Atrial fibrillation is a common arrhythmia in the elderly. Atrial fibrillation can lead to serious complications, causing cerebral embolism, heart failure, etc. The incidence of atrial fibrillation is as high as 7.5% for people over 80 years old. So, with atrial fibrillation, how should we treat it properly?
I will give a few examples of atrial fibrillation treatment:
One is a young patient of mine. After drinking once, he felt extremely panicked when he woke up the next day. He came to the hospital for treatment and found rapid atrial fibrillation, and the patient's blood pressure was low and accompanied by dizziness. Considering that the time for atrial fibrillation was short and no thrombus was found in the relevant examination, electroreplication was performed. As a result, the patient soon returned to normal sinus rhythm .
The second patient is that I was studying at a hospital in a tertiary hospital in Beijing. A director of an emergency department had atrial fibrillation himself. He had frequent attacks before. After visiting the hospital this time, he also considered paroxysmal atrial fibrillation. Because he was an acquaintance, he performed electroreversion directly without strict examination of esophageal ultrasound to eliminate thrombosis. The heart rhythm was reversal. As a result, he suddenly became unconscious and hemiplegic after half an hour. It was because during the reversal, the thrombosis in the atrial fell off and blocked the middle cerebral artery, causing large-scale cerebral infarction.
The third patient is a case of Professor Hu Dayi . A male was 68 years old and had no symptoms of atrial fibrillation. After undergoing three consecutive surgeries such as cryoballoon, radiofrequency ablation, etc., the patient still had frequent atrial fibrillation and paroxysmal attacks, resulting in irritability and anxiety, poor sleep, taking sleeping pills and anti-anxiety drugs. After the continuous attack of atrial fibrillation, he felt asymptomatic.
From these three examples, paroxysmal atrial fibrillation can be reversed, and atrial fibrillation is risky, which can cause cerebral infarction and hemiplegia. Surgical treatment is not omnipotent, and there is a high recurrence rate.
So, how to standardize the treatment of atrial fibrillation?
Atrial fibrillation is divided into three situations. One is paroxysmal atrial fibrillation, with a duration of less than one week, generally referring to less than 48 hours. The risk of this paroxysmal atrial fibrillation is lower; the second is persistent atrial fibrillation, which refers to a duration of more than one week; the third is long-term persistent or permanent atrial fibrillation, which refers to a duration of more than one year.
Most atrial fibrillation is caused by underlying diseases, and common rheumatic heart valve disease, which is less and less with the improvement of living standards; hypertensive heart disease , due to long-term hypertensive , will cause the heart to gradually increase, causing atrial fibrillation; coronary heart disease , long-term chronic myocardial ischemia, causing atrial fibrillation; in addition, such as pulmonary heart disease, cardiomyopathy , hyperthyroidism, etc. can be induced.
If there is atrial fibrillation, you must grasp the treatment principles:
has an acute attack and requires medical treatment in time to prevent hemodynamic disorders and unexpected situations.
For most chronic patients, drug treatment and non-drug treatment are selected in terms of treatment.
Because atrial fibrillation is prone to thrombosis, for paroxysmal atrial fibrillation, it is best to turn into normal sinus rhythm. If the heartbeat is too fast, medication is needed to control the frequency of the heartbeat, which can relieve symptoms such as panic chest tightness .
Because during atrial fibrillation, the heart is mainly in the left atrial atrial appendage. blood circulation forms a vortex, which will form a thrombus. This is an important reason for cerebral stroke and other arteries blockage. Therefore, anticoagulants need to be used to fight the formation of thrombus.
Therefore, drug treatment for atrial fibrillation, including olol drugs, such as bisoprolol, metoprolol, etc., control the number of heartbeats, so that the heartbeats are about 70 times when quiet, and no more than 100 times when slightly active. The specific medication needs to be taken under the guidance of a doctor.
The oldest drug for the selection of anticoagulant drugs is warfarin, but this drug requires monitoring of coagulation function and frequent blood tests for continuous blood tests. Many patients cannot accept it. This drug turned out to be rat poison, and the dosage used is very critical. If too much, it will cause serious bleeding complications, and if less, the anticoagulant effect will not be achieved.New anticoagulants include rivaroxaban, dypigatran, etc. The biggest benefit of this type of drug does not require blood drawing monitoring, and conventional doses can play a good anticoagulant effect. But it is not suitable for patients with valvular surgery.
We talked about the problem of controlling heartbeat and anticoagulation. In terms of converting to normal sinus rhythm, there are radiofrequency ablation and drug reversion methods. amiodarone . Cardiac rhythm level has the effect of reversing, but is very ineffective for permanentness. Specific medications require guidance from a specialist.
radiofrequency ablation can turn atrial fibrillation into sinus rhythm, but the success rhythm is not very high and strict indications are needed. Like the third patient I mentioned, I still had atrial fibrillation after three surgeries. Many patients have only a success rate of one surgery of about 60%-70%, and they need to weigh the pros and cons to choose.
Left atrial appendage blockade is also one of the methods to prevent thrombosis recently. It is effective for some people and requires strict grasp of the indications.
In short, for atrial fibrillation, don’t be nervous or anxious. If there is no symptoms, you don’t need active surgical treatment. Control the heart rate of and well. Pay attention to anticoagulation and prevent thrombosis, and there will be no greater risk.
