Disturbances in the normal functioning of cardiac activity are an urgent problem throughout the world. Most often they develop in old age, but they can also occur in young people and children. As is known from statistics, pathologies of the cardiovascular system are one of the main causes of death. Therefore, doctors around the world are looking for new methods of preventing such diseases. It is also important to help slow the development of the disease and maintain compensation for the condition as long as possible.

In recent years, to identify cardiac pathologies, a screening study has been carried out for the entire adult population, regardless of age. On an outpatient basis, each patient undergoes electrocardiography (ECG) once a year in the absence of complaints. If heart disease is detected, the person is registered, and all studies are carried out more often, treatment is prescribed. Often, patients have atrial fibrillation on the ECG. A synonym for this condition is atrial fibrillation.

What is atrial fibrillation?

On the ECG, one of the most common types of arrhythmias. According to statistics, it is observed in 1-2% of the population. To a greater extent, this rhythm disturbance affects people from 40 years of age and older. Sometimes atrial fibrillation is asymptomatic, and the patient is not aware of the presence of pathology. In some cases, atrial fibrillation is so pronounced that urgent hospitalization of the patient and emergency measures are required. The course of the pathology depends on its form and the general condition of the patient. occurs due to increased excitability of atrial tissue. As a result, chaotic pathological contractions appear. Most often, atrial fibrillation is combined with other cardiac pathologies.

Normal ECG: description and interpretation

Electrocardiography is the main method for diagnosing heart disease. It is performed on suspicion of ischemia, myocardial infarction, various arrhythmias and other cardiac pathologies. The ECG method is based on recording potentials from the surface of the heart. Thanks to the assessment of electrical activity, it is possible to judge the state of various parts of the myocardium. A normal ECG is observed in healthy people. In addition, there are a number of pathologies that are not detected by electrocardiography. Nevertheless, most of the diseases are recorded on the ECG. A doctor of any specialty can describe the results of this examination; nevertheless, it is recommended that cardiologists do the decoding.

The ECG is represented by horizontal lines with teeth and intervals. There are 12 leads, from the surface of which electrical impulses come in. The p wave on the ECG is responsible for the excitation of the atria. After it, a small P-Q interval is recorded. It characterizes the coverage of the atrial septum by excitation. Further, the QRS complex is observed. It is characterized by electrical excitation of the ventricles. This is followed by the relaxation time of the heart muscle - repolarization. It consists of an ST interval and a T wave. Normally, each ECG element should have a certain width (time) and height (amplitude). Changes in at least one indicator in lead 1 indicate pathology.

What does atrial fibrillation look like on an ECG?

Atrial fibrillation is a pathological condition in which extraordinary chaotic excitations of the myocardium occur. In this case, a violation of the normal rhythm occurs. Atrial fibrillation on the ECG is characterized by a change in the P waves, instead of them f-waves appear (they are located between the QRS complexes in large numbers), while the normal P wave should be 1 before each excitation of the ventricles. In addition, with fibrillation, there is a violation of the normal heart rhythm. This is reflected in the ECG by the fact that the distances between the R-R in one lead are not the same in width (time).

The difference between atrial fibrillation and atrial flutter

In addition to atrial fibrillation, there is also atrial flutter. On the ECG, these 2 pathologies differ from each other. Atrial flutter (AT) is a pathological condition in which there is a significant increase in the heart rate (200-400 beats per minute). It usually occurs in the form of sudden attacks - paroxysms. TP is characterized by sudden development and spontaneous termination. It belongs to the varieties. When an attack develops, the patient needs to be given emergency care. Atrial flutter on the ECG differs from fibrillation in that pathological excitations have a higher frequency and amplitude (F-waves). In this case, the heart rhythm remains correct. The distances between R-R are the same.

Symptoms of atrial fibrillation

There are 3 forms of atrial fibrillation. They differ in heart rate. Allocate:

1. Tachysystolic form. The heart rate is over 90 beats per minute.
2. Normosystolic form. The heart rate ranges from 60 to 90 beats per minute.
3. Bradystolic form. It is less common than the others. The heart rate is less than 60 beats per minute.

