Atrial fibrillation (AF) is a long-term disease (LTD). Doctors need to know how to deal with patients affected by this heart disease.
AF, which is a severe chronic disorder of the heart rhythm, affects 1% of the population, but from the age of 80, the figure reaches 8%. As the population is growing old, this pathology is affecting more and more patients.
- Very frequent diseaseatrial fibrillation is an anarchistic contraction of the atria, parts of the heart which receive blood.
- Several types of atrial fibrillation:
- Paroxystic: ends in one week, often within 48 hours, repeating;
- Persistent: recurring and requiring a treatment;
- To determine an atrial fibrillation, here are this pathology's associated symptoms :
- Difficulty of breathing (dyspnea),
- Thoracic disturbance,
- Cerebral vascular accident (CVA),
- Transient ischemic attack (TIA).
- Questions to be asked to a suffering patient of AF:
- Former episodes,
- Starting factors of AF,
- Frequency of AF,
- Its duration,
- The way in which the attacks end
- Effects of the treatment,
- Signs of hemodynamic instability (often requiring an emergency hospitalisation),
- Type of AF.
- Examinations are recommended, inter alia:
- ECG (electrocardiogram),
- Confirms the arrhythmia
- Measures the heart rate (HR)
- Searches for another heart pathology
- Thyreostimuline (TSH),
- Transthoracic Echocardiogram (TTE) (if subjacent heart disease suspected or within the framework of a cardioversion),
- Hematologic and biochemical examinations
- Complete blood count.
- Depending on the cases, combine with:
- Chest radiography,
- Transesophageal Echocardiography (TEE),
- Holter ECG,
- Cardiac stress test.
- The goal of therapeutic management:
- To decrease functional disturbance,
- To prevent thromboembolic events,
- To avoid the aggravation of a possible latent heart disease,
- To work out a strategy of management.
Prevent thromboembolic accidents with a antithrombotic treatment
- In case of AF:
- AVK: high-risk patients,
- Aspirin: low-risk patients,
- AVK or aspirin according to the case: patients with risk moderate.
- In case of a cardioversion:
- Patient in AF for more than 48 H: 3 weeks before and one month afterwards, AVK;
- Patient in AF for less than 48 H: anticoagulant treatment, according to the risks.
Treating the rhythm disorder
- To control HR, for permanent or persistent AF: beta-blockers and/or calcium antagonists bradycardia .
- To control the heart rhythm:
- Cardioversion (persistant AF)
- Drug treatment to maintain the sinus rhythm (amiodarone, flecainide, propafenone, sotalol, even cibenzoline, disopyramide and Quinidine )
- Other treatments
- Endocavitary ablation of the AF
- Operative treatments
Follow-up of a patient suffering from AF
- Follow-up allows assessing :
- Thromboembolic risks
- Benefit and risks of anticoagulant treatment
- Benefit and risks of antiarythmic treatment.
A consultation every 6 months is recommended, questioning the patient (life, symptoms, treatment...). Complementary examinations can be carried out.
Atrial Fibrillation Association (AFA)
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Prise en charge de la fibrillation auriculaire