Treatment and prognosis for permanent atrial fibrillation. Atrial fibrillation: symptoms, diagnosis, treatment ICD 10 code for paroxysmal fibrillation

February 03, 2018 No comments

Sometimes the electrical signals generated by the heart can become inconsistent. In atrial fibrillation, many parts of the atria, the two upper chambers of the heart, begin to generate uncoordinated electrical signals. Electrical impulses cause an irregular, erratic and unnaturally fast heartbeat. According to statistics, about 1 million Russians have atrial fibrillation, making it one of the most common types of arrhythmias (abnormal heart rhythms) and a serious disorder.

Signs and symptoms of atrial fibrillation

An abnormal heart rhythm is a change in either the speed or rhythm of the heartbeat. An arrhythmia can cause the heart to beat too slowly, or too quickly or irregularly. When the heart beats too slowly, too little blood is pumped to the rest of the body. When the heart beats too fast, it cannot fill completely to fully supply the body with the necessary volume of blood required to function properly.

A slow heart rate is called. Fast heart rhythms are called.

The heart consists of four chambers. The upper chambers, called the atria, receive blood. The lower chambers, called ventricles, pump blood from the heart to the rest of the body. Working together, the chambers of the heart move vital blood throughout the body.

There are several types of abnormal heart rhythms, some occur in one of the chambers called the atria, others occur in the ventricles and are called ventricular arrhythmias.

Atrial fibrillation may cause the following symptoms:

Chest pressure or pain;
Fainting, loss of consciousness;
Fatigue;
dizziness;
Palpitations that can be heard in the chest;
Hesitant breathing.

Diagnosis of atrial fibrillation

If your healthcare provider suspects that you have an arrhythmia, they will order one or more of the following diagnostic tests and tests to determine the source of your symptoms.

Electrocardiogram - An electrocardiogram (ECG or EKG) is a diagnostic method that records the electrical activity of the heart. Small electrodes are placed on the person's chest, arms and legs and connected by electrocardiograph wires. The electrical impulses generated by your heart are converted into a wavy line on a strip of moving paper, allowing doctors to determine the pattern of electrical current in the heart and diagnose arrhythmias and heart problems.

For ECG lead methods, see.

Daily ECG monitoring using a Holter monitor is a small portable machine that is worn by the subject for 24 hours. This allows continuous recording of an ECG while a person is engaged in normal daily activities. The patient is asked to keep a diary about all the actions performed and symptoms observed. The Holter monitor can detect abnormal heart rhythms (arrhythmias) that may not be visible with a standard ECG, which is recorded for only a few seconds.

A cardiac stress test, a test performed during exercise under stress (treadmill), allows doctors to record electrical activity in the heart that may not occur at rest.

The cardiac event recorder is a small, portable transtelephone monitor that can be used for several weeks. This type of recorder is useful for patients who experience infrequent symptoms. The device makes a two-minute recording into its built-in memory, which is constantly overwritten. When the patient experiences symptoms, he presses the “record” button on the monitor, which stores a correlation strip of ECG material. The recording is sent automatically to a 24-hour monitoring station and sent to a computer or fax directly to the requesting physician.

Magnetic Field Imaging – Magnetic source imaging (MSI) is used as an overlay to magnetic resonance imaging (MRI). The device senses weak magnetic fields generated by the heart muscle and localizes the arrhythmia non-invasively to save time during invasive testing.

Testing cardiac activity during bending. This type of diagnosis is used to identify fainting or other conditions (vasovagal syncope) by attempting to reproduce episodes of fainting. A person bends vertically up to 60 degrees on a special table for a certain period of time while continuously recording an ECG and blood pressure.

Electrophysiological studies (EPS) - the study allows doctors to obtain more accurate, detailed information and, in most cases, immediately perform treatment (for example, catheter ablation).

Treatment of atrial fibrillation

Depending on the type and severity of the arrhythmia, as well as the results of diagnostic tests performed, including electrophysiological studies, there are several treatment options. The attending physician decides which one is most suitable for the patient after consulting with the patient.

Drug therapy

Certain antiarrhythmic drugs modify the electrical signals in the heart and help prevent abnormal rhythms, such as irregular or rapid heart rhythms.

Repeated electrophysiological study

To ensure that the drug is working properly after two or more days in the hospital, the patient may be referred for a repeat electrophysiological study. The doctor's job is to find the medicine that is best for the patient.

Implantable device (pacemaker)

Implantable devices or pacemakers are used to treat slow heart rhythms. These are small devices that are implanted under the skin under the collarbone and connected to a probe electrode inserted into the heart cavity through a venous catheter. A pacemaker provides a small electrical impulse to stimulate the heart when it is beating too slowly.

Radiofrequency catheter ablation

Ablation of a radiofrequency catheter destroys or damages parts of the electrical pathways that cause arrhythmias, allowing it to help patients who have not responded to drug treatment or who choose not to take medication.