Signs of atrial fibrillation depend on how impaired ventricular function is. When there is a sudden increase in heart rate, a feeling of palpitations, trembling and increased sweating, shortness of breath, chest pain, dizziness. With severe tachycardia, loss of consciousness, the development of stroke, myocardial infarction is possible. A large number of people have a normosystolic form of atrial fibrillation. In this case, clinical symptoms are often absent.

Treatment of atrial fibrillation

Although atrial fibrillation is often asymptomatic, it increases the risk of blood clots and myocardial infarction. Therefore, with atrial fibrillation, antiplatelet agents are prescribed. Among them - drugs "Aspirin-cardio", "Thromboass". Antiarrhythmic drugs are prescribed to correct the heart rate during tachycardia. Most often these are medicines "Coronal", "Metoprolol", "Amiodarone". For persistent atrial fibrillation, surgical treatment is recommended.

Violation of the rhythm of the heart, in which the number of atrial contractions averages 300 times a minute, is called atrial flutter. An important difference between pathology and other arrhythmias is that the sinus rhythm is preserved. In connection with the growing spread of cardiovascular diseases, their "rejuvenation" (that is, an increase in the number of manifestations at a young age), it is worth knowing how dangerous atrial flutter is and what kind of help modern medicine provides to a sick person.

Atrial flutter refers to secondary pathologies, that is, diseases that have developed against the background of other disorders. Most often it manifests itself in a paroxysmal form, when a person may not feel an attack or complains of an uncomfortable condition. There are protracted paroxysms lasting days or even weeks. Atrial flutter can alternate with atrial fibrillation, which complicates the clinical course of the disease.

An increase in the number of heartbeats affects the severity of symptoms, which are often associated with hemodynamic disorders.

With a mild severity of the disease, the restoration of the normal rhythm occurs independently. In severe cases, the accompanying pathology of the disorder does not allow the heart to cope with its tasks, which becomes the reason for the provision of medical care. It is important to note that if antiarrhythmic drugs help with other rhythm disturbances, then cardiac surgery is often indicated for atrial flutter.

Video: Atrial fibrillation. Atrial fibrillation and atrial flutter are twins. Koshkina, EV

Description of atrial flutter

Atrial flutter (AT) refers to supraventricular tachycardias, in which pathological excitement occurs from a focus located in the atria. As a result, the rhythm remains correct, but its frequency increases from 200 to 400 beats per minute. The ventricles do not contract as often as the atria, because the impulse wave of excitation does not always reach them.

A healthy heart is normally excited regularly and orderly. The signal comes from the sinus node located in the right atrium, first into the left atrium, and then through the atrioventricular node into the ventricles. The conductivity of the AV node is several times lower than that of the sinus, which is necessary for alternate contraction of the atria first, and then the ventricles. Thus, blood first fills the upper parts of the heart (atria), and then, when they relax, passes into the lower (ventricles) and enters the pulmonary and systemic circulation.

The development of atrial flutter is associated with a violation of the conduction of an electrical impulse, which is reflected in the number of contractions of the upper heart. If normally it is 60-90 times per minute, then with flutter - 200-400 times per minute. At the same time, the AV node is not able to pass so many impulses, therefore, their number reaching the ventricles is two, three or more times less. Accordingly, the ventricles contract 75-150 times per minute.

Patients with WPW syndrome (congenital heart disease) are somewhat more difficult to tolerate TP, which often turns into ventricular flutter due to the presence of a pathological Kent's bundle. An impulse is conducted through it faster than through the AV node, which threatens ventricular fibrillation.

Symptoms of atrial flutter

The disease is characterized by common symptoms that occur in many cardiovascular diseases:

• palpitations;
• "Interruptions" of cardiac activity, feelings of "fading" and "turning" of the heart;
• heart failure is manifested by weakness, shortness of breath, and frequent urination.

With atrial flutter, sinus rhythm remains, which is correct and rhythmic, which distinguishes this pathology from atrial fibrillation.

Pulsating veins - Another characteristic sign of atrial flutter. When determining it, the difference with heart rate is visible, which consists in exaggerating the frequency of the pulsation of the veins by two to three times.

Atrial flutter is considered clinically unfavorable if the ratio of the frequency of contractions of the atria and ventricles is 1: 1. This option is very dangerous because of the high risk of developing ventricular fibrillation.

