Treatment of atrial fibrillation. How to provide first aid for atrial fibrillation? Emergency care for paroxysmal atrial fibrillation

Atrial fibrillation is a type of arrhythmia in which the atria contract at a frequency of 350-700 per minute, but only a part of the impulses reaches the ventricles, which creates the preconditions for their discoordinated activity and is expressed in the irregularity of the pulse.

Atrial fibrillation is considered one of the most common variants of cardiac arrhythmias. It occurs everywhere, mainly among people of mature and elderly age, and over the years, the likelihood of arrhythmia only increases. Pathology is not only of great socio-medical importance due to the high risk of severe complications and death, but also economic, as it requires significant material costs for prevention and treatment.

According to statistics, atrial fibrillation accounts for up to 2% of all cardiac arrhythmias, and the number of patients is constantly growing due to the general aging of the world's population. By age 80, the prevalence of atrial fibrillation reaches 8%, and in men, the pathology manifests itself earlier and more often than in females.

Atrial fibrillation very often complicates chronic heart failure, which in turn affects most people with coronary artery disease. At least a quarter of patients with chronic circulatory failure already have an established diagnosis of atrial fibrillation. The combined effect of these diseases causes mutual aggravation of the course, progression and a serious prognosis.

Another common name for atrial fibrillation is atrial fibrillation, it is more common among patients, but medical professionals also actively use it. The accumulated experience in the treatment of this pathology allows not only to eliminate arrhythmia, but also to timely prevent paroxysms of atrial fibrillation and their complications.

orderly formation of impulses in the sinus node, triggering a cardiac contraction in the norm (left) and chaotic electrical activity in atrial fibrillation (right)

Diagnosis and ECG signs of atrial fibrillation

If ventricular fibrillation is suspected, even if the attack occurred only according to the patient, and by the time of the examination it had stopped, need to conduct a thorough examination. To do this, the doctor asks in detail about the nature of complaints and symptoms, the time of their appearance and connection with stress, finds out if the patient suffers from any other cardiac or other pathology.

Examinations for suspected ventricular fibrillation can be carried out on an outpatient basis, although with a primary paroxysm, the ambulance will prefer to deliver the patient to the hospital after taking a cardiogram that confirms the presence of an arrhythmia.

Atrial fibrillation on the ECG has a number of characteristic features:

1. The disappearance of the P wave due to the lack of coordinated atrial contractions;
2. Waves f, characterizing the contractions of individual fibers and having a variable size and shape;
3. RR intervals of different duration with unchanged ventricular complex.

To confirm atrial fibrillation, at least one ECG lead must have typical changes. If at the time of the study the attack has stopped, then the patient will be offered to undergo daily monitoring.

Echocardiography can detect valvular defects, intraatrial thrombi, foci of structural changes in the myocardium. In addition to heart studies, tests for thyroid hormones, liver and kidney function, are shown.

Video: ECG lesson for non-sinus arrhythmias, fibrillations and flutters

Principles of treatment of atrial fibrillation

When planning the treatment of atrial fibrillation, the doctor is faced with a choice: to try to achieve the return of the correct rhythm, or to maintain the arrhythmia, but with a normal heart rate. Recent studies show that both treatment options are good, and pulse control, even in the presence of arrhythmia, improves survival rates and reduces the incidence of thromboembolism as complications.

Treatment of patients with atrial fibrillation aims to eliminate the negative symptoms of arrhythmias and prevent severe complications. To date, two strategies for managing patients have been adopted and used:

• Heart rate control- restoration of sinus rhythm and drug prevention of arrhythmia recurrence;
• Heart rate control(heart rate) - the arrhythmia persists, but the heart rate slows down.

All persons diagnosed with arrhythmias, regardless of the chosen strategy, are given anticoagulant therapy to prevent atrial thrombosis, the risk of which is very high in atrial fibrillation, both permanent and during paroxysm. Based on the manifestations of arrhythmia, age, comorbidity, a treatment plan is drawn up on an individual basis. This can be cardioversion, drug maintenance of the target heart rate, prevention of repeated episodes of fibrillation and thromboembolic syndrome is mandatory.

Anticoagulant therapy

Atrial fibrillation is accompanied by an extremely high risk of thrombosis with embolism in a large circle and the manifestation of the most dangerous complications, in particular - embolic stroke, so it is very important to prescribe anticoagulant therapy - direct or indirect action.