Catheter ablation involves puncturing (piercing) under anesthesia with a tiny metal tip with a catheter through a vein or femoral artery in the leg and inserting electrodes into the heart cavity. Fluoroscopy, which allows cardiologists to view the catheter as it passes through the vessel on a monitor, provides a road map. Other catheters, which are usually placed through the neck, contain electrical sensors to help locate the area causing the short circuit. A metal-tipped catheter is then maneuvered over each problem area, and radiofrequency waves—the same energy used for radio and television broadcasts—gently burn off each unwanted strand of tissue. When catheter ablation was first performed, direct shocks were used, but researchers subsequently developed the use of radiofrequency waves, a more precise form of energy. With radiofrequency catheter ablation, patients typically leave the hospital after one day.

For diseases such as Wolff-Parkinson-White syndrome, in which thin tissue creates an additional electrical path between the upper and lower chambers of the heart, radiofrequency ablation can provide effective treatment. Ablation has become a treatment option for patients with the disorder who respond poorly to drug therapy or are prone to rapid heart rate.

Even for arrhythmias that can be controlled with medication, it has been found that it is time and cost effective because it does not require hospitalization. Catheter ablation is also a good treatment option for older patients who are prone to experience serious side effects from drug therapy and women of childbearing age who cannot take medications due to potential risks to the health of the fetus.

Studies have demonstrated that catheter ablation is more effective than drug therapy or surgery, and patients who undergo this procedure also experience significant improvements in quality of life. A recent study of nearly 400 patients with dangerously fast heart rates (nearly a third of whom were considered candidates for open-heart surgery) found that one month after the ablation procedure, 98 percent no longer required medication, and 95 percent reported that their overall health has improved noticeably. The study also showed an improvement in the ability of those undergoing the study to work and perform physical activities.

Cardioversion of atrial fibrillation

Internal cardioversion to convert atrial fibrillation and atrial flutter to normal sinus rhythm was developed by scientists in 1991. Internal cardioversion is an electric shock (1 to 10 joules) delivered inside the heart through two catheters inserted into a vein through the thigh and a small electrode pad placed on the chest. This procedure is performed by an electrophysiologist.

During internal cardioversion, short-acting sedatives are administered to calm the patient. Atrial flutter is now successfully treated with a radiofrequency catheter; but treatment to restore atrial fibrillation to sinus rhythm has been the traditional use of medications and external cardioversion. External cardioversion is the delivery of high energy shocks of 50 to 300 joules through two defibrillator pads attached to the chest. In some cases, external cardioversion is ineffective because the electrical current must first pass through the chest muscle and skeletal structures before reaching the heart. Internal cardioversion was performed when medications and external cardioversion failed to restore the patient's rhythm to normal sinus rhythm.

The less time a patient has with atrial fibrillation, the easier it is to return to a normal rhythm, but even patients with long-term chronic atrial fibrillation can successfully return to a normal heart rhythm using internal cardioversion.

Implantable cardioverter defibrillator

An implantable cardioverter defibrillator is a device for patients who have life-threatening fast heart rhythms. It is slightly larger than a pacemaker and is usually implanted under the skin under the collarbone. It is connected to a defibrillation wire located inside the heart through a vein. It is able to suppress an electrical shock to the heart when it detects the heart rate is too fast. It is also able to stimulate the heart when its rhythm is too slow.

Biventricular pacing

Recently, a new type of pacemaker has been used that uses both ventricles of the heart to coordinate their contraction and improve their pumping abilities.

According to trial results, cardiac resynchronization therapy:

Increases the number of daily activities that the patient can perform without symptoms of heart failure;
Increases the performance of patients with heart failure, measured by the distance they can walk in 6 minutes;
Improves overall quality of life as measured by standard measurements;
Promotes changes in cardiac anatomy to improve cardiac function;
Reduces the number of days patients stay in the hospital and the total number of hospitalizations.

CRT devices work by simultaneously conducting the left and right ventricles, which resynchronizes muscle contractions and improves the efficiency of a weakened heart. Normally, the heart's electrical conduction system delivers electrical impulses to the left ventricle in a highly organized pattern of contractions that pump blood out of the ventricle very efficiently. In systolic heart failure caused by an enlarged heart (dilated cardiomyopathy), this electrical coordination is lost. Uncoordinated function of the heart muscle leads to ineffective ejection of blood from the ventricles.

Atrial fibrillation ICD 10

ICD International Classification of Diseases (ICD-10) code I48

Atrial fibrillation or atrial fibrillation ICD 10 is the most common type of arrhythmia. For example, in the United States, approximately 2.2 million people suffer from it. They often experience ailments such as fatigue, lack of energy, dizziness, shortness of breath and rapid heartbeat.

How dangerous is their future and is it possible to cure such a disease?

What is the danger of atrial fibrillation ICD 10?

Many people live with atrial fibrillation for a long time and do not feel much discomfort. However, they do not even suspect that instability of the blood system leads to the formation of a blood clot, which, when it enters the brain, causes a stroke.

In addition, the clot can enter other parts of the body (kidneys, lungs, intestines) and provoke various types of abnormalities.

Atrial fibrillation, ICD code 10 (I48) reduces the heart's ability to pump blood by 25%. In addition, it can lead to heart failure and heart rate fluctuations.