Causes of atrial flutter

Mainly associated with organic heart disease, expressed in the following diseases:

• infectious processes leading to inflammation of the myocardium (endo- and myocarditis);
• ischemic diseases, accompanied by sclerosis of areas of the myocardium or the formation of scar tissue (myocardial infarction, cardiosclerosis, cardiomyopathy);
• dystrophic pathologies in which myocardial trophism is disturbed (myocardial dystrophy),
• hypertension, which negatively affects the work of the left ventricle.

Noncardiac causes can also cause TP. Pulmonary diseases, expressed in obstructive chronically occurring form, lead to hardening of the lung tissue and an increase in pressure in the pulmonary circulation. Therefore, TP can be a complication of emphysema, chronic bronchitis, bronchial asthma. Also, surgical operations can be complicated by TP in the case of coronary artery bypass grafting, plastics on the heart valves.

To reduce the likelihood of developing atrial flutter, you should know the risk factors:

• male gender;
• age after 60 years;
• the presence of bad habits;
• lack of potassium in the body;
• idiopathic atrial premature beats;
• increased production of hormones by the thyroid gland.

If TP was previously observed, you need to know the provoking factors that can cause a new attack:

• taking alcoholic or narcotic substances;
• increased ambient temperature;
• psycho-emotional experiences;
• physical stress.

Types of atrial flutter

According to the classification of H. Wells, 1979, atrial flutter is divided into two types: typical and atypical. Also, according to the clinical course, TP are distinguished paroxysmal, permanent, persistent and newly identified.

Types of atrial flutter

Type I, or typical TP, develops in 90% of cases in the form of an exciting wave propagating counterclockwise. After generation, the electrical impulse passes in turn the interatrial septum, the posterior wall of the right atrium, bends around the superior vena cava and descends down the anterior and lateral wall to the tricuspid ring. Further, the interatrial septum passes through the isthmus again. In the remaining 10% of cases, the signal moves clockwise.

For surgical treatment of TP, this type is more favorable, since the pathological circulation of the impulse is interrupted in the isthmus zone, for which radiofrequency ablation is used.

Type II, or atypical TP, is created by the return passage of an impulse in the area of \u200b\u200bvarious anatomical structures (pulmonary veins, mitral annulus, coronary sinus, scars, etc.). This type of TP is mainly due to extensive atrial lesions, previous surgery, and catheter ablation. Carrying out cardiac stimulation in type II TP is ineffective.

Video: ECG for sinus tachycardia, atrial fibrillation and atrial flutter

Clinical forms of atrial flutter

Depending on the severity of the process and the duration of TP, the following forms of the disease are distinguished:

• First emerged TP - Previously, the patient's seizures were not detected. The clinical form is displayed regardless of the severity and duration of the pathological process.
• Paroxysmal atrial flutter - has a paroxysmal course, the duration of each attack is no more than 7 days. Its self-completion is possible.
• Persistent form - is unfavorable in its development, since it does not end on its own, medical intervention is required to stop the attack.
• Constantly flowing TP - rhythm disturbance is observed throughout the year and no improvement is seen in the dynamics of the disease.

Complications of atrial flutter

They develop mainly in patients with cardiovascular pathology:

• possible development of ventricular or atrial fibrillation, as well as ventricular flutter;
• prolonged attacks threaten the occurrence of a stroke, blockage of the pulmonary artery by a thrombus, failure of the kidneys;
• in the event of arrhythmias associated with heart disease, TP can be complicated by heart failure and arrhythmogenic cardiomyopathy, which leads to death.

Diagnosis of atrial flutter

First of all, patients with suspected atrial flutter are prescribed electrocardiography.

Typical flutter manifests itself on the ECG by rhythmic F-waves, which appear instead of the normal P wave. The frequency of contractions is 240-340 times per minute. To determine the passage of the impulse "out" or "counterclockwise" look lower and II, III leads. Signs of signal movement “counterclockwise”: sawtooth F waves have a negative phase in II, III leads, and in V1 the F waves are on top (positive). When the impulse moves “behind” the clockwise, the ECG shows signs exactly the opposite.