Indications for the appointment of anticoagulants are:

Anticoagulant therapy includes:

• Indirect anticoagulants - warfarin, pradaxa - are prescribed for a long time under the control of a coagulogram (INR usually 2-3);
• Antiplatelet agents - acetylsalicylic acid (thrombo ass, aspririn cardio, etc.) at a dose of 325 mg, dipyridamole;
• Low molecular weight heparins - are used in acute situations, before cardioversion, reduce the length of stay in the hospital.

It should be borne in mind that long-term use of blood thinners can cause adverse effects in the form of bleeding, therefore, people with an increased risk of such complications or a decrease in coagulability according to the results of a coagulogram should be prescribed anticoagulants with extreme caution.

a. Rhythm control strategy

The rhythm control strategy involves the use of pharmacological agents or electrical cardioversion to restore the correct rhythm. In the tachysystolic form of arrhythmia, before restoring the correct rhythm (cardioversion), it is necessary to reduce the heart rate, for which beta-adrenergic blockers (metoprolol) or calcium antagonists (verapamil) are prescribed. In addition, cardioversion requires mandatory anticoagulant therapy, because the procedure itself significantly increases the risk of thrombosis.

Electrical cardioversion

1. Procainamide;
2. amiodarone;
3. Propafenone;
4. Nibentan.

Procainamide administered intravenously, but causes many side effects - headache, dizziness, hypotension, hallucinations, changes in the leukocyte formula, which is why it is excluded from the list of drugs for cardioversion by European specialists. In Russia and many other countries, procainamide is still used due to the low cost of the drug.

propafenone It is available in both solution and tablet form. With a persistent variant of atrial fibrillation and flutter, it does not have the desired effect, and is also contraindicated in chronic obstructive diseases of the pulmonary system and is highly undesirable for prescribing to people with myocardial ischemia and reduced contractility of the left ventricle.

Amiodarone is produced in ampoules, administered intravenously and is recommended for use in the presence of organic lesions of the heart muscle (post-infarction scars, for example), which is important for the majority of patients suffering from chronic cardiac pathology.

Nibentan is available as a solution for intravenous infusion, but can only be used in intensive care units, where rhythm control is possible throughout the day after its administration, since the drug can provoke severe ventricular arrhythmias.

Indications for pharmacological cardioversion are cases when atrial fibrillation occurred for the first time or a paroxysm of arrhythmia occurs with a high heart rate, leading to negative symptoms and hemodynamic instability, not corrected by medication. If the likelihood of subsequent retention of sinus rhythm is small, then it is better to refuse medical cardioversion.

Pharmacological cardioversion is best when initiated within 48 hours of the onset of the arrhythmia. The main agents for atrial arrhythmias occurring against the background of congestive heart failure are considered to be amiodarone and dofetilide, which are not only highly effective, but also safe, while the use of procainamide, propafenone and other antiarrhythmics is undesirable due to possible side effects.

Amiodarone is considered the most effective means of restoring the rhythm in paroxysmal atrial fibrillation. According to research results, with its two-year intake by patients with chronic heart failure, overall mortality decreases by almost half, the probability of sudden death - by 54%, and the progression of heart failure - by 40%.

Antiarrhythmic drugs can be prescribed for a long time to prevent recurrent rhythm disruptions, but in this case, the high risk of side effects along with relatively low efficacy must be taken into account. The question of the advisability of long-term therapy is decided individually, and sotalol, amiodarone, propafenone, etatsizin are preferable for prescribing.

b. Rate control strategy

When choosing a strategy for controlling heart rate, cardioversion is not resorted to at all, but drugs are prescribed that slow down the heart rate - (metoprolol, carvedilol), (verapamil, diltiazem), amiodarone with the ineffectiveness of the previous groups.

The result of the chosen strategy should be a pulse no higher than 110 per minute at rest. If the symptoms are pronounced, then the heart rate is maintained at a level of up to 80 beats per minute at rest and no more than 110 with moderate exercise. Pulse control reduces the manifestations of arrhythmias, reduces the risks of complications, but does not prevent the progression of the pathology.

in. Catheter ablation

With rare paroxysms of atrial fibrillation, which, however, occur with severe symptoms, intra-atrial cardioverter-defibrillators can be implanted, which do not prevent arrhythmia, but effectively eliminate it if it occurs.

Prevention of recurrence of arrhythmia

Prevention of recurrent attacks of atrial fibrillation is very important, since in more than half of the cases the arrhythmia recurs in the next year after cardioversion, and sinus rhythm can be maintained only in a third of patients.