How to detect atrial fibrillation?

For diagnosis, specialists use 4 main methods:

Electrocardiogram.
Holter monitor.
A portable monitor that transmits necessary and vital data about the patient’s condition.
Echocardiography

These devices help doctors know if you have heart problems, how long they last, and what causes them.

There is also something called, you need to know what it means.

Treatment of atrial fibrillation

Specialists select a treatment option based on the examination results, but most often the patient must go through 4 important stages:

Restore normal heart rhythm.
Stabilize and control heart rate.
Prevent the formation of blood clots.
Reduce the risk of stroke.

In most cases, the doctor prescribes special anticoagulants, drugs that prevent thrombus formation, as well as antiarrhythmic drugs to restore normal rhythm.

In addition to taking your medications, you may want to change some of your habits:

If you notice that heart problems are associated with a certain activity, you should stop doing it.
Stop smoking!
Limit your alcohol intake. Moderation is key. Ask your doctor to formulate or select a safe dose of alcohol for you.
According to the specification - atrial fibrillation ICD 10 - drinks such as coffee, tea, cola and over-the-counter drugs containing caffeine are responsible for many heart-related symptoms. If possible, eliminate them from your diet or reduce your usual dose.
Beware of cough and cold medications. They contain a component that causes spontaneous heart rhythms. Read labels and ask your pharmacist to find the right and safe medicine for you.

Atrial fibrillation (AF)- chaotic, irregular excitation of individual atrial muscle fibers or groups of fibers with loss of mechanical atrial systole and irregular, not always complete excitations and contractions of the ventricular myocardium. Clinical characteristic: atrial fibrillation.

Code according to the international classification of diseases ICD-10:

I48 - Atrial fibrillation and flutter

Atrial fibrillation: Causes

Etiology

Rheumatic heart defects. IHD. Thyrotoxic heart. Cardiomyopathies. Arterial hypertension. Myocardial dystrophy. COPD TELA. Condition after coronary artery bypass surgery. Vagotonia. Hypersympathicotonia. Hypokalemia. Idiopathic AF. Combinations of etiological factors.

Classification

First identified. Paroxysmal - lasting up to 7 days, self-limiting. Persistent - usually lasts more than 7 days, does not stop on its own. Permanent form: cardioversion (CV) is ineffective or not indicated. According to the frequency of ventricular responses. Tachysystolic form is AF with a ventricular activation rate of more than 90 per minute. Normosystolic form ¾ with a ventricular contraction frequency of 60-90 per minute. Bradysystolic form is AF with a ventricular contraction rate of less than 60 per minute. Special forms. AF in Wolff-Parkinson-White syndrome. AF with weak sinoatrial node syndrome (brady-tachycardia syndrome). AF with complete AV block (Frederick's syndrome). According to ECG parameters. Large-wave AF - amplitude of ff waves is more than 0.5 mV, frequency 350-450 per minute. QRS complexes are not the same in shape. Medium-wave AF - the amplitude of ff waves is less than 0.5 mV, frequency 500-700 per minute. Shallow wave - difficult to distinguish ff waves.

Atrial fibrillation: Signs, Symptoms

Clinical manifestations

They range from moderate weakness, palpitations, shortness of breath, dizziness and fatigue to severe heart failure, angina attacks, and fainting. The most pronounced subjective sensations are with diastolic myocardial dysfunction, as well as tachysystole or bradysystole.

Atrial fibrillation: Diagnosis

Differential diagnosis

Atrial flutter - lower frequency, contractions more regular. Atrial multifocal paroxysmal tachycardia is characterized by synchronous depolarization of the atria, but the pacemakers are two or more ectopic foci in the atria, alternately generating impulses. Atrial polytopic tachycardia is often observed in severe lung diseases, intoxication with cardiac glycosides, coronary heart disease and pulmonary embolism. The variability of the P wave and unequal R-R intervals are characteristic.

Atrial Fibrillation: Treatment Methods

Treatment

Treatment tactics. Assessment of circulatory status. Conducting electropulse therapy (EPT) for emergency indications. Pharmacological CV - in the absence of urgent indications or necessary conditions for EIT. Pharmacological control of heart rate before CV and with permanent AF. If AF lasts for more than 2 days, indirect anticoagulants are prescribed for 3-4 weeks before and after CV (with the exception of patients with idiopathic AF under 60 years of age). Prevention of relapses of AF.

Restoration of sinus rhythm— contraindications: . The duration of AF is more than 1 year - the unstable effect of CV does not justify the risk of its implementation. Atriomegaly and cardiomegaly (mitral valve disease, dilated cardiomyopathy, left ventricular aneurysm) - CV is performed only for urgent indications. Bradysystolic form of AF - after elimination of AF, sick sinoatrial node syndrome or AV block is often detected. Presence of blood clots in the atria. Uncorrected thyrotoxicosis.

Indications: AF with signs of increasing heart failure, a sharp drop in blood pressure, and pulmonary edema.

Method of implementation - see Electrical cardioversion.

The prognosis is elimination of AF in 95% of cases.