Atypical flutter characterized by the appearance of the F wave with a frequency of 340-430 times per minute. Sometimes atrial waves are not visible on the electrocardiogram, then they can be determined using a transesophageal study (Echo-CG) on the corresponding VE lead.

Of the other diagnostic methods in determining atrial flutter, the following are effective:

Ultrasound - allows you to assess the state of the heart, to identify organic and structural changes, to clarify the size of the cardiac cavities.

Laboratory diagnostics - carried out in the presence of hormonal disorders associated with the thyroid gland or pancreas, the concentration of electrolytes (especially potassium) is determined, an analysis is made for rheumatoid factor.
Echo-KG - it is prescribed to clarify the direction of the impulse circulation, and also to see if there are thrombotic formations in the atria.

Treatment for atrial flutter

Atrial flutter attacks with the use of modern methods of treatment are effectively stopped in most cases. Such areas of medicine as drug therapy and surgical treatment are used. Also important is emergency treatment in the form of restoration of sinus rhythm, used to stop severe seizures.

Restoration of sinus rhythm

It is an emergency care that is performed with atrial flutter by medical personnel. There are several ways to restore sinus rhythm: drug and non-drug cardioversion.

Medication cardioversion rarely used for atrial fibrillation because it is not as effective as atrial fibrillation. Cardioversion begins with intravenous administration of ibutilide, which has the desired effect on average in 60% of cases. If there are contraindications to the use of ibutilide (hypersensitivity to it), amiodarone, sotalol are administered. If there is no result from drug cardioversion, then heart rate control is resorted to, in which calcium antagonists and digoxin are used.

Drug-free cardioversion is based on electro-pulse therapy. The defibrillator creates a 100 Joule shock that is effective 85% of the time. For comparison, if you do cardioversion with a discharge of 50 J, then the efficiency is achieved in 75%. In some cases, with type I TP, it is better to pacing with an electrode fed through the esophagus. Sometimes digoxin or an antiarrhythmic agent is additionally injected, which increases the overall effectiveness of the procedure.

Any type of cardioversion requires thromboembolism prophylaxis, especially if TP persists for 48 hours.

Drug therapy

Indications for drug treatment are poor patient tolerance to an attack, as well as the presence of a risk of complications.

It is based on the use of beta-blockers (metoprolol) under the cover of antiarrhythmic drugs (ibutilide, amiodarone). The introduction of the latter drugs is necessary to prevent the occurrence of ventricular fibrillation.

With the development of WPW syndrome, beta blockers, cardiac glycosides and other similar drugs cannot be used so as not to provoke a complication of the condition. The only thing is that you can use anticoagulants and antiarrhythmic drugs.

Catheter ablation

It is indicated for atrial flutter of the first type, when the impulse is circulated counterclockwise. In the isthmus region, radiofrequency catheter ablation is performed, the effectiveness of which is manifested in 95% of cases.

Another type of catheter ablation, cryothermal, has also proven to be effective and is not as painful as radiofrequency ablation. The only thing is that any such interventions are accompanied by a subsequent relapse of tachycardia. In addition, the risk of developing atrial fibrillation increases after the procedure. This is due to structural changes in the heart chambers. Therefore, surgical treatment should be carried out only in extreme cases, when other methods, in particular, drug treatment, do not help.

Secondary prevention of atrial flutter

It is associated with the prevention of the development of complications in the form of heart failure, thromboembolism, tachycardia, especially when the patient is at risk. You should also pay attention to the following recommendations:

• Take antiarrhythmic drugs on time and monitor the daily routine, the correct alternation of work and rest.
• In order to avoid the development of tachycardia and arrhythmias, you need to drink sedatives, which also help in stressful and emotionally stressful situations.
• The potassium level should be normal (3.5-5.5 mmol / L in the blood) so that the heart does not work, for this you can take appropriate medications or eat foods rich in potassium (raisins, bananas, kiwi, beets, carrots, beef , lean fish).

