Why is atrial fibrillation permanent

Symptoms of atrial fibrillation can vary greatly from person to person, and even in the same person at different times. Heart palpitations are the most common symptom. Although AF alone is not life-threatening arrhythmia, it can lead to complications (in particular stroke) that can lead to disability or death.

In most cases, at least before atrial fibrillation is adequately treated, it causes considerable concern, and even complete intolerance.

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Common symptoms

The most common symptoms of AF are:

  • fast heartbeat;
  • fatigue;
  • confused breathing;
  • chest discomfort;
  • episodes of lightheadedness.

As for young people, the appearance of this disease at an early age is quite rare, with the exception of patients with any underlying heart disease. However, the exact cause of atrial fibrillation has not yet been determined.

There are several possible main causes that increase the likelihood of the onset and development of atrial fibrillation. These include cardiovascular diseases, bronchopulmonary infections, lung diseases, and other diseases, which you will learn about below.

Atrial fibrillation occurs with heart diseases such as:

  • Hypertension – high blood pressure.
  • Coronary artery disease – also known as coronary heart disease. The occurrence of cholesterol plaques inside the coronary arteries. Using these arteries, the heart muscle is supplied with oxygen-rich blood.
  • Congenital heart disease – defects in the heart structure present from birth. These include defects in the internal heart walls, valves, and blood vessels. Congenital heart defects alter the normal flow of blood through the heart.
  • Mitral valve prolapse is an abnormal flow of blood passing through the mitral valve from the left ventricle of the heart to the left atrium.
  • Cardiomyopathy is a serious condition in which the myocardium becomes inflamed and does not work properly.
  • Pericarditis – inflammation of the pericardium – the protective membrane surrounding the heart.
  • Heart surgery – heart surgery can be the cause of atrial fibrillation. In a sufficiently large percentage of patients, atrial fibrillation develops after surgery.

Atrial fibrillation is also found in people with the following diseases:

  • Hyperthyroidism is hyperthyroidism.
  • Sleep apnea is a common disease in which the patient has one or more respiratory arrests or superficial breathing during sleep. Obstructive sleep apnea usually causes high blood pressure (hypertension), which greatly increases the risk of heart problems and stroke.
  • Atrial flutter – this disease is similar to atrial fibrillation, however, the pathological heart rhythms of the atria are less chaotic and more organized than with atrial fibrillation. Atrial flutter can develop into atrial fibrillation.
  • Pneumonia is pneumonia.
  • Lungs’ cancer.
  • Emphysema is a pathological expansion of the alveoli and the impossibility of their normal contraction, leading to impaired gas exchange in the lungs.
  • Bronchopulmonary infections.
  • Pulmonary embolism – blockage of the branches of the pulmonary artery and its blood clots.
  • Carbon monoxide poisoning.

The cause of atrial fibrillation can also be:

  • Alcohol abuse – regular, excessive, prolonged alcohol consumption significantly increases the risk of atrial fibrillation. A study by scientists at the Beth Israel Medical Center showed that the risk of atrial fibrillation is 45% higher among people who drink compared to teetotalers.
  • Smoking – smoking can cause a variety of heart conditions, including atrial fibrillation.
  • Excessive caffeine intake – Excessive intake of coffee, energy drinks, or cola can cause atrial fibrillation.

Cardiac pathology, which is characterized by chaotic activity of the atria with a significant increase in the frequency of impulses, as well as the complete absence of their coordinated contraction. It is the most common type of arrhythmia.

Such pathologies as: congenital malformations of the heart muscle, myocardial infarction, pericarditis of various etiologies, infectious lesions of a viral nature, arterial hypertension, stable angina pectoris, expansion of the cavities of the heart, mitral insufficiency, thyroid disease, respiratory diseases can cause the development of atrial fibrillation. overweight and obesity, alcoholism, diabetes.

The patient has shortness of breath, an increase in which is observed during physical exertion, an irregular heartbeat increases, a feeling of “freezing” of the heart appears, increased sweating, general weakness, dizziness, fainting, chest pain.

A history of the disease is collected, an analysis of the patient’s life history, family history is carried out. A complete examination and questioning of the patient is performed. An electrocardiography, chest x-ray, echocardiography,

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During treatment, a conservative or surgical method can be chosen, the tactic and choice of treatment methods are carried out by the attending physician. With conservative treatment, in the event of an episode of atrial fibrillation, patients are prescribed intravenous administration of antiarrhythmic drugs and electric cardioversion.