Complications of CV. Thromboembolism during prolonged paroxysm of AF (for 2-3 days or more) due to the formation of intraatrial thrombi (so-called normalization thromboembolism). Before electrical CV (as well as before pharmacological) if AF lasts more than 2 days, a 3-4 week course of therapy with indirect anticoagulants is recommended to prevent thromboembolism. Transesophageal echocardiography performed before EIT allows one to exclude a thrombus located in the left atrial appendage (the most common location of intra-atrial thrombi) and to conduct early CV with the administration of heparin, followed by the prescription of indirect anticoagulants for 3-4 weeks. Atrial asystole - see Atrial asystole.

Pharmacological CV most effective for early restoration of sinus rhythm (duration of AF 7 days or less). The administration of antiarrhythmic drugs should be carried out under constant ECG monitoring against the background of correction of hypokalemia and hypomagnesemia.

Procainamide 10-15 mg/kg IV, infusion at a rate of 30-50 mg/min, see Atrial flutter. In case of renal failure, the dose of the drug is reduced.

Propafenone 2 mg/kg IV over 5-10 minutes. Orally 450-600 mg at once or 150-300 mg 3 times a day for 1-2 weeks. Indicated in the absence or minimally expressed structural changes in the myocardium.

Amiodarone 5 mg/kg IV drip over 10-15 minutes (rate 15 mg/min) or 150 mg over 10 minutes, then either infusion 1 mg/kg over 6 hours, or orally 30 mg/kg (10-12 tablets) once, or 600-800 mg per day for 1 week, then 400 mg per day for 2-3 weeks. Indicated for patients with reduced myocardial contractile function.

A combination of quinidine 200 mg orally 3-4 times a day with verapamil 40-80 mg orally 3-4 times a day is effective. Sinus rhythm is restored in 85% of patients on days 3–11.

Heart rate control with a permanent form of AF and before CV: the choice of drug is determined by the underlying pathology (thyrotoxicosis, myocarditis, MI, etc.), as well as the severity of heart failure.

Verapamil. It is especially indicated for concomitant COPD and peripheral arterial disease. Arterial hypotension may develop. Combination with IV b-blockers is contraindicated. Schemes: . IV 5-10 mg over 2-3 minutes, if necessary, repeat after 30 minutes with another 5 mg IV, the initial effect can be maintained by infusing the drug at a constant rate of 0.005 mg/kg/min. orally 40-80-160 mg 3 times a day.

Diltiazem - 25 mg IV over 2-3 minutes or IV drip at a rate of 0.05-0.2 mg/min. Orally 120-360 mg per day.

B - Adrenergic blockers. Indicated for hypersympathicotonia, thyrotoxicosis. Arterial hypotension may develop. Drugs: propranolol IV slowly over 5-10 minutes 1-12 mg under blood pressure control or metoprolol 5-15 mg IV. Orally 20-40-80 mg of propranolol 3-4 times a day.

Cardiac glycosides are indicated for persistent AF, especially for AF with reduced ventricular systolic function; Contraindicated in the presence of Wolff-Parkinson-White syndrome. Fast saturation rate. Digoxin 0.5 mg IV over 5 minutes, repeat the dose after 4 hours, then 0.25 mg twice with an interval of 4 hours (total 1.5 mg in 12 hours). Digoxin 0.5 mg IV over 5 minutes, then 0.25 mg every 2 hours (4 times). With the development of intoxication with cardiac glycosides - solution of potassium chloride intravenously, see Intoxication with cardiac glycosides. Average saturation rate. Intravenous infusion of 1 ml of 0.025% solution of digoxin (or 1 ml of 0.025% solution of strophanthin K) and 20 ml of 4% solution of potassium chloride in 150 ml of 5% solution of glucose at a rate of 30 drops/ min daily. Digoxin first 0.75 mg orally, then 0.5 mg every 4-6 hours. The average dose for saturation is 2.5 mg.

If monotherapy with digoxin, beta-blockers and calcium channel blockers is ineffective, various combinations of them should be used. When verapamil is combined with digoxin, the level of the latter in the blood may increase significantly; the dose of digoxin should be reduced.

Treatment of AF due to Wolff-Parkinson-White syndrome— see Wolff-Parkinson-White syndrome.

Relapse Prevention

Selection of doses of antiarrhythmic drugs (amiodarone, quinidine, procainamide, etacizine, propafenone, etc.) with monitoring of hemodynamic parameters and ECG. Long-term use of antiarrhythmic drugs, especially subclass Ic, for the prevention of AF increases mortality in patients with post-infarction cardiosclerosis and impaired myocardial contractile function (see Cardiac Arrhythmias).

Treatment of the underlying disease.

Elimination of factors that provoke arrhythmia, such as psycho-emotional stress, fatigue, stress, drinking alcohol, coffee and strong tea, smoking, hypokalemia, viscero-cardiac reflexes in diseases of the abdominal organs, anemia, hypoxemia, etc.

