– rheumatism (especially in the presence of mitral stenosis (
– coronary artery disease,
– acute myocardial infarction,
– acute or chronic pulmonary heart,
– non-specific chronic lung diseases,
– obstructive chronic lung disease,
– in adults, an atrial septal defect,
– WPW – syndrome (ventricular pre-excitation syndrome)
– SSSU (sinus node dysfunction) or else this is called tahi-brady syndrome,
– pathological (atypical) atypical desympathization,
The pathogenetic significance of atrial flutter.
The main pathological factor is the excessively high frequency of atrial contractions and all the symptoms resulting from this.
Against the background of developing tachysystole, contractile diastolic myocardial dysfunction appears in the region of the left ventricle, which subsequently passes into contractile systolic dysfunction. Ultimately, this picture can go into dilated cardiomyopathy and result in heart failure.
Paroxysmal form of atrial flutter.
With this form of the course of the disease, the frequency of paroxysms, that is, seizures, can be from one per year to several per day.
A feature of paroxysmal atrial flutter is that there is no age or gender category. Attacks can occur in both men and women of any age. But of course, most often in people with myocardial disease.
Paroxysms can occur against the background of physical or emotional stress, overeating, drinking alcohol, with a sharp decrease in external temperature (immersion in cold water, going outside in winter, and so on) and even when drinking a lot of water or upset stomach.
The patient often describes the attack of atrial flutter as a sensation of a strong and frequent heartbeat that appears after some event or action. In more severe cases, dizziness, weakness, loss of consciousness, and even short-term cardiac arrest during the episode of atrial flutter during high-frequency conduction in the AV node (1: 1) are observed.
The constant form of atrial flutter.
This is a very dangerous form, since in the first stages of the development of the disease it usually proceeds asymptomatically and manifests itself with the accumulation of the consequences of a decrease in systemic blood pressure and arterial system pressure, which ultimately leads to a decrease in coronary blood flow. Patients usually come to the doctor with already expressed symptoms of heart failure.
– An ECG is performed to determine arrhythmia.
– Holter monitoring allows you to determine paroxysmal atrial flutter, the causes of the attack, track the work of the heart during sleep and determine the strength of paroxysms.
– Ultrasound examination of the heart (echocardiography) allows you to determine the condition of the valves, contractile myocardial function and the size of the heart chambers.
– A blood test will help identify the cause of atrial flutter. For example, with potassium deficiency, thyroid dysfunction, and so on.
– In some cases, it is necessary to conduct an EFI (electrophysiological study) of the heart.
Treatment and secondary prevention of atrial flutter, in fact, like primary prevention, practically does not differ from the treatment of atrial fibrillation. Comprehensive therapy is always carried out based on the elimination of the root cause of the development of atrial flutter and situations leading to paroxysms. A diet excluding salty, smoked, spicy and fatty foods is necessarily prescribed. You will have to forever give up alcohol and cigarettes and in general should switch to a healthy lifestyle.
Drug treatment is prescribed exclusively by a doctor. You should especially be careful when stopping paroxysms and use only those medicines that the doctor prescribed.
The prognosis of treatment is generally similar to that of atrial fibrillation.
Cardiologist urgent consultation
I want to note that it is very important to distinguish the true cause of atrial fibrillation from factors that only contribute to the manifestation of the disease.
At the moment, about 14 variants of changes in the genotype are known, leading to rhythm disturbance. It is believed that the most frequent and significant mutation is located on chromosome 4q25.
In this situation, a complex violation of the structures and functions of the myocardium of the atria occurs – it is remodeled.
In the future, it is supposed to resort to the help of genomic analysis, which will improve the prognosis of the disease and reduce disability due to early diagnosis of the pathology and timely treatment.
The most informative method for diagnosing atrial fibrillation is an ECG.
But before that, the doctor will collect an anamnesis. Important information will be information about:
- similar rhythm disturbances in the next of kin;
- concomitant diseases, for example, pathology of the lungs, thyroid gland, gastrointestinal tract;
- the initial manifestations of menopause in women.
If the patient independently noticed an irregular pulse, then the doctor will ask: how long have these changes been observed, and whether attempts were made to eliminate them. This is followed by a physical examination, which will immediately allow for differential diagnosis with flutter. Indeed, with atrial fibrillation, heartbeats occur at different intervals.
When listening, the inefficiency of the abbreviations of our “engine” is revealed. This means that the heart rate determined in this case will differ from the pulse rate palpable on the wrist. The “floating” volume of the first tone will also attract attention. No matter how informative the physical examination is, nevertheless, in a number of cases with severe tachycardia, the doctor cannot figure out the cause of the disease and give an opinion on the irregular rhythm. Then a cardiogram comes to the rescue.
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- Signs on an ECG
- Causes of the disease and genetic aspects
- Что провоцирует развитие недуга
- Treatment of atrial fibrillation (atrial fibrillation)
- First aid
- Causes of atrial flutter.
- Treatment of atrial fibrillation (atrial fibrillation)
- First aid
- International recommendations
- Possible complications and consequences
- What triggers the development of the disease
- Relapse prevention
- Medical advice
- Clinical case
- Classification of pathology
- Lifestyle with persistent atrial fibrillation
- Differential diagnosis
- How to conduct a cardiogram
- Terms and definitions
- Classification by episode duration
- Ventricular fibrillation and flutter
- Classification according to the nature of the waves F
Signs on an ECG
Examination of the patient, especially in old age, with the help of an ECG should be carried out during each visit to the doctor. This can significantly reduce the number of consequences of atrial fibrillation (ischemic stroke, acute heart failure) and improve the diagnosis of latent (asymptomatic) and its paroxysmal forms.
But all of them are still inferior in terms of informativeness to the traditional cardiogram, on which the following changes are detected during atrial fibrillation:
- there is no P wave;
- RR intervals, responsible for the rhythm of the ventricles, have different lengths;
- there are ff waves, considered the main sign of the disease.
I draw your attention to the fact that in order to diagnose a paroxysmal form of pathology, one should resort to either a daily short-term recording of an ECG or round-the-clock Holter monitoring.
The photo below shows examples of films of people with atrial fibrillation.
Many identify these concepts, but in fact these are two different states that are characteristic of. The difference between them is the mechanism of action:
- with fluttering, myocardial fibers are reduced slowly;
- during fibrillation, the impulses that are supplied to the myocardium are chaotic in nature and contribute to the fact that its fibers begin to contract too quickly and apart.