The goal of preventive treatment- not only to prevent repeated episodes of arrhythmia, but also to delay the development of its permanent variant, when the likelihood of embolism, progression of heart failure and sudden death increases significantly.

To prevent an attack of atrial fibrillation, 3 beta-blockers are recommended - bisoprolol, carvedilol and metoprolol. To maintain the correctness of the rhythm, it is better to prescribe amiodarone.

Lipid-lowering agents (), which have a cardioprotective, anti-ischemic, anti-proliferative and anti-inflammatory effect, are also included in the schemes for the prevention of recurrent attacks of atrial fibrillation. In patients with chronic coronary heart disease, statins help reduce the likelihood of arrhythmia recurrence.

Relief of paroxysm atrial fibrillation is always undertaken in case of its primary occurrence. To do this, cardioversion is performed using one of the methods described above, drug treatment with antiarrhythmics is prescribed in parallel with anticoagulant therapy. Especially important is the use of anticoagulants for arrhythmia lasting more than two days.

One of the presenters will answer your question.

The questions in this section are currently being answered by: Sazykina Oksana Yurievna, cardiologist, therapist

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(MA) is palpitations with an irregular heart rate. The pulse rate is 100 to 150 beats per minute. Flickering is paroxysmal or stable. This disease is more common in people with various heart diseases. From this article you will learn what to do if an attack occurs.

Actions before the arrival of the doctor

As with every human health disorder, there are distinctive signs of malaise that are characteristic of MA. The main indicators of cardiac arrhythmias are determined by the following features:

• feeling of a slow heartbeat or a sharp increase;
• increased heart rate;
• the appearance of shortness of breath, nausea, dizziness, trembling of the extremities;
• aching pains in the heart region.

First of all, it is necessary to call emergency medical help if the pulse rate exceeds 100 beats per minute.

Such characteristic features may appear all together or separately. In this case, it is necessary for the sick person to provide first aid to normalize the heart rhythm:

1. Lay on a flat surface, ensure peace, exclude any. With significant shortness of breath, it is better to organize a semi-sitting position of the body of a person with an attack.
2. Organize the flow of fresh air into the room.
3. Loosen the belt at the waist, unfasten the clothes on the chest and neck.
4. Convince the person to do breathing exercises.
5. To calm the sick, you can gently press on the eyelids for 10 seconds.
6. Provoked vomiting will help normalize the work of the heart.
7. If an arrhythmia is suspected, a sick person can be given, which contribute to the normalization of the heart rhythm.

Stopping the attack is a top priority until the arrival of professional doctors. Otherwise, a more serious disease in the form of heart failure may develop.

Other emergency measures for a person with signs of MA should be provided by a specialist. Therefore, an ambulance must be called immediately.

The presented video shows examples of self-reliance at home during an arrhythmia attack before the doctor arrives.

Actions of medical personnel

Hospitalization of a patient with signs of atrial fibrillation is mandatory if the primary measures provided did not lead to a positive result.

The main symptoms for hospitalization:

• a sharp increase or decrease in blood pressure;
• lack of visual signs of improvement;
• loss of consciousness;
• general weakness, increased pallor.

As a rule, the doctor establishes the probable cause of the manifestation of atrial fibrillation and prescribes treatment to eliminate it.

Possible reasons:

• dysfunction of the thyroid gland;
• heart failure;
• violation of the ventilation capacity of the lungs;
• violations of the water-electrolyte balance of a person;
• incorrect prescription of drugs.

To prescribe the correct treatment for the patient, diagnostic measures:

• the electrocardiogram of the heart confirms the presence of cardiac arrhythmias;
• Ultrasound of the heart with elements of cardiography - to determine the condition of blood vessels and heart valves, the size of the heart and its chambers;
• daily ECG - to fix the pulse and the work of the heart for 24 hours;
• laboratory tests for the presence of the required level of potassium and magnesium, determination of the state of the thyroid gland, identification of deviations in the acid-base state of the body.

Based on the data obtained, the patient is prescribed treatment.

And in the video presented, an explanation is given by a specialist about the consequences of an untimely visit to a doctor in the event of an attack of MA:

Therapy for atrial fibrillation

To stop the first attack of MA and eliminate painful manifestations, pharmacological preparations are used for:

• stabilization of the pulse, elimination of the causes of arrhythmia - Digoxin;
• adjustments of the work of the heart muscle towards improvement and stabilization, removal of an arrhythmia attack - Verapamil;
• rapid elimination of signs of MA - Adenosine;
• decrease in heart rate - Flecainide.