Video: Atrial flutter. Violation of the rhythm of the heart

- tachyarrhythmia with the correct frequent (up to 200-400 in 1 min.) Atrial rhythm. Atrial flutter is manifested by paroxysms of heartbeat lasting from several seconds to several days, arterial hypotension, dizziness, loss of consciousness. To detect atrial flutter, a clinical examination, 12-lead ECG, Holter monitoring, transesophageal electrocardiography, rhythmography, cardiac ultrasound, EFI are performed. Medication, radiofrequency ablation, and atrial pacemaker are used to treat atrial flutter.

General information

Atrial flutter is a supraventricular tachycardia characterized by an overly frequent but regular atrial rhythm. Along with atrial fibrillation (atrial fibrillation) (frequent, but irregular, irregular atrial activity), atrial flutter is a type of atrial fibrillation. Atrial fibrillation and atrial flutter are closely related and can alternate, mutually replacing each other. In cardiology, atrial flutter is much less common than atrial fibrillation (0.09% versus 2-4% in the general population) and usually proceeds in the form of paroxysms. Atrial flutter is more common in men over 60.

Causes of atrial flutter

In most cases, atrial flutter occurs against the background of organic heart disease. The causes of this type of arrhythmia can be rheumatic heart disease, coronary artery disease (atherosclerotic cardiosclerosis, acute myocardial infarction), cardiomyopathy, myocardial dystrophy, myocarditis, pericarditis, hypertension, SSSU, WPW-syndrome. Atrial flutter can complicate the early postoperative period after cardiac surgery for congenital heart defects, coronary artery bypass grafting.

Atrial flutter also occurs in patients with COPD, pulmonary emphysema, and pulmonary embolism. In cor pulmonale, atrial flutter is sometimes accompanied by end-stage heart failure. Risk factors for atrial flutter, not associated with cardiac pathology, can be diabetes mellitus, thyrotoxicosis, sleep apnea syndrome, alcoholic, drug and other intoxication, hypokalemia.

If atrial tachyarrhythmia develops in a practically healthy person for no apparent reason, they speak of idiopathic atrial flutter. The role of a genetic predisposition to atrial fibrillation and atrial flutter is not excluded.

Pathogenesis of atrial flutter

The basis of the pathogenesis of atrial flutter is the macro-re-entry mechanism - multiple re-excitation of the myocardium. A typical paroxysm of atrial flutter is caused by the circulation of the right atrial re-entry circle, which is bounded in front by the ring of the tricuspid valve, and behind by the Eustachian crest and vena cava. Trigger factors necessary for the induction of arrhythmias may be short-term episodes of atrial fibrillation or atrial extrasystoles. At the same time, there is a high frequency of atrial depolarization (about 300 beats per minute).

Since the AV node is not able to pass impulses of this frequency, only half of the atrial impulses are usually conducted into the ventricle (block 2: 1), so the ventricles contract at a rate of about 150 beats. per minute. Much less often blocks occur in a ratio of 3: 1, 4: 1, or 5: 1. If the rate of conduction changes, the ventricular rhythm becomes irregular, which is accompanied by an abrupt increase or decrease in heart rate. An extremely dangerous ratio of atrioventricular conduction is a ratio of 1: 1, manifested by a sharp increase in heart rate up to 250-300 beats. per minute, decreased cardiac output and loss of consciousness.

Classification of atrial flutter

There are typical (classic) and atypical variants of atrial flutter. In the classical variant of atrial flutter, the circulation of the excitation wave occurs in the right atrium in a typical circle; at the same time, the frequency of flutters of 240-340 per minute develops. Typical atrial flutter is isthmus-dependent, i.e., amenable to stopping and restoring sinus rhythm using cryoablation, radiofrequency ablation, transesophageal pacing in the area of \u200b\u200bthe cavo-tricuspid isthmus (isthmus) as the most vulnerable link in the macro-re-entry loop.

Depending on the direction of the circulation of the excitation wave, two types of classical atrial flutter are distinguished: counterclockwise - the excitation wave circulates around the tricuspid valve counterclockwise (90% of cases) and clockwise - the excitation wave circulates clockwise in the macro-re-entry loop (10% of cases ).

Atypical (isthmus-independent) atrial flutter is characterized by the circulation of a wave of excitation in the left or right atrium, but not in a typical circle, which is accompanied by the appearance of waves with a flutter frequency of 340-440 per minute. Taking into account the place of formation of the circle of macro-re-entry, right atrial (multiple cycle and upper loop) and left atrial isthmus-independent atrial flutter are distinguished. Atypical atrial flutter cannot be controlled by TEPEX due to the absence of a slow conduction zone.