Beta-blockers, cardiac glycosides, slow calcium channel blocker drugs, and anticoagulants are also prescribed. In the process of surgical treatment, radiofrequency ablation, implantation of a pacemaker, prosthetics and installation of an atrial cardioverter-defibrillator are performed.

Possible complications of this pathology: ventricular fibrillation, heart failure, thromboembolism, stroke.

It should exclude the use of alcoholic beverages, stop smoking, normalize body weight, include moderate physical activity in your daily regimen, eat rationally and moderately, avoid stress, monitor blood pressure and blood glucose. Do not use medications without a doctor’s prescription, treat diseases such as arterial hypertension, bronchial asthma, chronic obstructive bronchitis, hypothyroidism in a timely manner

What is a permanent form of atrial fibrillation?

Atrial fibrillation is an inconsistent myocardial excitation, when the frequency of contractions exceeds 300-500 beats per minute. However, the pulses are not strong enough to provide blood flow with oxygen. There are several classifications of pathology, but the following division of forms of arrhythmia is most common:

  • Paroxysmal – an attack lasts less than a week, usually stops within two days, even without the use of therapeutic agents;
  • Persistent form – on its own, rhythm disturbance does not pass within a week, the use of medications or other methods of treatment is required;
  • Permanent form – characterized by the fact that the therapy was unsuccessful and a decision was made to maintain fibrillation. It requires regular monitoring by a specialist and the treatment of concomitant diseases.

The development of the disease continues for several years, the state of health and the characteristics of therapy affect the rate of change. At first, attacks are not often disturbed, over time, their duration and breaks increase, which leads to pathological disorders in the work of the atria. In the future, the appearance of constant fibrillation is possible.


Symptoms caused by the loss of effective atrial contractions tend to cause much more problems in people who, in addition to atrial fibrillation, have heart disease in which the ventricles are relatively “stiff.” Conditions that usually lead to the formation of hard ventricles include hypertrophic cardiomyopathy, diastolic dysfunction, aortic stenosis, and even chronic high blood pressure (arterial hypertension).

In people with these conditions, the onset of atrial fibrillation usually causes complications that are especially serious.

In people with coronary heart disease, a rapid heartbeat in AF can cause angina pectoris (chest discomfort).

Sick sinus syndrome.

Sinus node weakness syndrome (SSS) is a generalized violation of the electrical system of the heart, manifested by a slow heart rate (bradycardia).

AF is often found in patients with CVS. In a sense, fibrillation “protects” patients with CVS because it usually causes an increase in heart rate, which is necessary enough to suppress the symptoms of bradycardia, such as dizziness and weakness.

However, AF often occurs and occurs periodically. When arrhythmia suddenly stops, there is often a very long delay before the sick sinus node starts working again. A long pause before the heartbeat is what leads to fainting.

Treatment of CVS requires the use of a permanent pacemaker. It is usually best for people suffering from both CVD and AF to put a pacemaker before taking aggressive measures to treat atrial fibrillation (since this treatment often causes a slowdown in heart rate).

For people with heart failure, an additional decrease in cardiac activity caused by AF can significantly worsen symptoms – mainly shortness of breath, weakness, and swelling in the legs.

In rare cases, atrial fibrillation in itself can cause heart failure. Any arrhythmia that can cause heart palpitations (tachycardia) for several weeks or months can lead to weakening of the heart muscle and cause heart failure.

Fortunately, this disease (heart failure caused by tachycardia) is a relatively rare consequence of AF.

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AF increases the risk of stroke by five times. An increased risk of stroke is the main reason that it is always important to carefully consider the optimal treatment for AF – even in cases where the condition is well tolerated and, apparently, does not cause special problems.

Some people experience episodes of AF without any symptoms until they finally have a stroke. Only after a stroke is it discovered that they experience atrial fibrillation.

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Available evidence suggests that “subclinical” atrial fibrillation is more common than experts suggested, and that unrecognized AF can be an important cause of cryptogenic stroke, that is, a stroke without an obvious reason.

Atrial fibrillation: causes of the disease, main symptoms, treatment and prevention

Atrial fibrillation (AF) can be caused by several heart diseases, including coronary heart disease, mitral regurgitation, chronic hypertension, pericarditis, heart failure, or almost any other heart problem. This arrhythmia is also quite common with hyperthyroidism, pneumonia, or pulmonary embolism.

Taking amphetamines or other stimulants (such as cold medicines containing pseudoephedrine) can cause AF in some people, as well as drinking just one or two alcoholic beverages — a condition known as festive heart syndrome. While doctors have traditionally said that caffeine also causes AF, recent clinical studies indicate that most people do not.