With the periodic occurrence of seizures in a patient with MA, the following can be used as an emergency:

• Sotalol, Amiodarone - antiarrhythmic drugs;
• Diltiazem, Verapamil - agents that promote calcium inhibition inside smooth muscle cells;
• Propranolol, Atenolol - help to slow down the heart rate, lower blood pressure.

Subsequent treatment is carried out with medications:

• , - improve the nutrition of the heart;
• Aspirin, Ticlopidin - thin the blood, prevent the formation of blood clots;
• Heparin, Warfarin - to prevent blood clots;
• Carvedilol, Pindolol - beta-blockers of calcium channels.

The choice of a therapeutic drug is made by the doctor strictly individually, taking into account the patient's condition and the presence of concomitant diseases.

The criteria for first aid for atrial fibrillation are simple. In this situation, self-discipline and the absence of confusion of others can play a decisive role. If you act strictly according to the above scheme, the timely assistance provided will help to avoid more serious complications.

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With attacks of atrial fibrillation, patients, as a rule, complain of a feeling of palpitations and "interruptions", often feel shortness of breath, pain in the heart. Objectively, pallor of the skin, cyanosis of the lips can be observed. These phenomena are more pronounced in the tachystolic form of atrial fibrillation.

With paroxysms of atrial fibrillation, the heart rhythm is incorrect, and a pulse deficit is often noted. There are two forms of atrial fibrillation - atrial fibrillation and flutter.

Diagnosis of atrial fibrillation

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Atrial fibrillation is characterized by the absence of a regular P wave and the presence of small or large F waves on the ECG, as well as an irregular, erratic ventricular rhythm, which is manifested by unequal R-R intervals on the ECG.

The QRS complexes usually retain the same shape as in a suns rhythm, but may be aberrant due to impaired intraventricular conduction or abnormal impulse conduction in WRW syndrome.

Emergency care for atrial fibrillation

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With attacks of atrial fibrillation, accompanied by a sharp tachycardia, moderate hemodynamic disturbances and poorly tolerated by the patient according to subjective sensations, one should try to stop the attack with the help of intravenous administration of medications:

• aymalin (giluritmal), which is administered slowly intravenously at a dose of up to 100 mg, and
• novocainamide, used similarly at a dose of up to 1 g.

An attack can sometimes be stopped with the help of intravenous jet administration of rhythmilene at a dose of 100-150 mg.

In the presence of severe hemodynamic disturbances, in particular with pulmonary edema, a sharp decrease in blood pressure, the use of these drugs is risky because of the risk of aggravating these phenomena. In such cases, the urgent use of electropulse therapy may be justified, but treatment aimed at slowing the frequency of the ventricular rate, in particular, intravenous administration of digoxin at a dose of 0.5 mg by jet, is also possible. To slow down the ventricular rate, you can also use verapamil (Isoptin, Finoptin) at a dose of 5-10 mg intravenously in a stream (contraindicated in arterial hypotension). A decrease in tachycardia, as a rule, is accompanied by an improvement in the patient's condition.

It is inappropriate to try to stop at the prehospital stage prolonged paroxysms of atrial fibrillation, lasting several days. In such cases, the patient should be hospitalized.

Attacks of atrial fibrillation with a low ventricular rate often do not require active tactics and can be stopped by oral medication, in particular propranolol at a dose of 20-40 mg or (and) quinidine at a dose of 0.2-0.4 g.

Paroxysms of atrial fibrillation in patients with premature ventricular excitation syndromes have features of the course and emergency therapy. With a significant increase in the ventricular rate (more than 200 per 1 min), urgent electropulse therapy is indicated, since this arrhythmia can transform into ventricular fibrillation. Of the medications, the use of aymalin, cordarone, novocainamide, rhythmilene, lidocaine intravenously with a string in the doses indicated above is indicated. The use of cardiac glycosides and verapamil is considered contraindicated due to the risk of increased ventricular rate.

Diagnosis of atrial flutter

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This arrhythmia is characterized by the presence of a frequent (usually more than 250 per minute) regular atrial rhythm. The ECG reveals rhythmic sawtooth waves F, which have a constant shape, the duration is more than 0.1 s, the isoelectric interval between them is often absent. Ventricular complexes tend to occur rhythmically, following every second, third, or fourth atrial wave. In such cases, they speak of the correct form of atrial flutter (Fig. 6, a). Sometimes there is atrial flutter with a ratio of atrial and ventricular rhythms of 1:1. In this case, there is a sharp tachycardia, usually more than 250 in 1 min.

