Atrial fibrillation: How can it be detected early and how is it approached therapeutically

What is atrial fibrillation and what are the symptoms?

Atrial fibrillation is the most common arrhythmia in the entire population. It affects about 10-15% of the population over 75 years of age.

Symptoms can be very varied, but the general rule is that patients notice either a sensation of a rapid pulse or palpitations, or lack of energy or fatigue on exertion. Sometimes the episodes are self-limiting. Usually lasting a few hours or days, this is known as paroxysmal atrial fibrillation. However, in other cases, the fibrillation persists for weeks or even months or years, without the appearance of clear symptoms suggesting its occurrence.

What is the treatment of atrial fibrillation?

Early detection of atrial fibrillation is essential for correct treatment and, more importantly, to determine the risk of thromboembolism associated with it. The fundamental pillars of treatment are:

  • Anticoagulation with drugs that prevent thrombus formation in relation to atrial fibrillation. At this point it is important to emphasize that aspirin, an antiplatelet drug, but not an anticoagulant, is often insufficient.
  • Symptom control with catheter ablation or antiarrhythmic drugs.
  • Control of comorbidities, i.e., accompanying diseases that worsen symptom control and the course of atrial fibrillation.

The approach to atrial fibrillation is individualized and there is no universal measure. Thus, in the presence of symptoms suggestive of atrial fibrillation such as irregular and rapid heartbeat, palpitations, episodic chest discomfort, or in patients who have suffered a stroke, it is essential to search for and diagnose atrial fibrillation for prompt treatment.

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On the other hand, in acute episodes of rapid atrial fibrillation, the best strategy is to go to an emergency center to assess early treatment by electrical cardioversion or antiarrhythmic drugs, in order to restore normal heart rhythm. This action should always be followed by a cardiological follow-up to detect possible triggers of the episode, correct them and ensure adequate follow-up and optimal treatment.

What is the most effective treatment?

Invasive treatment by catheter ablation constitutes the increasingly accepted option in those patients with significant impairment of their quality of life or with repetitive atrial fibrillation. In fact, a very significant fact is that, in the national registry of catheter ablation of arrhythmias, atrial fibrillation was for the first time the most treated arrhythmia since 2017 and has continued to grow steadily in recent years.

As a general guideline, when an episode of atrial fibrillation is first diagnosed, assessment by a cardiologist is pertinent. If episodes are repetitive, arrhythmia specialists can provide the most definitive treatment with catheter ablation of atrial fibrillation. It can be performed with cryoablation or radiofrequency, with excellent results with both techniques.

Admission is for a single night of hospitalization, although there are already cases in which this type of procedure is performed without requiring hospitalization.

Which specialist should be consulted?

Atrial fibrillation requires a multidisciplinary approach, led by arrhythmia specialists. For its management, it is essential to control possible triggers such as chronic arterial hypertension, obesity, heart valve problems or various endocrinological or medical disorders.