When atrial fibrillation or palpitations occur, how should you deal with this unusual heartbeat?

"My heart is pounding, tell me what to do?"

Atrial Fibrillation - My Heart Is Beating

Atrial fibrillation is the abbreviation of "atrial fibrillation". It is the most common pathological arrhythmia in clinical practice, mainly manifested by rapid and ineffective contraction of the atria and rapid ventricular rate. Its incidence rate gradually increases with age. The incidence rate of adults over 20 years old is about 3%. By the age of 55, the incidence rate of atrial fibrillation is expected to be as high as 37%.

Atrial fibrillation – unusual heartbeat sensations

When atrial fibrillation occurs, people often feel palpitations. Some people may experience difficulty breathing, fatigue, dizziness and other discomforts. In severe cases, people may experience low blood pressure, heart failure, syncope, or even shock. Because the atria contract rapidly and ineffectively, blood clots are easily formed in the atria. After the blood clots fall off, they flow to the cerebral blood vessels and cause cerebral infarction. At the same time, the rapid and irregular contraction of the ventricles can cause heart failure and heart failure, and reduce blood perfusion throughout the body. When blood perfusion to the brain is reduced, cognitive impairment and dementia will occur.

What to do when your heart is pounding?

Once you are diagnosed with atrial fibrillation, treatment should start from three aspects: anticoagulation to prevent stroke, control of ventricular rate, and identification of cardiovascular risk factors and complications.

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Anticoagulation for stroke prevention

If you have valvular atrial fibrillation, that is, moderate to severe mitral stenosis or implantation of a mechanical artificial valve, you need to take anticoagulants for a long time. Warfarin is currently recommended.

If you have non-valvular atrial fibrillation (i.e. excluding moderate to severe mitral stenosis and mechanical artificial valves), whether you need to take anticoagulants is mainly based on your age, gender, underlying diseases and other factors to assess the risk of cerebral infarction. The most commonly used thrombosis risk scoring scale is CHA2DS2-VASc, which includes congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and gender.

Atrial Fibrillation Thrombotic Risk Score (CHA2DS2-VASc)

Men with a CHA2DS2-VASC score of 0 and women with a CHA2DS2-VASC score of 1 do not need to take anticoagulant therapy, but anticoagulant therapy is recommended for men with a CHA2DS2-VASC score greater than or equal to 2 and women with a CHA2DS2-VASC score greater than or equal to 3.

Compared with the traditional anticoagulant warfarin, direct oral anticoagulants are currently recommended for non-valvular atrial fibrillation, including apixaban, dabigatran, rivaroxaban and edoxaban. The risk of bleeding should be closely monitored during the use of anticoagulants. For those who cannot take oral anticoagulants for a long time, left atrial appendage occlusion or resection can be considered.

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Controlling ventricular rate

The frequency and rhythm of the heart are controlled mainly through antiarrhythmic drugs, such as beta-blockers, amiodarone, etc., electrical cardioversion therapy or interventional therapy.

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Identify cardiovascular risk factors and comorbidities

Patients with other cardiovascular diseases such as hypertension and coronary heart disease should actively treat the complications. Patients with atrial fibrillation and renal insufficiency should pay special attention.

Perhaps most people would not easily associate atrial fibrillation with renal insufficiency, and even less understand why atrial fibrillation is accompanied by renal insufficiency. In fact, there is a close relationship between the two.

The European Journal of Heart Disease published a study in which researchers used data from the UK Biobank to measure renal function biomarkers, serum cystatin C levels, and conduct Mendelian randomization analysis. The results showed that atrial fibrillation is a causal risk factor for renal impairment.

It should be noted that long-term atrial fibrillation reduces systemic blood circulation and also reduces blood perfusion to the kidneys, leading to renal insufficiency. Anticoagulants are metabolized by the kidneys to varying degrees. Due to reduced drug metabolism, atrial fibrillation patients with renal insufficiency have drug accumulation in the body, which increases the risk of bleeding. Therefore, people with non-valvular atrial fibrillation and chronic renal insufficiency should choose drugs reasonably according to the degree of renal damage when receiving anticoagulant treatment.

If you have mild to moderate renal insufficiency, both warfarin and direct oral anticoagulants can be used, with direct oral anticoagulants being preferred;

If you have severe renal insufficiency, you may consider reducing the dose of warfarin or selectively reducing the dose of direct oral anticoagulants;

If you have end-stage renal disease or are on dialysis, your doctor will often individualize your anticoagulation therapy and carefully consider using warfarin or low-dose apixaban, but dabigatran, rivaroxaban, and edoxaban are contraindicated.

In short, atrial fibrillation is very common in the population, especially in the elderly, and is a common cause of cerebral infarction and heart failure. However, if you take individualized anticoagulation treatment according to your own situation under the guidance of a doctor, the risk of cerebral infarction, heart failure and bleeding will be greatly reduced, your quality of life will be improved, and you will survive with the disease.

▌The source of this article's popular science topic: "Union Medical Journal" review "Progress in the use of oral anticoagulants in patients with non-valvular atrial fibrillation and chronic renal insufficiency"

▌Original author: Li Xin, Liu Lu, Liu Zhihong, Zhao Zhihui, Luo Qin, Zhao Qing

Respiratory and Pulmonary Vascular Disease Diagnosis and Treatment Center, Fuwai Hospital

Li Xin, PhD candidate in Cardiology at Peking Union Medical College

Guidance experts

Professor Liu Zhihong, Respiratory and Pulmonary Vascular Disease Diagnosis and Treatment Center, Fuwai Hospital

Source: Peking Union Medical College Journal

Editor: Liu Yang and Zhao Na

Proofread by Li Na, Li Yule, and Dong Zhe

Producer: Wu Wenming