Surgical treatment

used for severe clinical manifestations and ineffectiveness of drug therapy. An alternative method is radiofrequency catheter destruction of the atrioventricular node with implantation of a permanent pacemaker (if heart rate control with pharmacological drugs or severe adverse reactions is ineffective). Radiofrequency destruction of the mouths of the pulmonary veins in AF, caused by the presence of foci of automatism in this area. Implantation of atrial defibrillators that automatically detect and eliminate attacks of AF by generating an electrical impulse. Open “corridor” and “labyrinth” operations, as well as isolation of the mouths of the pulmonary veins, are usually performed in combination with other open-heart interventions (valve replacement, etc.). In a small number of clinics, these same procedures are performed endovascularly.

Complications

Cardiogenic embolic stroke. Embolism of peripheral arteries. Bleeding during anticoagulant therapy.

Course and prognosis

The risk of stroke is small with long-term anticoagulant therapy. AF increases the risk of death from cardiovascular disease.

Synonym. Atrial fibrillation.

Abbreviations

FP - fibrillation atria. EIT - electric pulse therapy. CV ¾ cardioversion.

ICD-10 . I48 Fibrillation and atrial flutter

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Atrial fibrillation is a disorder of normal heart rhythm, which is characterized by rapid, erratic excitation and contraction of the myocardium. I 49.0 – according to ICD 10, the code for atrial fibrillation, which belongs to class IX “Diseases of the circulatory system”.

Normally, in a healthy person, with each contraction of the heart, the atria should first contract, and then the ventricles. Only in this way is it possible to adequately ensure hemodynamics. If this rhythm is disturbed, arrhythmic and asynchronous contraction of the atria occurs, and the functioning of the ventricles is disrupted. Such fibrillations lead to exhaustion of the heart muscle, which can no longer work effectively. Restrictive and then dilated cardiomyopathy may develop.

Heart rhythm disturbances in ICD 10 are coded as follows:

I 49.0 – “Ventricular fibrillation and flutter”;
I 49.1 – “Premature contraction of the ventricles”;
I 49.2 – “Premature depolarization emanating from the junction”;
I 49.3 – “Premature atrial depolarization”;
I 49.4 – “Other, unspecified premature reductions”;
I 49.5 – “Sick sinus syndrome”;
I 49.7 – “Other specified heart rhythm disturbances”;
I 49.8 – “Heart rhythm disturbances, unspecified.”

In accordance with the established diagnosis, the necessary code is indicated on the title page of the medical history. This encryption is the official and uniform standard for all medical institutions; it is used in the future to obtain statistical data on the prevalence of mortality and morbidity from specific nosological units, which has prognostic and practical significance.

Reasons for the development of rhythm pathology

Atrial fibrillation can occur for various reasons, but the most common are:

congenital and acquired heart defects;
infectious myocarditis (bacterial, viral, fungal heart disease);
IBS atrial fibrillation (usually as a serious complication of acute myocardial infarction);
hyperproduction of thyroid hormones - thyroxine and triiodothyronine, which have an inotropic effect;
drinking large amounts of alcohol;
as a consequence of surgical interventions or invasive research methods (for example, fibrogastroduodenoscopy);
arrhythmias after strokes;
when exposed to acute or chronic stress;
in the presence of dysmetabolic syndrome - obesity, arterial hypertension, diabetes mellitus, dyslipidemia.

Attacks of arrhythmia are usually accompanied by a feeling of interruptions in the heart and an arrhythmic pulse. Although often a person may not feel anything, in such cases the diagnosis of pathology will be based on ECG data.

Consequences of arrhythmia

Atrial fibrillation in ICD 10 is quite common and has a poor prognosis, subject to inadequate monitoring and treatment. The disease can be complicated by the formation of blood clots and the development of chronic heart failure.

Arrhythmia is especially dangerous in coronary heart disease, arterial hypertension and diabetes mellitus - in these cases, thromboembolism can lead to cardiac arrest, heart attack or stroke.

Heart failure can develop quite quickly and manifest itself as hypertrophy of the myocardial walls, which will aggravate existing ischemia. Arrhythmia in ICD 10 is a common complication of acute myocardial infarction, which can be a direct cause of death.

The above facts indicate the seriousness of the disease and show the need for constant and correct therapy. All kinds of antiarrhythmic drugs, potassium-containing drugs, and antihypertensive drugs are used for treatment. Great importance is given to taking anticoagulants and antiplatelet agents. Warfarin and acetylsalicylic acid are used for these purposes - they prevent the development of blood clots and change the rheology of the blood. It is very important to establish the primary cause of the development of atrial fibrillation and block its action in order to prevent all sorts of complications.

Content

A synonym for the concept of “atrial fibrillation” is atrial fibrillation. This is one of the common forms of heart rhythm disturbances. Patients can live with this pathology without experiencing any subjective sensations. This is dangerous, since atrial fibrillation can lead to the development of thromboembolism and thromboembolic syndrome. Paroxysmal fibrillation is variable in nature - attacks last from a few seconds to a week, i.e. continue inconsistently. The disease is treated with medications and, in more severe cases, with surgery.

What is paroxysmal atrial fibrillation?

