procedures for ablation

In rare instances, when other treatments for atrial fibrillation fail the atrioventricular nerve can be destroyed through the ablation process. Ablation typically involves using extremely high or extremely low temperatures near the tip of a catheter that is inserted in the heart for killing tissues. This procedure blocks conduction of the atria to ventricles, and reduces heart rate. However it is necessary to have a permanently artificial pacemaker is needed to stimulate the ventricles afterwards.

Another kind of ablation procedure eliminates atrial tissue in the vicinity of the veins of the pulmonary system (pulmonary vein separation). This procedure does not affect the atrioventricular node however it is less likely to be effective (60 to 80 percent) as the risk for serious problems is high (1 to five percent). Therefore, this procedure is usually reserved for the most qualified candidates (such as younger individuals with no heart condition that is structural, such as heart valve problems and those with no other options , for instance, people with atrial fibrillation which doesn’t respond to drug therapy, or for those suffering from the condition of heart failure.

For those who suffer from atrial flutter, ablation can be performed to disrupt the flutter circuit of the atrium to permanently restore the normal rhythm. This method is effective for about 90% of patients.

In preventing blood clots

Preventing blood clots (and consequently reducing the risk of stroke) is essential in cases of atrial fibrillation, or flutter has been converted into normal rhythm. A majority of people require measures to prevent clots during long-term treatments. Doctors usually prescribe anticoagulant like warfarin dabigatran or a clotting factor Xa inhibitor (rivaroxaban or apixaban and edoxaban). Patients who are not able to receive an anticoagulant might be prescribed aspirin, but it’s not as effective as warfarin.

Healthy people who experienced only one incident of atrial fibrillation which changed into the normal rhythm (spontaneously or in conjunction with treatment) require anticoagulant therapy for just four weeks. Individuals who have had multiple instances of atrial fibrillation, or atrial flutter or are in these rhythms even after treatment, must take medication to stop blood clots for as long as they are.

Doctors prescribe warfarin and other anticoagulants in patients with one or more risk factors that could lead to stroke. These risk factors include

• Age 65 or over
• High blood pressure
• Diabetes
• Heart failure
• A stroke prior to the event or an Ischemic attack
• Ailment that affects blood vessels
• Being female

Certain people who do not have these risk factors are prescribed aspirin. Others do not receive any treatment to avoid strokes.

Although atrial fibrillation or atrial flutter transforms into a regular rhythm, physicians typically keep the anticoagulant treatment going, usually for the rest of the patient’s life. This treatment for anticoagulation is required as the arrhythmia can be recur without even realizing it. Dangerous blood clots may develop in these instances.