Most people with atrial fibrillation also do not have any specific cause of the disease. This, called idiopathic atrial fibrillation, is often a condition associated with aging. Although AF is rare in patients under the age of 50, it is fairly common in people aged 80 or 90 years.

More recent studies have shown that this type of arrhythmia in many cases is associated with a lifestyle. For example, overweight people and a sedentary lifestyle have a much higher risk of AF. In people with AF associated with a lifestyle, an intensive lifestyle modification program helps eliminate arrhythmia.

Doctors have found that persistent atrial fibrillation is rare in healthy people. Pathology is manifested in patients who are already registered with a cardiologist, respectively, their heart is not working effectively, or violations are noted in the circulatory system.

What factors provoke the disease?

  • Long-term use of drugs for arrhythmia – especially if the patient is self-medicating, is not observed by the doctor, or the specialist does not have sufficient qualifications;
  • Asocial lifestyle – drinking alcohol and smoking throughout life lead to the fact that irreparable changes occur in the heart. Atrial fibrillation is only one of the possible pathologies;
  • Heart surgery – with some surgical interventions there is a risk of side effects, rhythm disturbance is one of them;
  • Intoxication of the body – we are talking about toxic substances, harmful products and microorganisms. If infection is not treated, changes in the functioning of the main muscle are likely;
  • Increased physical activity – when a person is often overworked, does excessive and difficult work, has little rest, the heart wears out much faster;
  • Vibration in the workplace – this factor is not common, although the disease can develop for this reason.

However, in most cases, constant atrial fibrillation occurs due to internal causes. These include heart disease, high blood pressure, pathologies of the kidneys and circulatory system, diabetes mellitus, pulmonary disorders, hyperthyroidism.

At risk are people suffering from enlargement of the left ventricle and its dysfunction. Most often, arrhythmia occurs in older people, so after 40 years the probability of deviations increases, and if alcohol is a frequent guest on the table, cardiac abnormalities will certainly be diagnosed.

How is the pathology manifested?

About a third of patients do not notice attacks and heart rhythm disturbances. However, there are still symptoms, they are simply ignored by a person and attributed to age, fatigue, and a lack of vitamins. The brightness of the symptoms depends on individual characteristics and the clinical picture, so atrial fibrillation, aggravated by heart failure or angina pectoris, will not go unnoticed.

What symptoms indicate violations and the need to visit a cardiologist?

  • Sensation of weakness and rapid fatigue – a person has noticeable apathy, lethargy, even in the absence of exertion, fatigue is felt;
  • Dizziness and fainting – occur for no reason, over time, their frequency may increase;
  • Unpleasant sensations in the chest area – many feel a rapid heartbeat, as if the muscle is ready to jump out, interruptions are often noted – the heart does not work in one rhythm;
  • The appearance of shortness of breath – since the necessary amount of oxygen does not enter the lungs, a person cannot “breathe”, because of this, depression is felt;
  • Chest pain is the most dangerous symptom, which is strictly forbidden to ignore. At the first attack you need to visit a doctor, otherwise the consequences will not be the most pleasant;
  • Cough – also caused by a lack of oxygen, usually it intensifies in a horizontal position;
  • Panic attacks – at the time of the attack, the pressure in a patient, even with hypertension, can drop significantly, which leads to autonomic disorders.

Violations are aggravated even with minimal physical exertion, so it becomes difficult for people to play sports, and even completely dangerous. The disease manifests itself and an irregular pulse, its deficiency is observed. At home, you can conduct elementary measurements: count the heart rate and pulse, if the readings of the latter are less than the heart rate, then there are violations. But to determine what kind of atrial fibrillation (permanent form or paroxysmal) you have should be a specialist.


Diagnosing atrial fibrillation is usually simple. It just requires an electrocardiogram (ECG) during an AF episode. This requirement is not a problem for people with chronic or persistent AF, in whom arrhythmia can occur every time an ECG is performed.

However, in people whose arrhythmias occur periodically, prolonged outpatient ECG monitoring may be required to make a diagnosis. This can be especially useful for people who have had cryptogenic strokes, since treating atrial fibrillation (if present) can help prevent a relapse of the stroke.

Treatment of a permanent form of atrial fibrillation is carried out on the basis of data obtained after a comprehensive diagnosis. The exact cause is established using clinical, laboratory and instrumental studies. The main symptom that helps to suspect the disease is considered to be frequent and rhythmic pulsation in the veins of the neck.