Atrial fibrillation and flutter are manifestations of atrial fibrillation, which is especially dangerous for the patient’s health. In particular, this pathology can cause thrombosis and pulmonary thromboembolism, the development of a stroke.
These conditions occur under the influence of factors such as:
- valvular heart disease;
- congenital or acquired pathologies of the heart muscle;
- coronary artery disease.
Atrial fibrillation, which manifests itself in atrial fibrillation or flutter, also causes pathologies that are not associated with impaired cardiac muscle function. So, adrenal tumors, hyperthyroidism, obesity and diabetes can provoke this condition.
Another factor that can cause atrial fibrillation and flutter is alcohol abuse.
Atrial flutter is a phenomenon that, like fibrillation, can manifest itself in various forms.
The main classification is the following division of pathology:
- Typical atrial flutter, or the first type. In this case, such changes are observed: the pathological wave of excitation is directed counterclockwise, up the interatrial septum. After that, she goes to the back wall of the right atrium. Further, the pulse bypasses the mouth of the superior vena cava, reaches its initial position, after which the cycle resumes.
- Atypical atrial flutter in the second type. In this case, the passage of a pathological impulse excludes isthmus.
From a clinical point of view, there are two main types of atrial flutter:
- . An arrhythmia attack occurs suddenly, usually under the influence of provoking factors, and does not last long.
- Permanent form. In this case, cardiac arrhythmias are observed on an ongoing basis.
Existing classifications of atrial fibrillation and flutter facilitate the diagnosis and management of atrial fibrillation. The classifications are based on various factors associated with the nature of the manifestation of pathology.
The pathology under consideration causes a violation of the course of the impulse in the heart through the atrial conducting system. It begins to circulate in a circle in the right atrium. This leads to repeated repeated excitations of the myocardium, which dramatically increases the frequency of contractions.
In this case, the rhythm of the ventricles can remain normal or be elevated, but not as much as the rhythm of the atria. This is due to the fact that the atrioventricular node cannot conduct an impulse so often. An exception to this are patients with WPW syndrome, in the heart of which there is a Kent bundle that conducts an impulse from the atrium to the ventricle at an increased speed compared with the atrioventricular node. In this regard, such patients may also have ventricular flutter.
Pathology is most characteristic of men over 60 years of age.
The passage time of an attack is called flutter paroxysm.
Causes of the disease and genetic aspects
На возникновение трепетания предсердий оказывают влияние как факторы, относящиеся к сердечно-сосудистой системе, так и те из них, которые обусловлены нарушением работы внутренних органов и иных систем.
К первым причинам относятся:
- аномальное строение сердца;
- гипертрофия его камер;
- кардиомиопатия разной тяжести и форм;
- повышенное артериальное давление;
- наличие склонности к образованию тромбов;
- ишемическая болезнь;
- осложнения после операции.
К непрямым причинам относятся следующие:
- эндокринные нарушения;
- легочная эмболия;
- эмфизема этого органа.
Факторы, способствующие развитию этой патологии, следующие:
- интоксикация медицинскими препаратами;
- признак сонного апноэ;
- сахарный диабет;
- сердечно-сосудистые заболевания у родственников;
- постоянные потрясения и стрессы;
- сверхнормативные физические нагрузки;
- бесконтрольный прием средств, имеющих в своем составе кофеин;
- вредные привычки.
При кардиологических причинах клиническая картина может быть невыраженной и присущей многим сердечно-сосудистым заболеваниям. Они могут быть приняты за признаки сопутствующей патологии:
- дефицит кислорода при физических нагрузках;
- снижение двигательной активности;
- подавленное состояние;
- быстрая утомляемость;
Люди, относящиеся к группе риска, должны проходить периодические медосмотры у кардиолога, поскольку при возникновении этой патологии и несвоевременном начале лечения возможно наступление летального исхода.
Что провоцирует развитие недуга
Проводя ЭКГ при явной фибрилляции предсердий, перед назначением лечения выясняют причину развития патологии. В некоторых случаях аритмии разных видов развиваются как осложнение после перенесенных вмешательств. Если операций не было или были, но давно, то обратить внимание на следующие заболевания:
- нарушения митрального клапана;
- ревматические болезни;
- сердечная недостаточность;
- хронические заболевания дыхательной системы.
Symptom Scale (EHRA Scale) is a clinical tool that can help you evaluate symptoms of episodes of atrial fibrillation. It helps determine the course of therapy for a patient suffering from arrhythmia.
Depending on this criterion, the following types of AF are distinguished:
- EHRA I – this value indicates the absence of symptoms;
- EHRA II – in this case, the severity of the symptoms of deviation is mild, so that the everyday activity of the patient is not disturbed;
- EHRA III – the clinical picture is expressed, the symptoms are so severe that the patient’s daily activity is disturbed;
- EHRA IV is the most difficult indicator, as it indicates the presence of symptoms, which leads to disability of the patient, which does not just limit, but completely stops the patient’s daily activity.
The diagnosis of atrial fibrillation is made according to the results obtained during the ECG. Often, a long ECG observation is required to confirm the diagnosis, which can last from 1 to 7 days.
In some cases, it is asymptomatic, which does not exclude the onset of death. There are the following signs of atrial flutter:
- pain having a pressing character located in the chest area;
- fainting and loss of consciousness;
- headache and dizziness;
- feeling of weakness;
- pallor of epithelial integument;
- heavy breathing, shallow;
- heart palpitations;
The following factors can contribute to the appearance of symptoms:
- disruption of the digestive tract;
- drinking plenty of fluids, including alcohol;
- transferred emotional overstrain;
- prolonged stay in the heat or stuffy room;
- excessive exercise.
Attacks can occur from a few per week to 1-2 per year and are determined by the individual characteristics of the body.
Treatment of atrial fibrillation (atrial fibrillation)
In many patients with atrial flutter, the treatment is to take medication continuously.
With the development of an attack, the patient should be given a half-sitting position, aerate the room, unfasten tight clothing and urgently call an ambulance.
At high blood pressure, acute heart failure, rhythm restoration is necessary with the help of electrical stimulation – electric cardioversion. It is carried out in a hospital.
If the rhythm disturbance persists for more than 2 days, they begin the prevention of thrombosis using warfarin or a new generation of anticoagulants – dabigatran etexilad (Pradax), rivaroxaban (Xarelto), apixaban (Elikvis).
