Atrial Fibrillation

A common consequence of arterial Hypertension is atrial fibrillation.

Atrial fibrillation refers to a type of heart rhythm disorder characterized by a disturbance in the electrical conduction within the heart.

 Normally, an electrical impulse originates in the right atrium - specifically in the sinus node located there - which is transmitted through the conduction system of the heart to the heart chambers. This impulse causes the muscle to contract. The heart pumps, and a heartbeat occurs.

In atrial fibrillation, however, there are circulating excitations in the atria, which are only partially transmitted to the chambers. This results in an irregular heartbeat, which is often too fast. In some cases, however, there may also be a slowed heartbeat if the electrical signal is not transmitted to the heart chambers due to a so-called "conduction block."

Due to the circulating excitations in the atrium, it cannot fill properly with blood and thus cannot pump the required amount of blood into the heart chambers. Ultimately, this reduces the pumping capacity of the heart, as the amount of blood ejected into the body is also decreased.

The conduction disorder usually occurs in the presence of high blood pressure due to the enlargement of the heart and the connective tissue remodeling within the heart. As a result, the electrical impulses cannot always be properly transmitted, leading to circulating excitations. Atrial fibrillation, in turn, promotes the progression of these changes.

Atrial fibrillation decreases the flow rate of blood in the atria. Especially in the so-called atrial appendages (small pouches within the atria), blood flows very slowly. Blood clots can form here, which can travel through the bloodstream to the brain and potentially cause a stroke.

Typical symptoms include palpitations, chest pain, and shortness of breath when the heart beats too fast. At normal speed, one may only notice weakness and fatigue or a general decrease in performance. However, if the heart rate slows down due to a conduction block, dizziness and fainting may also occur.

If atrial fibrillation becomes chronic, it is also possible to feel nothing at all. The body essentially gets used to it.

Treatment or monitoring by a doctor is important, even though atrial fibrillation - especially in the early stages - usually resolves on its own within 48 hours.

However, if left untreated, it can occur repeatedly or more frequently and ultimately persist. Treatment typically begins with medication, with some substances for treating high blood pressure also having antiarrhythmic effects. In some cases, a return to normal rhythm is sought through cardioversion. In this procedure, the doctor delivers an external electric shock to the heart under short anesthesia, which often causes it to revert to normal rhythm. In severe cases of arrhythmias, a pacemaker is implanted.
A more modern treatment option is catheter ablation, which is a minor surgical procedure. A catheter is usually inserted from the femoral vein into the right atrium, where the disturbed conduction pathway is destroyed using heat or cold. This treatment method is considered very successful for newly occurring or paroxysmal atrial fibrillation. If atrial fibrillation has been present for a longer time, the success rate is somewhat lower.

The heart is a unique organ. It is the only muscle capable of stimulating itself independently, synchronously, regularly, and in response to load. For this purpose, there is the so-called conduction system in the heart. The previously mentioned sinus node is located in the right atrium. It is the body's natural pacemaker. Here, electrical impulses are generated and transmitted to other stations in the heart. Specialized heart muscle cells receive these impulses and transmit them through both atria. The next station is the AV node (atrioventricular node), which is located between the right atrium and right ventricle. It slightly delays the impulse so that the atria can contract and direct blood into the heart chambers. From the AV node, the impulse is passed on to the His bundle, from which the two Tawara branches transmit the impulse to the Purkinje fibers. This ensures that all regions of the heart are reached.

A significant feature of conduction is that each subordinate station can generate an impulse if the predecessor fails. If the sinus node does not send signals, the AV node can generate impulses itself - albeit at a slower rhythm. If the AV node also stops sending impulses, the His bundle, Tawara branches, and Purkinje fibers can still stimulate the heart enough to beat at a very slow frequency.

• http://www.netdoktor.de/krankheiten/herzrhythmusstoerungen/vorhofflimmern/
• https://www.kompetenznetz-vorhofflimmern.de/de
• https://herzstiftung.de/service-und-aktuelles/presse/pressemitteilungen/vorhofflimmern-katheter-ablation
  

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