It corresponds to atrial contractions of the myocardium, but exceeds the frequency in the peripheral arteries. There is a noticeable difference between the data obtained during the inspection. Additional methods include the following:

  • blood test for biochemistry;
  • INR level (international normalized ratio);
  • ECG (electrocardiography);
  • daily monitoring of ECG;
  • samples;
  • ultrasound examination of the heart (ultrasound);
  • transesophageal echocardiography.

To establish a diagnosis, unlike other pathologies, several diagnostic methods from the list indicated are enough. In complex cases, a more detailed examination may be required.

The main indicator, which is determined with a paroxysmal rhythm, is the level of lipids in the blood plasma. It belongs to one of the predisposing factors of atherosclerosis. The following data is important:

  • creatinine;
  • liver enzymes – ALT, AST, LDH, CPK;
  • plasma electrolytes – magnesium, sodium and potassium.

They must be taken into account before prescribing treatment to the patient. If necessary, the study is repeated.

For diagnosis, this indicator is very important. It reflects the state of the blood coagulation system. If there is a need for the appointment of “Warfarin” – it must be carried out. During the treatment of atrial fibrillation or flutter, the INR level should be monitored regularly.

With atrial fibrillation or flutter, even in the absence of a disease clinic, changes are detected on the electrocardiogram film. Instead of the P waves, pyloric teeth appear in leads I, III and avf. The frequency of the waves reaches 300 per minute. There are patients who have a permanent form of atrial fibrillation of an atypical nature. In this situation, such teeth will be positive on the film.

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The study reveals an irregular rhythm, which is associated with impaired conduction of impulses through the atrioventricular node. There is also the opposite situation when normoform is observed. The pulse of such people is constantly within acceptable values.

In some cases, atriventricular blockade is found on the film of the electrocardiogram. There are several variations:

  • 1 degree;
  • 2 degree (includes 2 more types);
  • 3 degree.

When slowing down the conduction of nerve impulses through the pacemaker, the PR interval lengthens. Such changes are characteristic of blockade of the 1st degree. It appears in patients with constant treatment with certain drugs, damage to the myocardial conductive system or an increase in parasympathetic tone.

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Divide the 2nd degree of violations into 2 types. The first is the Mobitz type, characterized by an elongated PR interval. In some cases, an impulse to the ventricles does not occur. When examining an electrocardiogram film, a QRS complex is detected.

Often there is type 2 with a sudden absence of a QRS complex. No extension of the PR interval is detected. With blockade of grade 3, there are no signs of nerve impulses on the ventricles. The rhythm slows down to 50 beats per minute.

This method for fibrillation or atrial flutter is considered one of the main instrumental. With its help, you can trace what changes occur during the work of the myocardium in various situations. During the day, tachysystole, blockade and other disorders are found.

The study is based on the registration of electrical activity in the process of the heart. All data is transferred to a portable device, which processes them into information in the form of a graphical curve. The electrocardiogram is stored on the device media.

For some patients, a cuff is additionally applied to the shoulder area when flickering. This allows you to control the dynamics of the level of blood pressure electronically.

A physical exercise test (treadmill test) or bicycle ergometry is indicated to the patient to determine cardiovascular system disorders. The duration of the study may vary. When unpleasant symptoms appear, it is stopped and the data obtained is evaluated.

Signs of pathological changes in the heart are detected using ultrasound. The state of blood flow, pressure, valve apparatus, and the presence of blood clots are evaluated.

A special sensor for receiving data is inserted into the esophagus. When the patient has a constant form of fibrillation, atrial flutter, treatment should take about 2 days. For this reason, the main recommendation is to undergo therapy until normal rhythm is restored. The purpose of the instrumental study is to detect blood clots and assess the condition of the left atrium.

Features of diagnostic measures

Atrial fibrillation is an easily diagnosed disease. It is enough to contact a cardiologist and make the necessary tests to make an accurate diagnosis. There are several accurate and effective methods for examining a patient:

  • Visual examination – the doctor listens to the pulse and heartbeat, notes their irregularity, interruptions in the work of the heart, listens to the person’s complaints;
  • An ECG is the easiest and most effective way. On the cardiogram, the constant form is manifested by an irregular heart rate interval, an irregular rhythm, P-waves are absent, and the frequency of chaotic waves exceeds 200 units. Changes in ventricular rhythm may also be noted;
  • Monitoring using a cardioregistrator – a person carries equipment for a day or more. At the same time, the device works on the basis of an ECG, only continuously. So it is possible to identify more accurate data, but a daily examination will cost several thousand rubles.

The indicated methods are enough to make an accurate diagnosis and prescribe treatment. If a person has comorbidities, or the attack has been going on for a long time, other methods can be used to create a more complete clinical picture.