New generation anticoagulants
The basis of drug treatment is cardioselective beta-blockers of prolonged action (bisoprolol). They can be combined with digoxin in the tachysystolic form of arrhythmia. Amiodarone or verapamil is sometimes prescribed. Self-medication with these medicines is unacceptable.
The method of choice for atrial flutter is an operation that is performed with frequent seizures or a constant form of pathology. A minimally invasive cardiac surgery is performed – catheter ablation of the atrial region, along which a pathological excitation wave circulates around the tricuspid valve. The operation is performed under local anesthesia and lasts no more than an hour. Patients completely get rid of arrhythmias in 95% of cases.
Atrial fibrillation has two goals:
- stroke prevention
- symptom control AF
In order to help prevent a stroke, doctors prescribe blood-thinning medications (anticoagulants). These drugs help maintain normal blood viscosity by preventing a slowdown in blood flow in the area of the heart — the left atrial ear (LAP), as this can occur during atrial fibrillation.
People suffering from atrial fibrillation and high blood pressure (hypertension), diabetes, heart failure or the elderly, as well as those who have had a stroke, are recommended to take blood thinners. The risk of bleeding when taking anticoagulants is lower than the risk of a stroke without taking them.
The following drugs are used as blood thinners used to prevent the formation of blood clots (blood clots):
- Warfarin (Coumadin): It is perhaps the most famous of all anticoagulants. However, it has its drawbacks, including the risk of severe bleeding. When taking this drug, regular blood tests should be done.
- Dabigatran (Pradaxa): Does not require blood tests. However, it is worth considering the fact that dabigatran is a shorter-acting drug.
- Rivaroxaban (Xarelto): It is taken once a day and does not require regular blood tests.
- Apixaban (Elikvis): A very effective tool to reduce the risk of stroke.
Atrial fibrillation leads to arrhythmias and heart palpitations. That is why doctors often prescribe drugs whose action is aimed at controlling the speed and normalizing heart rate. In some cases, the drug is used to control both of them.
- Beta-blockers: These are a class of drugs that are commonly used to control heart rate. These drugs block some of the effects of adrenaline, which contributes to an accelerated heartbeat. Metoprolol is an example of a commonly used beta blocker.
- Calcium Channel Blockers: These are other commonly used drugs to control heart rate. An example is the drug Diltiazem, which belongs to this class of drugs. These drugs affect the channels in the heart cells that regulate the flow of calcium into and out of these cells. Blocking the transport of calcium through these channels slows down the speed of the heart.
- Digoxin: It is a drug that is still used to control heart rate in people with atrial fibrillation.
- Amiodarone: This medicine is prescribed to restore normal sinus rhythm of the heart. Or it can be used to normalize the heartbeat after a procedure called electrical cardioversion, which is used to eliminate the symptoms of persistent and constant atrial fibrillation.
- Sotalol: Can be used to control heart rhythm.
- Propafenone and Flecainide: Mentioned as a class of IC drugs. Class I drugs transfer sodium across cell membranes to the heart. These drugs are used to control heart rate in people who have only atrial fibrillation due to heart problems. People with coronary heart disease, dysfunction of the heart muscle, and weakened heart muscle are not usually prescribed these drugs.
- Quinidine: Can be used to control heart rate.
- Dronedaron: It is a drug for controlling heart rate.
If your doctor sees the need to use any of the above medicines, then an appropriate treatment plan will be drawn up for you and the necessary drugs will be prescribed.
If adjusting your diet does not help with atrial fibrillation, your doctor will prescribe the necessary medications as the main therapy.
- ERW syndrome. Congenital heart defect. It is characterized by the formation of an excess conductive beam (Kent beam), which provides excessive excitation of cardiac structures.
It is accompanied by severe symptoms. Atrial flutter is one of the possible options, but not the most common. According to statistics, the frequency of this form is 0.3-0.5%, fibrillation, which is also likely, is determined in almost 4% of cases.
- Infectious-inflammatory or autoimmune lesions of the heart muscle, pericardium. Symptoms are also expressed, which will not allow to ignore the condition. Treatment is carried out in a hospital with the use of antibiotics, corticosteroids, and, if necessary, immunosuppressants in minimum dosages.
The acute process entails the destruction of the atria in the short term. Surgical recovery in such a situation without guarantees of success. The same consequence of a long-running chronic process with frequent relapses.
- Cardiomyopathy Impaired development of the heart muscle. There are several forms. All of them are similar in one: the normal tone of the muscles decreases, its volume increases or decreases, depending on the type of process. Perhaps the expansion of the chambers of cardiac structures. Treatment only makes sense in the early stages. Then – a symptomatic effect, it fights with the consequence, and not with the cause.
- Heart defects are congenital and acquired. The most common violations of functional activity, and the anatomical development of valves (aortic, mitral). Correction is strictly surgical, in a short time. According to indications. To lay down, as they say, under a knife without sufficient grounds is not a good idea.
- Heart attack, and subsequent cardiosclerosis. From the point of view of dangerous complications, the threat is not so much the very acute death of heart cells, but the subsequent scarring of the affected areas.
Areas of coarse connective tissue appear. They do not contract, do not have elasticity, do not conduct a signal.
Hence the violation of the normal functional activity of cardiac structures. The same effect is provoked by myocarditis, other inflammatory pathologies, ischemic disease, coronary insufficiency.
In accordance with the current classification, there are several forms of atrial fibrillation:
- The first occurrence is the first recorded episode of arrhythmia, when the likelihood of relapse cannot be established.
- Paroxysmal form of atrial fibrillation – occurs in the form of more or less frequent episodes of rhythm failure, which is restored in no more than a week.
- Persistent (recurrent) fibrillation – lasts more than 7 days and requires cardioversion.
- Permanent form – to restore the rhythm is impossible or not required.
It is important for a practitioner to determine the first occurring form of fibrillation, however, it is far from always possible to establish its duration and exclude the fact of previous episodes of arrhythmia.
When a second or more paroxysm is established, atrial rhythm disturbances are diagnosed as a persistent form of atrial fibrillation. If the rhythm is capable of spontaneous recovery, then such persistent (recurring) arrhythmia will be called paroxysmal, and the term “persistent” will be used for its duration of more than seven days. The first detected arrhythmia can be either paroxysmal or persistent.
The constant form of atrial fibrillation (permanent) is said to be when the rhythm disturbance lasts more than one year, but neither the doctor nor the patient plan to restore the rhythm by cardioversion. In the case when the therapeutic strategy changes, arrhythmia will be called long-term persistent.