In medicine, atrial fibrillation refers to uncoordinated excitation of the atrial myocardium up to 350–700 times per minute without their full contraction. Depending on the specific frequency indicator, the term “atrial fibrillation” refers to two forms of atrial arrhythmias:

Atrial fibrillation. With it, high-frequency impulses propagate chaotically throughout the myocardium. Only individual fibers contract extremely quickly and uncoordinatedly.
Atrial flutter. In this case, the heart muscle fibers contract more slowly compared to fibrillation (flicker) - up to 200–400 times per minute. The atria still work, but only a portion of their impulses reach the ventricular myocardium. As a result, they work slower. Hemodynamic disturbances with this type of fibrillation are less significant.

The impulses do not affect all the muscle fibers of the heart, which causes disruption of the functioning of individual heart chambers. This form of rhythm disturbance accounts for 2% of all types of arrhythmias. There are several types of atrial fibrillation:

newly identified – characterized by the first occurrence in life, regardless of duration and severity;
paroxysmal (variable) - doctors detect it if disruptions in the heart function last no more than a week;
persistent - this form does not end spontaneously within a week and requires drug treatment;
long-term persistent – lasts more than 1 year even with the chosen method of rhythm correction;
constant - characterized by a chronic course in which attempts to restore the rhythm were unsuccessful.

Attacks of paroxysmal fibrillation often stop within 2 days. When rhythm disturbances persist for more than a week, permanent atrial fibrillation is diagnosed. Paroxysm of atrial fibrillation has a separate code according to ICD-10 - I 48.0. It is considered the initial stage because if left untreated it leads to chronic heart rhythm disturbances.

Reasons

Doctors note that paroxysmal atrial fibrillation occurs not only against the background of cardiac pathologies. Often the cause is a person’s poor lifestyle. This applies to uncontrolled use of medications (glycosides), stress, alcohol abuse, exhaustion of the nervous system and physical overload. These factors lead to cardiac dysfunction, including paroxysmal atrial fibrillation. Other reasons for its occurrence:

heart failure;
essential hypertension with increased heart muscle mass;
condition after surgery;
weak sinus node;
diabetes mellitus;
lack of potassium and magnesium;
coronary heart disease;
pericarditis, endocarditis, myocarditis (inflammatory heart diseases);
hypertrophic and (or) dilated cardiomyopathy;
heart defect, congenital or acquired;
Wolff-Parkinson-White syndrome;
infectious diseases.

Classification of pathology

According to one classification, fibrillation is divided into two forms: flickering and fluttering. In the first case, the heart rate exceeds 300 beats per minute, but not all myocardial fibers contract. Paroxysm of atrial flutter causes atrial contraction up to 300 times/min. The sinus node stops working completely. From this we can understand that the frequency of contractions during flickering is higher than during fluttering.

Separately, it is worth noting the recurrent type of fibrillation paroxysm. Its difference is its periodic repetition over time. Features of such atrial fibrillation:

Initially, attacks appear infrequently, last a few seconds or minutes and practically do not bother the person;
subsequently their frequency increases, due to which the ventricles increasingly experience oxygen starvation.

Most patients with atrial fibrillation are already registered with a cardiologist with congenital or acquired heart diseases. Another classification of atrial fibrillation divides it into types based on the ventricular contraction factor:

Tachysystolic. This form is characterized by the largest number of ventricular contractions - 90–100 beats per minute. The person himself feels that the heart is not working correctly. This is manifested by a feeling of lack of air, constant shortness of breath, chest pain and uneven pulse.
Normosystolic. It is characterized by a small number of ventricular contractions – 60–100 beats per minute. It has a more favorable prognosis.
Bradysystolic. The frequency of ventricular contractions is the smallest - does not exceed 60 beats per minute.

Symptoms

The paroxysmal form of atrial fibrillation has several characteristic signs that reflect the state of deterioration of the blood supply to the brain. The first symptoms to appear are:

shiver;
coldness in the extremities;
general weakness;
sudden onset of palpitations;
feeling of suffocation and increased sweating;
cyanosis - a bluish tint to the lips.

A severe attack may be accompanied by dizziness, fainting and panic attacks. At the same time, the person feels a sharp deterioration in his condition. The attack ends with increased intestinal motility and copious urination. All other signs disappear as soon as sinus rhythm returns to normal. Some patients, on the contrary, may not even notice that they have atrial fibrillation. In asymptomatic cases, the pathology is diagnosed only in a doctor’s office.

Complications

The danger of atrial fibrillation is that it causes blood to be pushed out of the heart unevenly. As a result of this process, it can stagnate in some parts of the myocardium, which leads to the formation of blood clots. They easily adhere to the wall of the atria. With persistent arrhythmia, this can cause congestive heart failure. Due to arterial thrombosis, the risk of developing gangrene is high.

An attack of arrhythmia that lasts more than 48 hours causes a stroke. Possible complications of paroxysmal atrial fibrillation also include:

thromboembolism;
persistent or permanent atrial fibrillation;
pulmonary edema;
ischemic stroke;
arrhythmogenic shock;
dilated cardiomyopathy;
cardiac asthma.