From the point of view of the clinical course, the first developed atrial flutter, paroxysmal, persistent and permanent form is distinguished. The paroxysmal form lasts less than 7 days and stops on its own. The persistent form of atrial flutter lasts more than 7 days, while independent restoration of sinus rhythm is impossible. A persistent form of atrial flutter is spoken of if drug or electrical therapy did not bring the desired effect or was not carried out.

The pathogenetic significance of atrial flutter is determined by the heart rate, on which the severity of clinical symptoms depends. Tachysystole leads to diastolic, and then systolic contractile dysfunction of the left ventricular myocardium and the development of chronic heart failure. With atrial flutter, there is a decrease in coronary blood flow, which can reach 60%.

Symptoms of atrial flutter

The clinic of newly developed or paroxysmal atrial flutter is characterized by sudden attacks of heartbeat, which are accompanied by general weakness, decreased physical endurance, discomfort and pressure in the chest, angina pectoris, shortness of breath, arterial hypotension, and dizziness. The frequency of paroxysms of atrial flutter varies from one per year to several per day. Attacks can occur under the influence of physical activity, hot weather, emotional stress, heavy drinking, alcohol consumption, and intestinal upset. At a high pulse rate, presyncopal or syncope conditions often occur.

Even an asymptomatic course of atrial flutter is accompanied by a high risk of complications: ventricular tachyarrhythmias, ventricular fibrillation, systemic thromboembolism (stroke, kidney infarction, pulmonary embolism, acute occlusion of mesenteric vessels, vascular occlusion of the extremities), heart failure, cardiac arrest.

Diagnosis of atrial flutter

Clinical examination of a patient with atrial flutter reveals a rapid, but rhythmic pulse. However, with a conduction ratio of 4: 1, the pulse can be 75-85 beats. in minutes, and with a constant change in the coefficient, the heart rate becomes irregular. A pathognomonic sign of atrial flutter is a rhythmic and frequent pulsation of the cervical veins, corresponding to the rhythm of the atria and exceeding the arterial pulse by 2 or more times.

Treatment for atrial flutter

Therapeutic measures for atrial flutter are aimed at stopping paroxysms, restoring normal sinus rhythm, and preventing future episodes of the disorder. For drug therapy of atrial flutter, beta-blockers (for example, metoprolol, etc.), calcium channel blockers (verapamil, diltiazem), potassium preparations, cardiac glycosides, antiarrhythmic drugs (amiodarone, ibutilide, sotalol hydrochloride) are used. To reduce thromboembolic risk, anticoagulant therapy is indicated (heparin intravenously, subcutaneously; warfarin).

For the relief of typical paroxysms of atrial flutter, the method of choice is transesophageal pacing. In case of acute vascular collapse, angina pectoris, cerebral ischemia, an increase in heart failure, electrical cardioversion is indicated by low-power discharges (from 20-25 J). The effectiveness of electrical impulse therapy increases with antiarrhythmic drug therapy.

Recurrent and persistent forms of atrial flutter are indications for radiofrequency ablation or cryoablation of the macro-re-entry lesion. The effectiveness of catheter ablation for atrial flutter exceeds 95%, the risk of complications is less than 1.5%. Patients with CVS and paroxysms of atrial flutter are shown RFA of the AV node and implantation of a pacemaker.

Forecast and prevention of atrial flutter

Atrial flutter is characterized by resistance to antiarrhythmic drug treatment, persistence of paroxysms, and a tendency to recurrence. Recurrences of atrial flutter can turn into atrial fibrillation. Long-term course of atrial flutter predisposes to the development of thromboembolic complications and heart failure.

Patients with atrial flutter need the supervision of a cardiologist-arrhythmologist, consultation of a cardiac surgeon to resolve the issue of the expediency of surgical destruction of the arrhythmogenic focus. Prevention of atrial flutter requires treatment of primary diseases, reduction of stress and anxiety levels, cessation of caffeine, nicotine, alcohol, and certain medications.