Depending on the heart rate, three forms of atrial fibrillation are distinguished:
- Tachysystolic – more than normal pulses reach the ventricles, from the atrial pacemakers, as a result of which the pulse reaches 90-100 beats per minute or more.
- Bradisystolic fibrillation – the frequency of contractions of the ventricles does not reach 60.
- Normosystolic – the ventricles contract with a frequency close to normal – 60-100 beats per minute.
The treatment of patients with atrial fibrillation is aimed at eliminating the negative symptoms of arrhythmia and preventing serious complications. To date, two management strategies have been adopted and are being used:
- Heart rhythm control – restoration of sinus rhythm and drug prevention of recurrence of arrhythmia;
- Heart rate control (heart rate) – arrhythmia persists, but heart rate decreases.
Causes of atrial flutter.
Typical (classical) – the frequency of flutter per minute is 240-340 beats. A wave of excitations circulates in a typical circle in the right atrium.
Atypical – the frequency is 340-440 beats, the correct rhythm is not observed. A wave of excitations circulates there, but not in a typical circle.
By the nature of the course, pathology is divided into the following forms:
- first developed;
The clinical picture in the form of the pathology is almost identical, therefore, it is possible to establish what kind of violation is only possible by carrying out special diagnostic measures.
Paroxysmal atrial flutter lasts up to one week, stops on its own, persistent – more than this period, the sinus rhythm is not restored on its own. Permanent occurs when the applied therapy did not bring the expected result or when it was not carried out.
Tachysystology leads first to diastolic and then to systolic left ventricular myocardial dysfunction, as well as the appearance of heart failure. With this pathology, coronary blood flow decreases up to 60%.
Myocardial fibrillation, atrial flutter have similar mechanisms of appearance, but also a number of differences. The first term refers to the supraventricular type of tachyarrhythmias. At this point, heartbeats become chaotic, and the frequency when counting reaches 350-750 beats per minute. The presented feature excludes the possibility of rhythmic atrial work with atrial fibrillation.
Depending on the classification, fibrillation is divided into several forms. Development mechanisms may have some differences from each other. These include the following:
- provoked by a specific disease;
- atrial fibrillation at rest, permanent form;
- potassium deficiency;
A constant form of atrial fibrillation (or paroxysmal) becomes a manifestation of a number of diseases. In many patients, mitral stenosis, thyrotoxicosis, or atherosclerosis are most often found. The circle of patients with arrhythmia with a dystrophic process in the alcoholic myocardium, diabetes mellitus and hormonal imbalance is expanding.
Paroxysmal arrhythmia occurs in patients in a horizontal position. During sleep, they often awaken from unpleasant symptoms. It can appear with a sharp turn of the body when a person is lying. The mechanism of occurrence of such disorders is associated with pronounced reflex effects on the vagus nerve myocardium.
Under their influence, the conduction of nerve impulses in the atria slows down. For this reason, fibrillation begins with them. The described form of cardiac arrhythmias is able to normalize itself. This is due to a decrease over time of exposure from the nerve to the muscle.
Hyperadrenergic paroxysms are more common than those described above. They appear in the morning and during physical and emotional stress. The last, chronic variant of arrhythmia is called hemodynamic.
It is attributed to stagnant forms of pathology, which is associated with the presence of an obstacle to the normal contraction of the myocardium. Gradually, the atria begin to expand. The leading place among the reasons is occupied by the following:
- weakness of the wall of the left ventricle;
- narrowing of the lumen of the holes between the cavities in the heart;
- insufficiency of the valve apparatus function;
- reverse blood flow (regurgitation) in the atrium;
- tumor-like formations in the cavities;
- chest trauma.
In many cases, fibrillation becomes a manifestation of the disease. For this reason, before starting treatment, you need to establish its origin.
Flutter is characterized by heartbeats up to 350 per minute. This form is called supraventricular or atrial myocardial flutter. Tachyarrhythmia differs from that described above by the presence of the correct rhythm in most patients.
There are people with features of such a disease. Their normal sinus contractions alternate with episodes of flutter. The rhythm is called permanent. This variant of the pathology of the heart has the following etiology (causes):
- CHD (coronary heart disease);
- malformations of rheumatic origin;
- arterial hypertension;
- after surgery for defects or shunting;
Tachysystolic rhythm occurs in patients with diabetes mellitus, insufficient potassium levels in the blood, with intoxication with drugs and alcohol. The basis of pathogenesis (development mechanism) is repeated repeated excitation in the myocardium. Paroxysm is explained by the circulation of such impulses a large number of times.
The provoking factors include episodes of flickering and ectrasystole. The frequency of contractions in the atria increases to 350 beats per minute.
Unlike them, the ventricles cannot. This is due to the lack of opportunity for the pacemaker to high bandwidth. For this reason, they are reduced by no more than 150 per minute. The permanent form of atrial fibrillation is characterized by blocks, which explains such differences between the cardiac cavities.
- pain in the heart or discomfort in this area;
- weakness that does not disappear after rest;
- feeling of heartbeat;
- low blood pressure;
- sensation of interruptions in the region of the heart.
Transient disorders can occur several times a year or more often when the normosystolic rhythm is replaced by a flutter. At a young age, they appear under the influence of provoking factors. In older people, the signs of arrhythmia are disturbing even at rest.
An asymptomatic course is considered the most dangerous. The patient is not worried about anything, which increases the risk of complications – stroke, myocardial infarction, thrombosis and heart failure.
Ventricular fibrillation (or ventricular fibrillation) is characterized by frequent asynchronous contractions of cardiomyocytes due to multiple pathological circles of excitation. In this case, the heart does not cope with its pumping function, and if cardioversion is not done on time, the patient will die.
The electrocardiographic picture of ventricular fibrillation is characterized by the following features:
- The absence of ventricular complexes (QRS).
- The presence of multiple irregular and disorganized waves of conduction of excitation through the ventricles.
- An increase in heart rate to 180 beats per minute and higher.
The ECG of a patient with ventricular fibrillation, figuratively speaking, represents a lot of chaotic sawtooth and wave-like patterns, the number of which corresponds to the number of recorded leads on the apparatus.
Without emergency cardioversion, a patient with ventricular fibrillation will die, therefore, every person who is suspected of having this arrhythmia should immediately receive medical attention.
To stop paroxysm of ventricular fibrillation, both drug and non-drug methods of treatment are used. The most effective electrocardioversion using a defibrillator. If this is not possible for one reason or another, intravenous administration of antiarrhythmic drugs is indicated. Further therapeutic tactics necessarily include finding the causes of ventricular fibrillation.