The form of atrial flutter, characterized by an irregular rhythm of the ventricles, is called irregular (see Fig. 6, b). During a physical examination of the patient, this form of arrhythmia is difficult to distinguish from atrial fibrillation, but sometimes with an irregular form of flutter, allorhythmia, such as a bigeminal rhythm, may occur.

With atrial flutter, as well as with atrial fibrillation and supraventricular tachycardia, aberration of ventricular complexes is possible. In such cases, the correct form of atrial flutter must be distinguished from paroxysmal ventricular tachycardia. Of decisive importance for differential diagnosis is the identification of f waves associated with ventricular complexes on the ECG. Sometimes for this it was necessary to register the esophageal assignment of the ECG.

First Aid for Atrial Flutter

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When deciding on the tactics of providing assistance, it should be borne in mind that atrial flutter usually causes less hemodynamic disturbances compared to atrial fibrillation at the same ventricular rate. Atrial flutter, even with a significant frequency of ventricular contractions (120-150 per 1 min), is often not felt by the patient. In such cases, emergency care is not required and therapy should be planned.

With an attack of atrial flutter, which is accompanied by hemodynamic disorders and causes painful sensations for the patient, drugs are used that reduce the frequency of the rhythm of ventricular contractions, in particular verapamil at a dose of up to 10 mg or propranolol at a dose of 5-10 mg intravenously bolus slowly. These drugs are not used if there are signs of acute heart failure or arterial hypotension. In such cases, it is better to use digoxin at a dose of 0.5 mg intravenously. Propranolol or verapamil can be used in combination with digoxin. Sometimes, after the use of these drugs, an arrhythmia attack stops, but often paroxysms of atrial flutter are delayed for several days. Aymalin, novocainamide and rhythmilen are much less effective in paroxysms of atrial flutter than in atrial fibrillation. In addition, there is a risk of paradoxical acceleration of the ventricular rate due to slowing of the atrial rate and the development of 1: 1 flutter under the influence of these drugs, so they should not be used for this arrhythmia. Sometimes it is possible to stop an attack of atrial flutter only with the help of electrical impulse therapy.

Atrial fibrillation is a severe heart rhythm disorder that occurs with certain diseases of the cardiovascular system and is accompanied by frequent, heterogeneous and irregular contractions of the atrial myocardium. Atrial fibrillation may accompany, heart defects,.

Atrial fibrillation: emergency care

If the patient has symptoms (interruptions in the work of the heart, dizziness, weakness, pain in the heart, rhythm disturbances, fainting), it is necessary to provide first aid. First of all, you need to call an ambulance. After that, calm the patient. It is necessary to unfasten tight clothes on him, if the patient is worried about shortness of breath, you need to give him a semi-sitting position. It should be remembered that some people (especially the elderly) often carry heart medications (validol, corvalol, valocardin, valerian) with them. If an attack of atrial fibrillation occurred with a person in a crowded place, ask who has the medicine and give it to the patient.

The tachysystolic form of atrial fibrillation, in which the heart rate increases significantly (more than 100 beats per minute), is more dangerous, since the heart experiences significant oxygen starvation and overload.

Atrial fibrillation (emergency care) in a hospital (medical care) is based on the relief of an attack of atrial fibrillation. Two drugs are administered intravenously to the patient: novocainamide (1 g) and aimalin (giluritmal) (100 mg). Slow administration of drugs after a while stops the attack. Sometimes the patient is injected intravenously with a stream of rhythmylene (100-150 mg). In addition, the patient is prescribed drugs from the group of cardiac glycosides: digoxin (500 mg) or verapamil (Isoptin, Finoptin) 5-10 mg each.

In case of severe hemodynamic disturbances (a sharp drop in arterial blood pressure, pulmonary edema, shock), the patient is shown electrical impulse therapy, which is also called cardioversion. The main goal of electrical impulse therapy is to restore normal sinus rhythm. In this case, the treatment is carried out by applying electric current pulses with an energy of 50 -100 J. An impulse is formed between the two electrodes, which is transmitted to the patient's chest. Electropulse therapy is carried out using special equipment (defibrillator, electrocardiograph, ventilator, air ducts, etc.)

Video: Arrhythmia Help