Atrial flutter: causes, diagnosis, treatment
Cardiovascular diseases are the most global problem on the planet, regardless of where a person lives - in the United States or African countries. This group of diseases is most dangerous for its complications, and more precisely, heart attacks and strokes, which annually claim several tens of millions of lives. The provoking and often the main factor that triggers the occurrence and development of these complications is arrhythmia.
Modern classifications of arrhythmias suggest an extensive system of their separation into various types and classes, but tachyarrhythmias, atrial fibrillation and atrial flutter, are among the most dangerous. Their danger is due to serious and sometimes fatal complications.
Atrial flutter is referred to a large group of tachyarrhythmias, that is, rhythm disturbances with an increased heart rate.Normally, the heart rate should be from 60 to 90 beats per minute, while trembling it averages 200-300 per minute. The source of pathological changes is localized in the atria.
Normal pulse propagation through the heart and its changes during atrial flutter
The heart can be compared to a pump for pumping blood with an “autonomous” and “central” power supply. By “central” nutritional apparatus is meant a combination of nerve plexuses and endings that correct the work of the heart muscle depending on signals from the central nervous system. "Autonomous" power means the cardiac conduction system through which the nerve impulse circulates in a certain direction.
Autonomous power supply consists of such structures - sinus node, AV node, His bundle legs and Purkinje fibers. Sinus node plays an important role, because it acts as a pacemaker, independently (like a battery) generates a nerve impulse with a frequency of 60–90 beats per minute (variant of the norm).
Originating in the sinus node, the impulse spreads first from the right to the left atrium, then to the AV node, which is a kind of boundary between the atria and the ventricles.After the passage of the atrioventricular node, the impulse along the legs of the bundle of His (right and left) spreads to the ventricles and causes their contraction. Purkinje fibers are small branches from the legs of the bundle of His, which providethe prevalence of impulse in all parts of the ventricular myocardium.
With atrial flutter, the mechanism of pulse propagation changes significantly. After formation in the sinus node, the excitation extends not only to the AV node, but also independently circulates along special alternative paths within the atria.
The frequency of pulse generation is too high to completely reach the ventricles and cause them to contract. At the same time, the atrial contraction is defective and inconsistent, that is, carried out by separate muscle bundles. The ventricles do not have time for the frequency of atria due to the restrictive properties of the atrioventricular node. The load on the atrium gradually increases, leading to stagnation in the inferior and inferior vena cava.
If we consider blood circulation, then the atria, which are reservoirs,they cannot completely fill with blood, respectively, the ventricles fill very little and the heart pushes several times less blood volume into the bloodstream. There is an overload of the atria and ventricles, as a result of which the stroke volume of the heart drops. Hypoxia and often loss of consciousness develop.
Atrial Flutter Forms
The most common classification identifies typical and atypical forms.
This separation is based on different paths of impulse circulation and has prognostic significance for both treatment and the further possibility of relapse.
A typical form is the constant circulation of the pulse across the atrium counterclockwise around the tricuspid valve. On the contrary, with an atypical form, the path of propagation of the impulse changes due to organic changes in the heart muscle and quite often occurs after surgical interventions on the heart.
The typical form is prognostically easier for both treatment and drug relief. Catheter ablation contributes to almost 100% cure of atrial flutter. Treatment is considered the gold standard in all foreign clinics.
Immediately it should be said that this type of arrhythmia can occur in both healthy and sick person. Usually its occurrence in a healthy person is associated with the influence of drugs, stress, nicotine and caffeine. If atrial flutter is detected on an ECG in a healthy man or woman, then it is called idiopathic. Often an attack of fluttering may occur in response to a stressful situation or significant physical exertion.
Atrial fibrillation and flutter have similar causes. There are factors that can provoke the development of flutter. They can be divided into factors related and unrelated to the pathologies of the cardiovascular system.
The first group includes heart disease, the symptoms of which provoke the occurrence of arrhythmias: hypertension and hypertension, heart disease of various origin, myocardial inflammation, coronary heart disease and heart failure. Provocateurs that are not associated with the heart and blood vessels are usually represented by endocrine diseases (most often thyrotoxicosis and diabetes mellitus), chronic obstructive pulmonary diseases,various intoxications (both alcoholic and drug), excessive use of caffeine-containing foods and beverages.
Depending on the specific reasons, further treatment is determined. If this
diseases that have no connection with the heart and vessels, then the effectiveness of the curehigh and directly depends on the complete elimination of the provoking factor. If heart diseases are revealed, the symptoms of which provoke the occurrence of arrhythmias, it is necessary to constantly monitor and monitor the work of the organ, and take appropriate pharmaceutical preparations regularly.
Atrial fibrillation can manifest itself in different ways. If this is an episodic attack, then the patient may not even notice any changes. Sometimes there may be a slight excitement, interruptions in the work of the heart. The degree of manifestation of flutter depends on the time, age and condition of the heart muscle.
Older people usually notice symptoms similar to ischemic heart disease - interruptions in the heart area, dizziness, slight weakness, shortness of breath with little exertion.Quite rarely observed non-intense aching or stabbing pain. If there is a significant change in the blood supply of the vascular bed, then a loss of consciousness is possible.