Diagnostics

During the initial examination, the cardiologist detects irregularities in the pulse and heart rhythm. There is a difference between heart contractions and pulse upon auscultation. Additionally, the doctor asks the patient about the presence of concomitant heart diseases, finds out the nature of the symptoms and the time of their onset. The standard for diagnosing atrial fibrillation is electrocardiography (ECG). Signs of this pathology:

registration of fc waves instead of P waves, having a frequency of 350–600 times per minute;
different RR intervals against the background of an unchanged ventricular complex.

Atrial fibrillation is confirmed if the indicated signs are observed in at least one lead of the cardiogram. In addition to ECG, the following diagnostic methods are used:

Holter monitoring. The procedure involves continuously recording cardiac dynamics on an ECG throughout the day. Daily monitoring is carried out using a Holter device, named after Norman Holter, its inventor.
Ultrasound of the heart (echocardiography). Helps detect valve defects, structural changes in the myocardium, and intraatrial thrombi.
Bicycle ergometry. This is a physical exercise test using an ECG machine. Through such a study, the doctor can understand the true heart rate.

Treatment of paroxysmal atrial fibrillation

To prescribe adequate therapy, the doctor must determine the cause of paroxysmal fibrillation. If it appears for the first time and goes away on its own, the patient is recommended to follow the rules for preventing the following attacks:

eliminating digestive problems;
replenishment of magnesium and potassium deficiency;
taking medications to relieve emotional stress;
therapeutic exercises;
giving up alcohol and smoking;
weight loss if you are overweight;
introducing more rest time into the daily routine.

If the attacks have recurred several times, the doctor will prescribe more serious therapy. In this case, the specialist is faced with a choice: to achieve normalization of the heart rhythm or to maintain the arrhythmia, but stabilize the heart rate. According to statistics, both treatment methods are effective. Even with persistent arrhythmia, by controlling the pulse, doctors are able to improve survival rates and reduce the incidence of thromboembolism.

The treatment plan is established individually, based on the cause of atrial fibrillation, the patient’s age and the presence of concomitant pathologies. Based on these criteria, therapy may include:

medicinal maintenance of target heart rate;
cardioversion - normalization of rhythm through electric current;
taking anticoagulants to prevent thrombosis;
surgical intervention if conservative therapy is ineffective - involves removal of pathological foci of the myocardium.

Drugs

When paroxysmal atrial fibrillation occurs for the first time, doctors attempt to stop it. For this purpose, medical cardioversion is performed with antiarrhythmic drugs:

Class I – Flecainide, Propaphenone, Quinidine, Novocainamide;
Class III – Amiodarone, Nibentan, Dofetilide, Ibutilide.

The first intravenous administration of antiarrhythmic drugs in life is carried out under the control of ECG monitoring. Among such drugs, Novocainamide, based on procainamide, is considered effective. Scheme of its application:

medication dosage – 1000 mg intravenously over 8–10 minutes;
for the procedure, the drug is diluted to 20 ml with isotonic sodium chloride solution;
administration is stopped after restoration of sinus rhythm;
the infusion is carried out with the patient in a horizontal position.

The advantage of Novocainamide is that in the first 30–60 minutes, paroxysm of atrial fibrillation is stopped in 40–50% of patients. The rest are indicated for repeated administration of the drug. Novocainamide is prohibited for arrhythmia due to an overdose of glycosides, leukopenia, 2-3 degree AV block. Side effects of drugs:

ataxia;
convulsions;
myasthenia gravis;
depression;
headaches;
hallucinations.

If the patient’s medical history contains information about the effectiveness of Novocainamide or another of the listed drugs, it is preferred. If the attack lasts less than 48 hours, it can be stopped without anticoagulant preparation, although the administration of unfractionated Heparin or low molecular weight heparins intravenously will be justified in this case. Dosage – 4000–5000 units.

If paroxysmal fibrillation lasts more than 2 days, then the risk of thromboembolism is high. In such a situation, before restoring sinus rhythm, the patient is prescribed the following drugs:

anticoagulants - Xarelton, Heparin, Fraxiparin, Warfarin, Fondaparinux, Pradaxan;
antiplatelet agents – Acetylsalicylic acid, Aspirin, Acecardol;
low molecular weight heparins – Nadroparin, Enoxaparin, Heparin.

Warfarin is considered the most stable drug from the group of anticoagulants. The drug is based on the component of the same name. Warfarin is prescribed before restoring sinus rhythm together with low molecular weight heparins (Enoxaparin, Nadroparin). The anticoagulant effect of the drug appears after 36–72 hours. The maximum therapeutic effect is observed on the 5th–7th day after the start of administration. Warfarin dosage regimen:

5 mg per day (2 tablets) for the first 4 days;
on day 5, the INR is determined (INR, international normalized ratio - an indicator of the functioning of the hemostatic system (blood clotting));
in accordance with the results obtained, the dose is adjusted to 2.5–7.5 mg per day.