Atrial fibrillation, or, as it is also commonly called, atrial fibrillation, is a pathological change in the heart rhythm in which an electrical impulse in the atria moves randomly at a frequency of 350-700 beats per minute, which makes normal contraction of the atrial muscles impossible.

The doctor may suspect atrial fibrillation in the patient during the assessment of the pulse and auscultation of the heart, but the final confirmation of the diagnosis can only be an ECG study.

Cardiogram procedure

The process of taking an electrocardiogram is painless and non-invasive, and the availability of this research method is wide: an electrocardiograph can be found in any hospital.

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Removing an electrocardiogram is not such a simple matter as it seems at first glance. Much in the process of diagnostic research depends not only on the patient, but also on the professionalism of the doctor, therefore, without special preliminary preparation, they are not allowed to the procedure.

Taking an ECG consists in the correct placement of the electrodes. At the same time, it is important for the patient himself to follow a number of recommendations before the study, so as not to accidentally influence its results.

• overeating before the procedure;
• it is recommended not to smoke 12 hours before the procedure;
• alcohol is prohibited before the procedure;
• before the procedure, it is necessary to exclude for a while the intake of certain medications that may affect the results, but this can be done only after consulting a doctor, self-withdrawal of drugs is unacceptable;
• you can not get carried away on the eve of hard physical work or be exposed to severe stress;
• coffee is also prohibited on the eve of the procedure.

Before the procedure, the patient is advised to sit and calm down for a few minutes in order to calm down and mentally prepare for the examination (this way, the effect of the so-called "white coat syndrome" - a sharp jump in blood pressure accompanied by an attack of tachycardia) can be avoided.

When the patient is ready, he is asked to undress to the waist, and also to free the legs from the tissue at least to the middle of the shin. That is why it is recommended to wear light and loose clothing that can be easily removed for the study.

After undressing, the patient lies down on the couch. Now his main task is to lie still and wait until the research is over.

In the meantime, the nurse or doctor will lubricate the electrodes with a special gel, which will improve adhesion to the skin, and place the electrodes. During the study, the patient must lie still, therefore it is recommended to immediately take a comfortable position.

The study does not last long, and at the end of the study, the patient is given the results, which are deciphered by the attending physician.

What to look for

The reasons for the development of atrial fibrillation can be easily explained from a scientific point of view. To do this, the doctor must first of all find out from the patient information about whether there are any lesions of the cardiovascular system, and especially the heart muscle itself.

It is also necessary to clarify whether the person has recently undergone any surgical interventions directly on the heart or in the immediate vicinity of it.

If the interventions were very recent, then the development of arrhythmias is a normal phenomenon, which should decline over time, but still needs therapy and monitoring.

It is also imperative to clarify whether the patient's history has the influence of the following factors:

• lesions of the heart muscle by rheumatic diseases, damage to the general body by pathologies of the rheumatoid type;
• various forms;
• diseases of the bronchopulmonary system of a chronic course.

Full physical health reduces the risk of developing atrial fibrillation to zero, and the absence of diseases of the cardiovascular system significantly reduces it.

Ratio ratio

When calculating the ratio of the coefficients, the doctor usually estimates how many atrial waves seen on the ECG preceded the appearance of the ventricular complex. Even ratios, such as 1: 2, 1: 4, etc., which are characteristic of atrial flutter, and not fibrillation, are considered more favorable prognostically.

Analysis of the ratio of the ratio is important. Its rates according to the 1: 2-1: 4 principle are more favorable and, more often than not, are tolerated by patients more easily than the odd ratio characteristic of fibrillation.

Also, the coefficient helps in the differential diagnosis of atrial flutter and atrial fibrillation. Fibrillation is characterized by the irregularity of the coefficient and its oddness, although in a number of cases an odd coefficient is also encountered during flutter (this happens rarely, but even in the case of oddness during flutter, the coefficient remains regular).

This is due, first of all, to the fact that with an even rate of contraction, the atria remain coordinated, while with an odd one, complete desynchronization occurs. This is why patients generally tolerate flutter more easily than atrial fibrillation.

Atrial fibrillation is an insidious pathology with its own characteristics. Its development is difficult to predict due to the fact that the jump in the heart rate is too sharp as soon as the conduction coefficient changes.

