Fibrillation (blinking) of auricles

Description:

Fibrillation of auricles (FP, synonym: a ciliary arrhythmia) — a kind of a supraventricular tachyarrhythmia with chaotic electric activity of auricles with a frequency of impulses of 350 — 700 a minute that excludes a possibility of their coordinate reduction. It is one of the most widespread arrhythmias. Often FP can be is found out during the determining of pulse and detection that heartbeat happen to an irregular interval. However the final diagnosis is exposed on an ECG signs: lack of teeth of P which are present at a normal heart rhythm and characterize electric activity at reduction of auricles. Instead of them there is a set of waves of f which characterize fibrillation (that is blinking, trembling) auricles.

Frequency of reductions of ventricles at a ciliary arrhythmia depends on electrophysiologic properties of an atrioventricular node, level of activity of a sympathetic and parasympathetic nervous system, and also effect of medicines. The risk of emergence of FP increases with age. This arrhythmia is quite often connected with organic heart diseases. The disturbance of a hemodynamics and tromboembolic episodes connected with fibrillation of auricles lead to substantial increase of incidence, mortality and cost of medical care. The chronic current of FP leads to increase in risk of death approximately by 1,5 — 2 times.

Reasons of fibrillation (blinking) of auricles:

Fibrillation of auricles — one of the most widespread arrhythmias. This disease suffer from 1 — 2% of the general population, and this indicator grows in recent years and it will be probable to increase in the next 50 years in connection with aging of the population. Number of sick FP in the USA estimate more than at 2,2 million people, in the countries of the European Union — 4,5 million. According to a framingemsky research, the risk of development of FP in men and women is more senior than 40 years makes 26 and 23% respectively. FP comes to light approximately at 6 — 24% of patients with a stroke. Prevalence of FP also increases with age, making about 8% at patients 80 years are more senior.
Fibrillation of auricles is connected with various cardiovascular diseases which promote development and maintenance of arrhythmia. Treat them:
Arterial hypertension;
Heart failure of the II—IV functional class on NYHA;
The acquired defects (mitral are more often) heart valves;
Inborn heart diseases (defect of an interatrial partition, the only ventricle, Mastard's operation at a transposition of large arteries, Fontaine's operation);
Cardiomyopathy (especially dilatatsionny);
Coronary heart disease — occurs at 20% of patients with FP;
Inflammation (pericardis, myocarditis);
Heart tumor (myxoma, angiosarcoma).

About 30 — 45% of cases of paroxysmal FP and 20 — 25% of cases of persistent FP arise at young faces without heart pathology (the isolated FP form).

Also there are risk factors which are not connected with heart pathology. Carry a hyper thyroidism, obesity, a diabetes mellitus, HOBL, an apnoea in a dream to them, a chronic disease of kidneys. Existence of FP at close relatives of the patient in the anamnesis can increase risk of development of FP. The research of more than 2200 patients with FP showed that 30% from them have parents with FP. Various genetic mutations can be responsible for development of FP.

FP can also develop at excessive alcohol intake (a syndrome of festive heart), surgery on heart, blow of electric current. At such states treatment of a basic disease often leads to normalization of a rhythm. Risk factor of FP is HIV infection.

Symptoms of fibrillation (blinking) of auricles:

Depending on expressiveness of hemodynamic disturbances the clinical picture varies from an asymptomatic current before heavy displays of heart failure. At a paroxysmal form episodes of fibrillation of auricles sometimes proceed asymptomatically. But usually patients feel a cardiopalmus, discomfort or thorax pains. Also there is heart failure which is shown by weakness, dizziness, short wind or even preunconscious states and faints. The attack of FP can be followed by the speeded-up urination that is caused by the increased production of atrial natriuretic peptide.

Pulse is arrhythmic, there can be a deficit of pulse (ChSS on a heart top more, than on a wrist) because at a frequent ventricular rhythm the stroke output of a left ventricle is insufficient for creation of a peripheral venous wave. At patients from asymptomatic FP or with the minimum manifestations of FP the thromboembolism (is more often in the form of a stroke) can become the first display of a disease.

Diagnosis:

In the presence of characteristic complaints collect the anamnesis of a disease for the purpose of definition of its clinical form (for example, find out the beginning of the first attack or date of detection), the reason and risk factors, efficiency of antiarrhytmic drugs for this patient at the previous attacks.

Apply the standard ECG in 12 assignments to diagnosis of FP. At the same time find the ECG signs following: lack of teeth of P, wave of fibrillation of f with a different amplitude and a form, absolutely unequal intervals of RR (the QRS complexes are usually not changed). Also determine the associated heart pathology by an ECG (a myocardial infarction in the past, other arrhythmias, etc.). At suspicion of a paroxysmal form and lack of an ECG during an attack carry out holterovsky monitoring.

Besides, carry out an echocardiography for detection of organic pathology of heart (for example, pathologies of valves), the sizes of auricles. Also determine by this method blood clots in ears of auricles, however for this purpose transesophageal Ekho-KG informativny transthoracic. At for the first time the revealed FP, difficulties of control of a rhythm of ventricles or an unexpected recurrence after cardioversion estimate function of a thyroid gland (level of thyritropic hormone in blood serum).

Treatment of fibrillation (blinking) of auricles:

In treatment of FP there are 2 types of strategy:
The strategy of control of a rhythm — by means of cardioversion recover a normal sinoatrial rate and then carry out prevention of a recurrence;
The strategy of control of ChSS — preservation of FP with a medicinal urezheniye of frequency of reductions of ventricles.

Also for prevention of thromboembolisms carry out anticoagulating therapy.