13 March 2019 Author : João Primo In Portugal, its prevalence is 2.5%, according to a study carried out over a short period of time and involving 10,000 people aged over 40 from all regions of the country. The prevalence of atrial fibrillation increases greatly with age . This increase becomes more marked with age: after the age of 50, the incidence doubles with each decade of life. It therefore takes on epidemic aspects in our civilisation, where life expectancy continues to increase. What are the risk factors associated with atrial fibrillation? In addition to becoming more likely with age, atrial fibrillation is associated with various concomitant diseases such as: High blood pressure; Diabetes; Obesity; Sleep apnoea; Heart failure; Valvular heart disease; Coronary disease; Smoking. How does atrial fibrillation become apparent? The spectrum of clinical manifestations is very varied, and can involve irregular and very symptomatic palpitations. These affect patients in the form of a violent outburst (with severe seizures) and require repeated visits to hospital emergency departments. On the other hand, the condition sometimes evolves quietly and may not be noticed , remaining undiagnosed until a complication develops. What are the risks associated with atrial fibrillation? However it manifests itself, the risk of stroke is 5 times greater with atrial fibrillation. Mortality in patients with atrial fibrillation is twice that of people with a normal heart rhythm, known as sinus rhythm. The relationship between atrial fibrillation and dementia syndromes is also well demonstrated. What is the best treatment for atrial fibrillation? The first priority for treatment is the reduction of thromboembolic risk factors , with the use of oral hypocoagulants recommended for all patients at increased risk of stroke. Cardiovascular risk tables make it possible to estimate risk factors for each patient and to exclude only those with low risk from treatment. The use of new oral anticoagulants in these patients is currently preferred. These are associated with greater, more constant protection , as well as a lower risk of intracranial bleeding . Moreover, they do not require periodic monitoring. The second treatment priority is to maintain the sinus rhythm , which is achieved by using antiarrhythmic drugs or by catheter ablation . Achieving sustained sinus rhythm can be a complicated task. Therefore, it is often necessary to choose between controlling heart rate with specific drugs alone , or by using pacemakers . Pacemakers are considered an imperfect solution, but together with oral hypocoagulation they may be appropriate in more elderly patients. Antiarrhythmic drugs vs catheter ablation Antiarrhythmic drugs are not highly effective, and may be responsible for proarrhythmic effects. As such, they may therefore be responsible for the emergence of new arrhythmias, which can often be more serious, as well as other side effects. Catheter ablation has been shown to be more effective in maintaining sinus rhythm. Therefore, it is recommended for patients with relapsed atrial fibrillation after use of an antiarrhythmic, or as first choice in selected cases. What is the procedure for catheter ablation? Patients should be referred in good time to an electrophysiology centre with experience in ablation of atrial fibrillation: that is, as soon as the procedure is indicated. Treatment should not be delayed, because ablation is less successful at later stages of the disease. In fact, when atrial fibrillation persists, changes in atrial structure such as dilation and fibrosis can take place. They are preceded by electrical and ultrastructural changes , which become irreversible . At an early stage, electrical stimuli that can be suppressed by ablation are predominant. Recent studies have shown that the ablation of atrial fibrillation not only controls symptoms , but can also contribute to a reduction in mortality, stroke risk and dementia. The prognosis for patients with atrial fibrillation who have undergone catheter ablation and in whom it is possible to maintain the sinus rhythm is identical in all ways to people without the disease. In addition, their results are superior to those of patients who have not undergone ablation. In summary, the ablation of atrial fibrillation is an effective treatment , which: Enables conversion to a sustained normal heart rate; Leads to a reduction in the damaging effects of cardiac dysrhythmia, which is without question a modern epidemic. At the hospitals and clinics of the Hospital da Luz network, you can find cardiologists who specialise in the diagnosis and treatment of heart disease. Meet the cardiology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