Flutter is a frequent regular
atrial activity; flickering is a frequent irregular
(promiscuous) their activities. According to many researchers, flutter and atrial fibrillation more often occurs against the background of organic heart disease (cardiosclerosis, cardiomyopathy, heart disease, coronary heart disease).
What does the ECG look like with fluttering and atrial fibrillation, see photo.
A feature of atrial flutter is a change in the ratio of atrial and ventricular complexes, causing a different degree of conduction: 2: 1, 3: 1 or 4: 1.
For non-specialists, it will be enough to know that atrial flutter is almost the same as atrial fibrillation, only the atrial rhythm is not as chaotic as in AF. However, even with atrial flutter, the frequency is too high and ineffective for normal heart function.
Like atrial fibrillation, atrial flutter refers to paroxysmal cardiac arrhythmias. These arrhythmias are similar in symptoms and well-being of patients. The only way to understand that the patient has atrial flutter is an ECG. Electrocardiography gives a slightly different picture than with AF.
Atrial flutter on an ECG is determined by the following symptoms.
- In the II standard or right chest leads, “sawtooth” waveforms F are observed.
- Fluctuations on the graph pass into each other, on the ECG there are no intervals between them
- Also, waves can be observed in the right thoracic intracardiac leads, while, most often, they are passing one into another, with a frequency of sinus vibrations of more than 220 per minute, equal to height / width.
- In patients, an incomplete atrioventricular block is often found, its level changes all the time;
- Ventricular contractions normal in duration.
Atrial flutter quite often passes into atrial fibrillation and vice versa. Even an ECG, at times, does not make it possible to distinguish between these diseases.
Therefore, the diagnosis of flickering-flutter is considered legitimate, while the same data are indicated as with atrial fibrillation. This does not play a decisive role, since treatment involves the use of similar methods and techniques.
Atrial flutter (ECG confirmed) is difficult to correct with medication. What explains the frequent use of transesophageal atrial electrostimulation, with an efficiency of up to 80%.
Doctors, when decoding the electrocardiogram of patients with suspected atrial fibrillation, pay attention to the following analysis features:
- Lack of a P-wave in the places of assignment.
- The presence of atrial waves, which are frequent and irregular, which is triggered by chaotic arousal and atrial contractions. The large-wave and small-wave form of the amplitude of f waves are distinguished. A large-wave form with an indicator of more than one millimeter is observed in people suffering from a pulmonary heart in a chronic form, as well as in those who suffer from mitral stenosis. The small-wave form is inherent in patients with myocarditis, myocardial infarction, thyrotoxicosis, intoxication, cardiosclerosis.
Treatment of atrial fibrillation (atrial fibrillation)
In order to stop arrhythmias, novocainamide is administered intravenously at 50-100 mg / min until the effect is obtained, quinidine powder is prescribed at 400 mg every 2-3 hours to a total dose of 1,4-1,6 g. Less commonly used isoptin at a dose of 5- 10 mg or obzidan in a dose of 5 mg.
With a rapid increase in signs of heart failure, electropulse therapy is carried out in a hospital.
To prevent recurrence of atrial flutter or atrial fibrillation, quinidine, novocainamide, b-blockers, cordarone, isoptin, ethacyzine and ethmosine are prescribed. The drug and its doses are selected individually.
Take cardiac glycosides: digoxin, celanide or isolanide at a dose of 0,125-0,75 mg per day. If they are not effective, b-blockers or isoptin are added.
Despite the fact that many patients live with this condition for many years and do not experience any subjective sensations, it can provoke serious complications such as fibrillation tachyform and thromboembolic syndrome.
The disease is treatable, several classes of antiarrhythmic drugs have been developed that are suitable for continuous administration and rapid relief of a sudden attack.
- Electric cardioversion
- Cardiac Surgery.
- Medication method:
- heart rate control;
- resumption of sinus rhythm;
Achieving normalization of heart rate is the primary task of the doctor at the beginning of therapy, since it is a violation of the stability of the heartbeat that leads to acute heart failure.
Beta blockers reduce the effects of adrenaline on beta adrenoreceptors:
Drugs are taken during or after meals in order to reduce the occurrence of side effects. In no case should you take other medicines at the same time without consulting your doctor.
Calcium channel blockers affect myocardial contractility, vascular tone, and activity of the sinus node. Calcium antagonists slow down the process of calcium penetration through channels and reduce its concentration in the muscle cells of the heart.
As a result, the coronary and peripheral vessels expand. Of the groups of calcium channel blockers in the treatment of paroxysmal atrial fibrillation are suitable:
- derivatives of phenylalkylamine – Verapamil;
- derivatives of benzothiazepine – Diltiazem.
Drugs are taken orally or administered intravenously.
Calcium antagonists are prescribed if there are contraindications for taking beta-blockers, unexpressed symptoms of heart failure.
- hemodynamic stability (blood pressure indicators), severity of the clinical picture;
- the presence of concomitant cardiovascular and other diseases (thyrotoxicosis, sepsis, etc.) that exacerbate the course of arrhythmia;
- the risk of stroke and the need for the appointment of blood thinners (anticoagulants);
- Heart rate and the importance of reducing this indicator;
- symptoms of pathology and the possibility of restoring sinus rhythm.
Only after a comprehensive assessment of the patient’s condition, a decision is made on the tactics of his further management.
It has long been proven that atrial fibrillation significantly increases the risk of developing ischemic strokes. This occurs due to the formation of blood clots in the chambers of the heart with their subsequent migration into the vessels of the brain.
Therefore, the treatment of a constant form of atrial fibrillation, as well as other types of the disease, includes the use of blood-thinning drugs.
Previously, everyone was almost uncontrollably assigned in such a situation antiplatelet agents (Aspirin-cardio, Cardiomagnyl). But now their inefficiency in the prevention of thromboembolism has been proven. Now resorting to the use of vitamin K antagonists (Warfarin) and new anticoagulants that are not vitamin K antagonists (Apixaban, Dabigatran). Moreover, the appointment of the latter group of drugs is accompanied by a lower risk of hemorrhagic strokes (intracerebral hemorrhages).
There are two key strategies to combat atrial fibrillation that are used by practicing cardiologists. One of them is aimed at controlling the heart rate, and the second – at restoring the physiological sinus rhythm. As you know, the choice of tactics depends on many factors. This is the patient’s age, the length of the illness, and the presence of serious concomitant pathologies.