It is correct to recognize that the atrial flutter has arisen, can be experienced hypertension or the core, which over the years has studied your body and knows its characteristic manifestations. For the average person, the pulse rate rarely can indicate the true cause of the deterioration of well-being.
What is dangerous trembling
Atrial flutter, which is not corrected in time with medicines, can have serious and sometimes tragic consequences for the body.
First of all, hemodynamic changes that occur due to impaired pumping function of the heart should be noted. The nervous system and the heart muscle respond most strongly to this change. As a result, a person may lose consciousness or a possible attack of angina.
Thromboembolic complications occur due to impaired blood movement. The atria serve as a kind of reservoir for the formation of blood clots. In the future, a blood clot comes off and clogs the arterial trunks of various organs.Especially often this situation is observed in patients with heart failure.
Diagnosis of atrial flutter
The simplest method of diagnosis is the electrocardiogram. It captures the characteristic changes in the heart and allows you to establish the form of arrhythmia. However, the method will not work in case of episodic attacks. In this case, conduct daily monitoring of ECG - the so-called Holter monitoring.
In some cases, there is a need to carry out a metered load in the form of bicycle ergometry or treadmill test to provoke the occurrence of arrhythmias.
Echocardiography (or ultrasound of the heart) allows you to examine the inside of the heart chamber and establish the presence or absence of blood clots. Also determine the size of the atria and ventricles, the structure and timing of the valves of the heart. Various additional assays (fibrinogen, D-dimers, etc.) are used to identify thromboembolic complications.
Treatment can be divided into 2 large groups:
If atrial flutter is detected on an ECG (paroxysm), then this eliminates symptomatic treatment.Various groups of antiarrhythmic drugs are used, which block the circulation of the pulse throughout the atria and restore normal sinus rhythm.
Such therapy has a temporary effect and is used to eliminate atrial flutter in young people and patients with provoking pathologies. In the case of arrhythmia, which cannot be relieved by drugs, instrumental methods of regulating the heart rate are used. We are talking about electropulse therapy, which can be carried out either as cardioversion or as esophageal stimulation. The methods differ somewhat in the method of conduction, however, they have one principle of operation - the device generates a powerful electrical charge, which drastically slows the circulation of the pulse through the atria, due to which the normal sinus rhythm is restored.
Usually for effective adjustment of the correct rhythm is enough from one to three discharges of the apparatus. After electropulse therapy, the patient should be kept for several days under the supervision of physicians to prevent possible repeated attacks.
For young patients it is important to identify and eliminate in time the factor that causes the pathology, which in turn will lead to a complete cure.If there is a hormonal disorder, chronic obstructive pulmonary disease or a different type of intoxication, they should be immediately cured or put into remission. Only in this case, it is possible to quickly eliminate atrial flutter. The treatment is carried out in the form of courses for several years.
Radical treatment involves the organic removal of areas of the atria that pathological arousal may circulate. The only and quite highly effective method is called catheter ablation.
Preparation, as well as for any other operation, requires additional analyzes and
surveys. Laboratory tests of blood and urine, ECG monitoring, various types of echocardiography are performed to determine the state of the heart cavities.
Catheter ablation is a minimally invasive surgical procedure, the essence of which consists in radiofrequency annealing of areas of pathological excitation circulation. A special radiofrequency catheter is inserted through a small incision in the vessel and advances along the inferior vena cava to the right atrium.There are several radiofrequency ablation procedures in this area. The catheter is monitored by a doctor through an x-ray machine. An operation with an uncomplicated course lasts on average from 30 to 60 minutes.
In cases of atypical arrhythmia, an additional atrial hardware reconstruction is performed for electrical mapping of points, which should be influenced by a hardware impulse and atrial flutter should be completely eliminated.
In the postoperative period, you should strictly follow all the recommendations of the doctor. Moderate and intense physical exertion is limited, an anti-cholesterol diet is prescribed, and blood thinners are taken.
Preparations for blood thinning are represented by heparins, which are injected subcutaneously during inpatient treatment, then they are replaced by so-called indirect anticoagulants, which are represented by tablet formulations (drugs "Warfarin", "Sinkumar" and others). The latter are taken at least a month after the operation in doses prescribed by the attending physician. The effectiveness of the action of these drugs is checked by delivery of a coagulogram (analysis of blood clotting).This analysis indicates how much the blood potential for clotting is changed and whether there is a risk of blood clots.
If the postoperative period is uneventful, the patient should visit the doctor in a planned manner. Usually the first visit is planned in a month, then in two months in order to dynamically monitor the state of the heart and blood vessels.
Possibility of relapse
Symptomatic therapy eliminates paroxysm of atrial flutter and does not affect the true cause. Therefore, a very high probability of relapse.
The radical method effectively eliminates atrial flutter. Treatment limits the likelihood of relapse to a limit of 5–10%. This can usually happen after suffering an irregular form of arrhythmia. In case of recurrence, a repeated procedure of catheter ablation is recommended to eliminate additional sources of circulation of pathological impulses.