Symptoms to look out for when diagnosing atrial fibrillation are an important part of the diagnosis. The main criterion is the heart rate. In addition to the heart rate, the characteristics of cardiac pathology in each individual patient are also assessed.

In the clinical diagnosis of this cardiac pathology, an assessment of the arterial pulse plays an important role. In atrial fibrillation, the arterial pulse is usually characterized as arrhythmic, while in atrial fibrillation it will be rhythmic and rapid.

Despite the importance of assessing the arterial pulse, its assessment is still not the main method of clinical differential diagnosis. It is not used for these purposes due to the fact that a 4: 1 ratio can be an indication that the heart rate is kept within 85 beats per minute.

The conclusion of an ECG in atrial fibrillation can only be performed by a doctor, since only he is able to assess all the factors and fully carry out a differential diagnosis between atrial fibrillation and flutter.

The therapy that is prescribed to the patient in a particular case depends on the correctness of the diagnosis, therefore it is extremely important to distinguish between diseases.

ECG display of atrial fibrillation

Signs of atrial fibrillation on the ECG are characterized by the following features, which are important to pay attention to when evaluating the results of an electrocardiogram and making a diagnosis:

• the P wave completely disappears in all leads;
• the P wave is replaced by a variety of waves of different amplitude and width, which are called f waves;
• the frequency of these waves can reach 200-400 beats per minute;
• characteristic waves that do not have a clear consistency are best seen in leads aVF, II, III, V1 and V2;
• the rhythm of the ventricles changes, becoming irregular, which is characterized by a change in the intervals between the R waves;
• the ventricular complexes themselves do not undergo any diagnostically significant changes, maintaining the correct shape without dilatation.

In some cases, atrial flutter can be, like fibrillation, irregular.

In this case, the differential diagnosis of pathologies is carried out according to the following criteria:

• with atrial fibrillation, the ventricular complexes will be located arrhythmically;
• the P wave will be completely absent;
• characteristic small waves f will be determined;
• the heart rate will be around 300 beats per minute, and sometimes more.

Naturally, most experienced doctors pay attention to the rhythm of the ventricular complexes, since this criterion in differential diagnosis plays the greatest role and is the most obvious.

If the first diagnostic criterion is in doubt, then special attention is paid to the third and fourth criteria.

So, the flutter is characterized by the correctness of the waves, they are called large waves F. These waves resemble in their appearance the teeth of a saw and the interval between them is always the same. Also, flutter is characterized by the value of the heart rate, which does not exceed 300 beats per minute.

An experienced physician usually only needs the first criterion to make a correct diagnosis.

It is important to determine the correct diagnosis and differentiate from atrial flutter, since the therapy of diseases and their prognosis are different.

So, with fibrillation, full-fledged drug treatment is required, which the patient will have to adhere to all his life, while the issue of flutter is most often solved using the catheter ablation procedure, which allows you to completely get rid of the disease.

Definition and pathogenesis

ECG with atrial fibrillation (fibrillation).
a - large-wavy form;
b - fine-wavy form. On the right is a schematic representation of the vortex motion of the excitation wave along the atria.
Mechanisms: formation of multiple micro-re-entry waves in the atria as a result of complete electrical disorganization of the myocardium and local conduction disturbances and duration of the refractory period.

Forms of atrial fibrillation

• large-wavy form
• fine-wavy form

Causes of atrial fibrillation (atrial fibrillation)

ECG - signs of atrial fibrillation

Classification of atrial fibrillation (atrial fibrillation)

By heart rate:
- normosystolic heart rate 60 - 80 per minute,
- bradystolic heart rate 60 per minute,
- tachysystolic heart rate\u003e 100 per minute.

Tasks and tactics at the prehospital stage for atrial fibrillation

48 hours is the time during which sinus rhythm can be restored with minimal risk of thromboembolytic complications.
Restoration of the rhythm at a later date requires 4 weeks of preliminary anticoagulant therapy with warfarin.

Tasks for a constant form of atrial fibrillation:
- heart rate control in the normal range (routinely digoxin, beta-blockers),
- prevention of thromboembolic complications (aspirin)

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