Treatment of the chronic form of atrial fibrillation in the elderly is most often based on the first of the above methods and can significantly reduce the manifestations of the disease, improve the daily activity of patients.
In normal cases, the treatment of atrial flutter involves taking the following drugs:
- potassium products;
- cardiac glycosides;
- beta adenoblockers
- antiarrhythmic drugs;
- calcium channel blockers.
With an attack lasting no more than 2 days, use electrical pacemaker with the following drugs:
Anticoagulants are administered to prevent thromboembolism.
In addition, the following activities are also carried out:
- installation of a pacemaker;
- radiofrequency ablation.
With irregular flutter, drugs are used to thin the blood.
A course of drug therapy is prescribed after the operation.
Treatment of atrial flutter should be performed when the first clinical signs appear. However, to completely eliminate the pathology today is impossible. Only the probability of their occurrence is minimized if the patient takes all the drugs prescribed by the doctor.
In addition, carrying out this procedure can lead to the development of strokes, so before it is possible, intravenous and subcutaneous injections are prescribed to dilute blood.
If conservative treatment does not help and relapses of arrhythmia are observed, then the doctor prescribes:
- radiofrequency ablation;
They are carried out in relation to the conductive paths along which the pulse is circulated during the attack.
With the onset of various complications and a severe course of the pathology, an operation is performed. It is necessary in order to:
- Stabilize your heart rate and heart rate
- improve the general condition of the patient;
- suppress the focus of pathology.
Typical paroxysms are controlled by transesophageal pacing.
Therefore, the AB node establishes a kind of block for these impulses and passes only every second atrial impulse to the ventricles. Sometimes every third or every fourth. But more often, atrial and ventricular contractions correlate as 2: 1. This prevents an overly rapid ventricular contraction, which can be extremely dangerous.
World experts suggest the use of the following drugs for the implementation of antithrombotic therapy, depending on the level of risk of thromboembolic complications:
- in the presence of a thrombus in the atrium, a history of thromboembolism, artificial heart valves, mitral stenosis, arterial hypertension, thyrotoxicosis, heart failure, 75 years of age and older, with ischemic heart disease and diabetes mellitus – from the age of 60 – oral anticoagulants;
- in case of failure to reach 60 years of age and the presence of cardiac pathologies that do not imply the presence of congestive heart failure, arterial hypertension – Aspirin (325 mg / day);
- for the same age in the absence of heart ailments – the same medicine in the same dosage or the absence of treatment.
Recommendations for atrial flutter include control of indirect coagulants at the beginning of treatment – from once a week and more often if necessary, in the future – once a month.
The procedure for taking an electrocardiogram is not complicated. It is only necessary to adhere to the phased implementation of the action plan, which every specialist is familiar with. He will explain in detail what should be done to the patient at the time of diagnosis. The total duration of the procedure on average does not exceed 10 minutes.
Electrodes are fixed on the patient’s body, the position of which the doctor or laboratory assistant changes to obtain various ECG leads.
It is very important that the patient lies calm and motionless during the ECG. In this case, you can guarantee an informative result. Any movement, coughing, sneezing negatively affects the results of the electrocardiogram, and they can no longer be called reliable.
If the restoration of the rhythm after the occurred paroxysm was successful, then the prognosis is favorable. Subject to all therapeutic recommendations, the patient will be able to lead his normal life. When paroxysmal atrial fibrillation has become permanent, the prognosis worsens. This is especially true for people leading an active lifestyle.
It is quite difficult to predict the outcome of the disease, since the nature of the pathology course is individual for each patient. In the absence of severe lesions of the cardiovascular system and conducting competent antiarrhythmic therapy, the risk of complications is minimized.
Atrial fibrillation is a direct threat only in the presence of concomitant heart disease. If there is no simultaneously occurring pathology, then the arrhythmic process does not affect the organ. With protracted forms, due to a violation of the filling of the ventricles and a decrease in the discharge of blood into the arteries, heart failure may develop.
Possible complications include:
- Ischemic stroke
- Atrial thrombosis
- Extensive heart attack
- Regular angina attacks
The described pathology poses a threat to other organs and systems, which is explained by a decrease in the volume of blood ejected. First of all, the liver, kidneys and lungs are exposed to increased stress, which is fraught with additional complications.
The disease is characterized by resistance to therapeutic treatment against arrhythmia, a tendency to relapse, and persistence of paroxysms.
The long-term outlook is unfavorable. Hemodynamics are disturbed, the work of the cameras becomes inconsistent, cardiac output is reduced by 20% or more. There is a mismatch between the capabilities and needs of the body for the implementation of metabolic processes, which leads to chronic circulatory failure. Atrial flutter, the prognosis of which is disappointing, can lead to expansion of the cavities of the heart muscle, which can provoke a fatal outcome.
In the chronic form of the disease, parietal thrombi form in the atria. In the event of their separation, catastrophic conditions in the vessels can be observed. The consequences of the disease can occur in the small and large circle of blood circulation, causing heart attacks of the intestine, spleen, kidneys, gangrene of the extremities, strokes.
Possible complications and consequences
The main complication of PFFP can be a stroke or gangrene due to possible arterial thrombosis. Many people, especially after an attack that lasted more than 48 hours, are likely to have thrombosis, which will provoke a stroke. Due to the chaotic contraction of the atrial walls, blood circulates at a tremendous speed. After this, the blood clot easily adheres to the wall of the atrium. In this case, the doctor prescribes special drugs to prevent thrombosis.
If the paroxysmal form of atrial fibrillation develops into a constant, then there is a likelihood of developing chronic heart failure.
To discuss what complications can arise as a result of atrial flutter is problematic, since TP is an unstable rhythm that proceeds in the form of episodes. However, there are indications that:
- possible development of ventricular fibrillation;
- when arrhythmias occur, atrial flutter can be complicated by heart failure, which can lead to death;
- prolonged seizures can trigger a stroke, which is the greatest danger to life, blockage of the pulmonary arteries, and insufficient kidney function.
It is believed that about 15% of strokes occur as a result of arrhythmia, which was not diagnosed on time.
Various forms of atrial flutter can lead to the following complications:
- heart failure;
- myocardial infarction;
- a stroke;
- ventricular tachyarrhythmia;
- ventricular fibrillation.
All these pathologies can lead to death.
What triggers the development of the disease
An explanation of the pathology formation method is required to understand the correction paths.
Normally, the heart works autonomously, without support from other organs and systems. The brain, meanwhile, provides the very fact of the functioning of the heart. Change in heart rate is possible through stimulation with hormones, etc.