Doctors classify atrial fibrillation into different types. In fact, several confusing AF classification systems have been used. To help decide which treatment approach is right for you, it’s useful to combine the types of AF in only two groups:

  1. A new beginning or intermittent atrial fibrillation. Here arrhythmia is either a new problem, or arising only periodically. Intermittent AF is often called paroxysmal atrial fibrillation. People in this category have a normal heart rate in the vast majority of cases, and their episodes of atrial fibrillation tend to be relatively short and usually infrequent.
  2. Chronic or persistent atrial fibrillation. Here, arrhythmia is either present all the time, or occurs so often that periods of normal heart rhythm are relatively rare or short-lived.

How is the treatment carried out?

Treatment of a constant form of atrial fibrillation is reduced to restoring the correct sinus rhythm. This can be done with medication or a cardioverter; in addition, you need to control the formation of blood clots, which entail the closure of blood vessels and death.

The specialist is faced with the task of restoring or not restoring the rhythm, since taking pills can lead to aggravation of the pathology, provoke even greater deviations and lead to death. The patient gets used to the constant form, but if jumps in the heart rate are observed in the body, the condition will significantly worsen.

Drug therapy includes the following drugs:

  • Medications for rhythm retention – Digoxin, Diltiazem or analogues of 120-400 mg per day, beta-blockers are additionally used;
  • Drugs that prevent the appearance of blood clots. Usually, 300 mg acetylsalicylic acid is used, or warfarin if there is a risk of complications.

Another method of treatment is the use of a pacemaker – an apparatus that acts on the ventricles by electrical impulses. The effectiveness of therapy increases if atrial fibrillation is observed up to 2 years, otherwise the chances of recovery are not more than 50%.

A pacemaker helps to eliminate the symptoms of the disease, it acts even in a situation where drug treatment has failed. However, the installation of the device is associated with surgical intervention, and in the future, constant monitoring by a cardiologist is still necessary.

Lifestyle & Home Remedies

With the constant form of fibrillation, it is necessary not only to take pills, but also to significantly change your life. Only with an integrated approach will you be able to feel comfortable and eliminate the occurrence of complications. What measures should be taken?

  • Revise your diet, refuse harmful and fatty foods. The daily menu should include cereals, fruits, vegetables, as well as foods high in potassium and magnesium;
  • You can not give up physical exertion, however, sports are carried out in a gentle mode – just walk and morning exercises. But the exhausting workouts will have to be completely forgotten;
  • Be attentive to your health – if dangerous symptoms appear, you should immediately visit a doctor. Heart rate is constantly monitored, it is advisable to keep track of their performance.

Without a doubt, you will need to abandon bad habits – alcohol and cigarettes are banned, abuse will lead to side effects that threaten life. With a constant form of the disease, you will have to become a frequent visitor to a cardiologist, do an ECG and take various tests. If surgery is planned (for example, tooth extraction with anesthesia), you must definitely warn the doctor about the presence of pathology and tell the names of the drugs you are taking.

Atrial fibrillation in constant form is a dangerous and difficult to treat pathology. Symptoms may not be noticeable, because violations develop over time, misleading patients. However, one can live with such a disease, and in high quality, the main thing is to follow all doctor’s prescriptions, give up bad habits, and lead a healthy lifestyle.

You may need to make lifestyle changes that improve the overall condition of your heart, especially to prevent or treat conditions such as high blood pressure and heart disease. Your doctor may suggest several lifestyle changes, including:

  • Eat healthy foods. Eat a healthy diet low in salt and hard fats and rich in fruits, vegetables, and whole grains.
  • Exercise regularly. Exercise daily and increase your physical activity.
  • Quit smoking. If you smoke and cannot quit on your own, talk with your doctor about strategies or programs to help you break the smoking habit.
  • Maintain a healthy weight. Being overweight increases your risk of developing heart disease.
  • Keep your blood pressure and cholesterol under control. Make lifestyle changes and take medications as prescribed to correct high blood pressure (hypertension) or high cholesterol.
  • Drink alcohol in moderation. For healthy adults, this means that every day for women of all ages and men over 65, and up to two drinks per day for men 65 and under.
  • Support follow-up care. Take your medicine as prescribed and meet with your doctor regularly. Tell your doctor if your symptoms worsen.

Millions of people live perfectly normal lives, despite AF. While making the right decision about treatment can be challenging, and although managing the therapy can take some time and effort, you can return to normal as soon as this happens. When discussing treatment options with your doctor, make sure they expect the same from you.

Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.