Atrial fibrillation

Heart flutter is often associated with the pleasant feeling of being newly in love. When the heart actually fibrillates, this is called atrial fibrillation and it is a specific type of cardiac arrhythmia. Dr. Alexander Hierl explains how best to respond.

Our heart beats about 60–100 times per minute, that is 80,000 to 150,000 times a day. Its task is to pump blood through the body. What our heart achieves over a life of 70–80 years is an endurance performance unique in nature and technology.

Atrial fibrillation is the most common significant cardiac arrhythmia. In Germany about 1 million people are affected. With increasing age the frequency rises from less than 1% under 60 years to more than 10% over 75 years. That is because diseases that promote atrial fibrillation also increase with age. The most important of these are heart failure, high blood pressure and coronary artery disease. Hyperthyroidism, alcohol use and overweight are also important causes of atrial fibrillation.

Normally the ventricles and atria beat regularly about 60 to 100 times per minute. In atrial fibrillation the atria stand still and only the ventricles still work. This leads to a drop in performance. Patients accordingly report shortness of breath, sweating, dizziness and weakness; existing heart failure can worsen. In addition the sinus node fails as the rhythmic pacemaker, and the heartbeat becomes completely irregular and usually also very fast.

This is then felt as inner restlessness, skipped beats and palpitations. It becomes dangerous if, after several days, blood clots form in the inactive atria and can cause an embolism or a stroke. For this reason blood clotting must be inhibited.

There are many drugs for treating this arrhythmia, but they must be selected carefully and in some cases used with close monitoring. If atrial fibrillation is not yet permanent, cardioversion (drug-based or electrical under brief anaesthesia) can restore regular sinus rhythm. In selected cases ablation or surgery can be the right treatment. If atrial fibrillation is permanent, heart-rate control must be ensured.