The contents of this page have been produced by a team of physicians and experts of the Italian Institute of Telemedicine in compliance with the recommendations of the latest medical and scientific guidelines. Institutional communication not subject to authorisation pursuant to the Ministerial Decree 23/02/2006
What is the atrial fibrillation?
The atrial fibrillation has to be considered as an arrhythmia, i.e. a heartbeat disorder arising in the atria, two of the four cardiac chambers. By atrial fibrillation, atria contract in an uncoordinated manner, causing blood stagnation inside them. The risk in this case is the formation of clots, o. e. solidified blood clusters.
Clots are very dangerous because they can enter the blood stream, reach the brain, obstructing the cerebral arteries and causing a brain stroke, which can be defined as a real infarction, but at brain level.
Atrial fibrillation is often a symptom-free condition. This means it causes no complains and is therefore particularly dangerous because who suffers from it, is not aware of it and does not get duly treated, with the resulting increase in the risks of cardiovascular diseases and of cerebral strokes. Only specific exams such as, for instance, an electrocardiogram can give a definitive diagnosis, anyway there are also instant check indicators (for instance feel the wrist pulse to look for possible anomalies) which may point to an atrial fibrillation.
Atrial fibrillation in figures
The atrial fibrillation is the most common cardiac arrhythmia among the adult population. On average it affects the 2% of adult people and the risk grows along with the age: 1 person out of 4, over 40, has risk factors of the arising of the atrial fibrillation.
In Italy more than 1 million people are affected by atrial fibrillation, with 120 thousand new cases each year. The most serious consequence of the atrial fibrillation is the cerebral stroke, which in one case out of five is due to this arrhythmia.
The risk factors of atrial fibrillation
There are particular conditions relating to a high risk of atrial fibrillation.
- Old age (over 65)
- Diabetes mellitus
- Thyroid disorder
- Cardiac problems
- Chronic obstructing bronchopathy
- Sleep apneas
- Renal insufficiency
- Alcoholic beverages and cocaine abuse
Atrial fibrillation is symptom-free in approximately one third of the patients, a highly dangerous situation because not being treated gives a significant increase in the risk to be affected by a stroke. Furthermore, not rarely the atrial fibrillation appears in “paroxysmal” form characterized by an unexpected outbreak which generally resolves spontaneously. This makes the diagnosis even harder.
The symptoms of atrial fibrillation
- Feeling a “strange” heartbeat, irregular or quick
- Breathing difficulty under stress (dyspnea)
- Easy fatigue (asthenia)
The easiest way to check the existence of a possible arrhythmia, and in this specific case of the atrial fibrillation, is the wrist palpation.
An arrhythmia has to be suspected when the heart rate is much higher or lower than the usual beat, when the intensity of the pulse is not always the same or when or the interval between a pulse and the next one is not constant (irregular pulse).
Now it’s possible to check in a much easier way the occurrence of a possible atrial fibrillation thanks to the use of automatic electronic blood pressure monitors equipped with validated algorithms to detect the occurrence of this kind of arrhythmia.
The wrist pulse palpation or the blood pressure measurement is important for the screening of the atrial fibrillation, but it must be followed by the control of the physician who shall perform the needed tests, such as an electrocardiogram, to reach a definitive diagnosis of atrial fibrillation.
The physicians recommend the screening of the atrial fibrillation for all elder people over 65 years or for people of at least 50 years of age with hypertension, diabetes, cardiac insufficiency or who already suffered from a stroke.
How to check the heartbeat at the wrist
- Perform the detection in the seated position, in a quiet environment, with a comfortable temperature
- The test must be performed possibly away from food and from the smoke of cigarettes and never after an intense exercise (ex. running, climbing stairs)
- During the test breathe regularly
- Keep one hand with the palm facing upwards and slightly bend your elbow
- With the other hand place your index and middle fingers on the wrist, looking for the point in which you can feel the intermittent skin lifting and exert a slight pressure
- Using a watch count the beats for 30 seconds and multiply by two to get the heart rate
- Check that the pulse is regular
- The heart rate and the regularity of the heartbeat can be assessed also by means of a single channel electrocardiograph or a blood pressure monitor equipped with an algorithm for the detection of the atrial fibrillation
- In case of detection of the atrial fibrillation during the performance of the single-channel electrocardiogram or of the blood pressure measurement and in case no disorder is detected check the regularity of the wrist pulse by means of the palpation of the radial artery and make a new detection one hour later. In case of disorders immediately contact your physician
How to treat the atrial fibrillation
The atrial fibrillation, as well as all the deriving complications, can be treated and monitored, especially if diagnosed on time.
Thanks to the available therapies it’s now possible to treat an average amount of 3 out of 4 cerebral strokes caused by the atrial fibrillation.
The formation of clots can be prevented by specific medications which, by keeping the blood thinner can effectively reduce the risk of stroke.
Furthermore the physician can administer antiarrhythmic drugs which can eliminate arrhythmia and thus restore the regular heartbeat or maintain the arrhythmia, but lowering the heart rate and so reducing the symptoms. The atrial fibrillation can be also prevented by maintaining healthy lifestyles.