Cardiomyocytes are the only ones capable of spontaneous self-excitation and further contraction. This is a natural mechanism for ensuring work. For the adequate generation of an electrical impulse, the so-called sinus node is responsible.
If the signal begins to be created by other cardiac structures, excessive organ activity occurs. As a rule, the atria (80% of situations), less often the ventricles, are the source of pathology development.
Identification of a specific cause rests with instrumental methods: electrocardiography and daily monitoring. Based on their results, we can talk about a solution.
Preventing the disease is much easier than curing. Therefore, it is necessary to monitor the state of your heart, and at the slightest change in his work or his own health, it is necessary to visit the doctor’s office.
With the congenital form of the disease, special preventive measures do not exist. The expectant mother should eliminate bad habits and rationally build her diet.
General preventative recommendations include the following:
- timely treatment of various ailments to exclude their transition into a chronic form;
- moderate physical activity;
- balanced diet;
- rejection of bad habits.
Unfortunately, there is no specific prevention of atrial fibrillation, because preparations and technologies capable of combating genetic mutations have not yet been developed. Therefore, all that remains is to prevent, as far as possible, the appearance of diseases that provoke the development of arrhythmia.
I think there is no need to talk about lifestyle modifications that can reduce the risk of obesity, diabetes and hypertension. But many forget that, having a family history of arrhythmias, it is necessary to treat all diseases of the lungs and bronchi on time, to choose a profession correctly, avoiding working with high levels of dust in the air (for example, mining). This will reduce the risk of fibrillation associated with COPD.
Patient A., 25 years old, was brought to the admission department with complaints of lack of air, inability to breathe fully, palpitations, dizziness, sharp general weakness. The patient was engaged in semi-professional powerlifting, and with the next approach he lost consciousness. In the family, grandmother and mother were diagnosed with atrial fibrillation. Objectively: the skin is pale, shortness of breath at rest, Blood pressure 90/60 mm Hg, heart rate during auscultation 400 beats / min, also the first tone is heard louder than normal, the rhythm is wrong, the pulse on the radial artery is 250 beats / min . Preliminary diagnosis: “First detected atrial fibrillation.”
To confirm the diagnosis used: clinical blood and urine tests, determination of the level of TSH, ECG, Echo-KG. The patient underwent pharmacological cardioversion “Dofetilide”, after which the sinus rhythm with heart rate was restored within 60-64 beats / min. During the hospital stay, XNUMX-hour ECG monitoring was performed, and paroxysms of fibrillation were not observed. The patient was recommended to limit physical activity.
To prevent repeated attacks, you should regularly take medications prescribed by your doctor at the indicated dosage. Remember the names of the drugs, always keep them at hand, as well as previously taken ECG. Timely check a blood test for clotting, INR levels, sugar, cholesterol.
Preventive measures include:
- elimination of potassium and magnesium deficiency;
- solving digestive problems;
- compliance with the regime of the day with a predominance of time for rest;
- blood pressure correction;
- decreased body weight;
- rejection of bad habits.
With strong excitement or stress, it is recommended to use herbal sedatives, practice yoga, meditation, and auto-training. Compliance with medical prescriptions, the exclusion of risk factors and severe stress, the regular use of anticoagulants, and the control of heart rate reduce the risk of recurrence of paroxysm to a minimum.
With the onset of an attack, it is necessary to provide access to fresh air, take a comfortable position in the body, take a sedative, call an ambulance.
Classification of pathology
According to doctors, paroxysmal atrial fibrillation can occur in two forms:
- Flickering – Frequent contractions will be noticeable in ECG images, however, pulses will be insignificant due to the fact that not all fibers are reduced. Frequency exceeds 300 beats per minute;
- Flutter – the sinus node stops its work, the atria are reduced with a frequency of up to 300 beats per minute.
Regardless of the form, the disease carries a danger, since an insufficient number of impulses enter the ventricles. Accordingly, in the most pessimistic case, this will lead to cardiac arrest and death of the patient.
This classification does not take into account the frequency of seizures, so there is another type of pathology – recurrent. This is called paroxysm of atrial fibrillation, which is repeated in time. Initially, seizures can be infrequent, practically do not disturb a person, their duration will be only a few seconds or minutes. Over time, the frequency will increase, which will negatively affect health – the ventricles will experience starvation more often.
For what reasons, paroxysm develops. In most cases, the development of the disease is promoted by primary disturbances in the heart. That is, patients who were diagnosed with paroxysm of atrial fibrillation were already registered with a cardiologist, as they had congenital or acquired diseases.
Some common causes include:
- Inflammatory processes leading to deviations in the work of the cardiovascular system;
- Ischemic strokes
- Heart defects that caused an increase in the size of the heart chambers;
- High blood pressure, which contributed to an increase in heart weight;
- Congenital inherited cardiomyopathy.
However, not only the disease can cause paroxysm, but also the patient’s improper lifestyle or other causes. For instance:
- Alcohol and coffee abuse;
- Untreated infections or intoxication of the body;
- Lack of magnesium and potassium;
- Postoperative condition;
- Disturbances in the work of the lungs, which led to pressure on the heart muscle;
- Hormonal disruptions in the body;
- Frequent and intense overload, lack of sleep, depression, a rigid diet and exhaustion of the body;
- Frequent use of energy, glycosides and other substances that affect the level of adrenaline and heart function.
IHD, congenital or acquired disorders, as well as other non-cardiac factors can cause pathology. It is very important to identify the cause and eliminate it, since without this it is impossible to talk about successful treatment.
Lifestyle with persistent atrial fibrillation
From the diet exclude:
The intake of fluid is limited, the number of meals should be large, while it is taken in small portions. Do not eat foods that can cause flatulence and bloating. The diet is almost salt-free.
The patient should be disciplined, take prescribed medications and avoid the influence of factors that can cause an exacerbation of pathology.
From the diet you need to exclude sweets – honey, sweet pastries, chocolate, sugar.
Excess glucose in the blood damages blood vessels, which, together with high cholesterol, leads to the progression of atherosclerosis, which to one degree or another is the cause of all acquired cardiovascular diseases.
It is also necessary to refuse fatty and fried foods, and avoid overeating – an overflowing stomach provokes arrhythmia.
Known products that improve the contractility of the heart and blood circulation. These include:
These products should be included in the diet for atrial fibrillation daily.
Excessive exercise is contraindicated, but constant and sufficient physical activity is necessary.
Necessarily need daily walks, perhaps Nordic walking.
Useful daily exercises in health gymnastics – Indian yoga or Chinese qigong is suitable.
The main diagnostic method is to detect an irregular, non-sinus rhythm with atrial waves on the ECG, in connection with which a differential diagnosis is made with conditions similar to ECG data: atrial tachycardia, atrial flutter, frequent atrial ectopia, double antegrade conduction through the AVU.
With atrial tachycardia and atrial flutter, an extended atrial cycle of ≥200 ms is often observed. In the treatment of AAP, an increase in the duration of the atrial cycle against the background of AF is noted. For the differential diagnosis of AF from other rare supraventricular arrhythmias with irregular intervals, it is necessary to register an ECG during arrhythmia.
Any episode of suspected AF should be recorded on an ECG in 12 leads, the duration and quality of which should be sufficient to assess atrial activity. Sometimes, with frequent ventricular rhythm, AVU blockade against a Valsalva test, massage of the carotid sinus or iv administration of adenosine allows atrial activity to be detected.
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Differential diagnosis and justification of additional studies Table 9. Differential diagnosis of AF / TP according to ECG
|Arrhythmia||Rhythm||Atrial frequency |
|Ventricular rate |
|Sinus tachycardia||right||100 – 180||100 – 180||sinus node||present before every QRS||gradual slowdown|
|ФП||wrong||400 – 600||75 – 175||atria||no||Frequency slowdown, irregularity persists|
|Atrial flutter||correct (sometimes alternating block)||250 – 350||75-150 (often holding 3: 1, 2: 1)||atria||negative sawtooth in lead II||Temporary conductivity reduction|
|AV nodal reciprocal tachycardia||right||180 – 250||180 – 250||AV node||In the QRS complex||stopping|
|Atrial tachycardia||right||120 – 250||75 – 200||atria||The P wave preceding the QRS complex is different from the sinus origin||Temporary AV unit|
|Atrial ventricular recurrent orthodromic tachycardia||right||150 – 250||150 – 250||AV ventricle re-entry||RPlt;gt;||stopping|
|AV nodal tachycardia||right||60 – 100||70 – 130||AB – node||RPlt;gt;||contraction|
Clinically atrial fibrillation manifests itself in several forms:
- paroxysmal, when an attack of fibrillation lasts no more than 48 hours in the case of a successful treatment (cardioversion), or paroxysm is restored in 7 days;
- persistent – arrhythmia lasts more than a week, or it is possible to eliminate fibrillation later than 48 hours when conducting drug therapy and electrical exposure;
- permanent form when chronic fibrillation is not eliminated by cardioversion. Medication in this case is ineffective.
Given the heart rate and signs of typical atrial fibrillation on an ECG, three options for fibrillation are determined:
- normosystolic form – heart rate within 60-100 beats per minute;
- tachysystolic – heart rate of more than 90 beats per minute;
- bradysystolic – heart rate less than 60 beats per minute.
The clinical diagnosis of the patient includes a characteristic of arrhythmia and ECG data, which decipher: atrial fibrillation, persistent form, tachysystolic variant.
How to conduct a cardiogram
Atrial fibrillation ecg. An electrocardiogram is removed quickly enough. The accuracy of the result depends not only on the experience of the doctor, but also on the patient himself. Before undergoing the procedure, he must fulfill several recommendations of the attending physician. 24 hours before the examination is prohibited:
- drink drinks containing alcohol and caffeine;
- to smoke;
- Exercise (it is better to avoid any exertion).
It is also necessary to minimize or eliminate the negative impact of stress factors, eat heavy food. In order for the studies to be as accurate as possible, the doctor may recommend stopping some medications for a while. Compliance with these requirements will make it possible to obtain the correct result.
The procedure is carried out in a prone position and takes a little time. The patient removes his outer clothing so that the doctor can fix the electrodes. During the examination, the person lies motionless. Decipher the results should be the attending physician.
Terms and definitions
Atrial fibrillation (AF) and atrial flutter (TP). They are often combined with the term “atrial fibrillation” since both of these arrhythmias have similar etiological factors, pathogenetic mechanisms, and are often found in the same patients. However, these AF and TP are two separate nosological forms, each of which has its own specific approaches to diagnosis and treatment [1,2].
Classification by episode duration
Depending on the duration, the following types of atrial fibrillation are distinguished:
- First identified. This form is diagnosed if the manifestations of deviations are detected for the first time, regardless of the severity or presence of the clinical picture. The attack lasts 10-15 minutes.
- Paroxysmal. Heart rhythm disturbance is recurrent and stops spontaneously. Usually an attack lasts two days or less. The specified type of atrial fibrillation is not characterized by the duration of episodes and does not exceed seven days. Most often, the phenomenon is observed for 1-2 days, but its minimum duration is 3 minutes. With this form, as with the previous one, there is a chance of spontaneous recovery of the heart rhythm.
- Persistent. This type of fibrillation is different in duration: an attack can last more than 7 consecutive days. With long-term persistent forms, the symptoms of deviations are observed for more than twelve months.
- Constant. This form has existed for a long time. The clinical picture of constant AF is determined by periods of recurring seizures. The constant type of atrial fibrillation is special: in this case, it is not possible to restore the rhythm. Measures are being taken to control heart rate indicators.
Ventricular fibrillation and flutter
According to the factor of ventricular contractions, these forms of pathology are distinguished:
- Tachysystolic. In this case, the number of impulses arrives to the ventricles more than necessary, due to which the pulse rate is more than 100 beats per minute.
- Bradisystolic. With this form, the heart rate indicator is either normal or reduced (less than 60 beats per minute), and the heart rate remains normal.
- Normosystolic. Ventricles with this form contract with a frequency that is as close as possible to normal values (from 60 to 100 beats per minute).
With changes in the nature of physical activity, as well as depending on the degree of emotional stress, various pathology options, classified by the frequency of contraction of the ventricles of the heart, can succeed each other.
Classification according to the nature of the waves F
Waves F on the electrocardiogram represent the total action potential of the heart muscle that occurs with electrical stimulation.
Depending on this criterion, the following types of fibrillation are distinguished:
- Large-wave. On the ECG, in this case, large and rare teeth of atrial fibrillation are noted. This form of AF is usually observed in heart muscle defects, which causes atrial overload.
- Small-fiber. On the ECG, frequent and small waves of atrial fibrillation are noted, which is usually characteristic of cardiosclerosis.