If the arrest of the arrhythmia is successful, Warfarin continues to be taken for a month. Side effects of the drug include bleeding, abdominal pain, diarrhea, anemia, and increased activity of liver enzymes. Contraindications to the use of Warfarin:

arterial aneurysm;
acute bleeding;
stomach or duodenal ulcer;
bacterial endocarditis;
acute internal combustion engine syndrome;
the first trimester of pregnancy and the last 4 weeks of gestation;
thrombocytopenia;
lumbar puncture;
malignant hypertension.

If the doctor has chosen the tactic of not preserving the arrhythmia and reducing the heart rate, then the patient is not prescribed cardioversion, but antiarrhythmic drugs. The purpose of their use is to maintain the heart rate at a level of no more than 110 beats per minute at rest. To ensure this effect, the following groups of drugs are used:

Beta-blockers: Anaprilin, Cordarone. They reduce the effect of adrenaline on beta-adrenergic receptors, thereby reducing the frequency and strength of heart contractions.
Cardiac glycosides: Digoxin. This drug has antiarrhythmic and cardiotonic effects. Increases the contractility of the heart, reduces the need of myocardial cells for oxygen.
Calcium antagonists: Verapamil, Diltiazem. They slow down the process of penetration of this electrolyte through the channels, due to which the coronary and peripheral vessels expand. Used if there are contraindications to beta blockers.
Medicines based on potassium and magnesium: Magnerot. This drug increases the resistance of cardiomyocytes (heart cells) to stress and has an inhibitory effect on neuromuscular transmission.

To prevent the development of an ischemic state of the myocardium, metabolic therapy is additionally carried out. For this, one of the following cardioprotective drugs is used:

Mildronate;
Preductal;
Asparkam;
Riboxin;
Cocarboxylase.

Electrical cardioversion

In addition to medication, there is also electrical cardioversion. This is the restoration of sinus rhythm through the action of electric current. Such cardioversion is indicated when the patient’s acute heart failure worsens or there are no results after drug treatment. Electrical normalization is more effective, but also more painful. For this reason, the procedure is performed under general anesthesia or while taking sedatives.

Sinus rhythm is restored using a cardioverter-defibrillator. It sends an electrical impulse to the heart that is synchronized with the R wave. Electrical cardioversion is performed externally by shocking the skin. There is also an intracardiac version of this procedure. It is indicated when superficial cardioversion is ineffective. Depending on the patient’s condition, he is prescribed:

Planned cardioversion. The patient takes Warfarin for 3 weeks before and 4 weeks after. The elective procedure is indicated for patients whose arrhythmia either lasts more than 2 days or whose duration is unknown.
Urgent cardioversion. It is carried out when the duration of the paroxysm is less than 48 hours and the presence of severe circulatory disorders, for example, hypotension. Additionally, heparin or its low molecular weight analogues must be administered.

Surgical methods

If drug and electrical pulse treatment is ineffective or frequent relapses of paroxysmal fibrillation, doctors perform surgical intervention. This is an extreme method of therapy, which involves removing foci of arrhythmia. Treatment is carried out by ablation - destruction of pathological areas of the heart by inserting a catheter that conducts an electrical current. Methods for carrying out such an operation:

Without opening the chest. In this case, the catheter is inserted through the femoral artery and sent to the heart, where the source of the arrhythmia is destroyed by electric current.
With an opening of the chest. This is a traditional method that is used more often than others. The disadvantage is the long recovery period.
With installation of a cardioverter. This is a special device that is implanted into the heart. The device does not prevent arrhythmia, but eliminates it if it occurs.

Diet

The paroxysmal form of atrial fibrillation requires mandatory diet. It helps prevent recurrent attacks and possible complications. The diet is composed with an emphasis on foods containing potassium, magnesium, and calcium. These microelements are necessary for the normal functioning of the cardiovascular system. The following products contain them:

bran or grain bread;
buckwheat;
legumes – green beans;
pumpkin and sunflower seeds;
wheat bran;
cocoa;
wheat germ, soy;
red rice;
oats and oatmeal;
potato;
bananas;
cilantro;
hard cheeses;
fatty homemade cottage cheese;
nuts;
fish fillet;
fermented milk products;
vegetable oil.

If you have atrial fibrillation, you need to avoid sugar, sweets, soda, and energy drinks. Table salt and fatty foods are prohibited. The following types of food should also be avoided:

homemade sour cream;
scrambled eggs;
spicy dishes;
spices;
canned foods;
fatty meat;
smoked meats;
chocolate;
marinades;
rich meat broths;
lard;
alcohol.

Forecast

If the restoration of the rhythm after the paroxysm has occurred successfully, then the prognosis is favorable. If all therapeutic recommendations are followed, the patient will be able to lead his normal life. When paroxysmal atrial fibrillation becomes permanent, the prognosis worsens. This is especially true for people leading an active lifestyle. After a few years, with constant atrial fibrillation, heart failure develops. This significantly limits a person's physical activity.

Relapse Prevention

A full life with atrial fibrillation is possible. It is important to follow an appropriate diet, ensure regular physical activity, and treat existing heart and vascular diseases. Preventive measures to prevent repeated paroxysms include: