Atrial Fibrillation

"If combined with the use of the defibrillator (defibrillator-synchronizer), it makes it possible to treat potentially malignant arrhythmias that sometimes coexist in the patient with heart failure".

DR. IGNACIO GARCÍA BOLAO

Non-persistent or paroxysmal atrial fibrillation is the most common sustained cardiac arrhythmia. Its increase is associated with an aging population.

It is an alteration of the normal conductivity of the heart (called sinus rhythm), when the atria do not contract properly and the ventricles contract irregularly and excessively fast, preventing the normal functioning of the heart.

The Department of Cardiology of the University of Navarra Clinic has an Arrhythmia Unit specialized in its diagnosis and treatment.

We are a reference in terms of medical advances and their use in the treatment of diseases, which offers new opportunities.

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What are the symptoms of atrial fibrillation?

Patients often have palpitations, choking sensations, chest pain, fatigue, dizziness, etc. In general, atrial fibrillation makes it impossible to perform simple everyday tasks.

Throughout the evolution of the disease, the patient may experience symptomatic and asymptomatic periods, since, with time, the palpitations may even disappear. This is important because one can be in danger without feeling any discomfort.

Sometimes, it is discovered that a patient presents auricular fibrillation because suddenly suffers a cerebral ischemia (transitory or permanent), whose clinical manifestations (difficulty to mobilize half of the body or to speak or both) could disappear in 24 hours or remain permanent (or even produce death).

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Learn how heart arrhythmias are diagnosed and treated (available in spanish)

The most common symptoms are:

  • Palpitations.
  • Choking sensation.
  • Pain in the chest.
  • Fatigue.
  • Dizziness.

Do you have any of these symptoms?

You may be suffering from atrial fibrillation

What are the causes of atrial fibrillation?

It can occur both in hearts with previous pathology and in healthy hearts.

Atrial fibrillation can occur in hearts with cardiac pathology (mitral valve disease, coronary disease, pericarditis, congenital heart disease), associated with other diseases (high blood pressure, lung cancer, etc.), or even when there is excessive alcohol intake.

But it can also appear in apparently healthy people who, in principle, do not present any cardiac pathology.

Who can suffer from it?

Atrial fibrillation (AF) is the most frequent maintained arrhythmia nowadays (with an estimated prevalence in the adult population between 0.4 and 2%), conditioned by a significant increase in mortality due to cardiovascular problems.

It is usually associated with mitral valve disease (but can also appear in isolation or associated with other diseases). It is characterized by the lack of coordination of the rhythm of contraction of the atrium.

It can cause thrombosis and embolism and major cardiovascular complications such as stroke.

How is atrial fibrillation diagnosed?

The patient's pulse and an electrocardiogram show whether atrial fibrillation is present.

The pulse of the patient with atrial fibrillation, which is irregular, can be made by palpation of the radial artery in the wrist.

The diagnosis is confirmed by an electrocardiogram (ECG), which is a graphic record of the heart's electrical activity. 

Once the diagnosis is confirmed, the echocardiogram will make it possible to evaluate the causes of the arrhythmia and to exclude the presence of clots in the heart chambers.

How is atrial fibrillation treated?

Pharmacological treatment is the first therapeutic choice for atrial fibrillation, through the use of antiarrhythmics, in what is called pharmacological cardioversion.

Although they are effective in a high percentage, they may not be effective in patients with persistent arrhythmia. Sometimes, they produce side effects that prevent their use as a chronic treatment.

Heart rate control is achieved with beta-blocker drugs, calcium channel antagonists, and digoxin.

Despite their effectiveness, they do not manage to restore the sinus rhythm by themselves, nor do they significantly reduce the risk of embolic accidents, which is why oral anticoagulants are necessary, so that the blood has less facility to coagulate and clots cannot be produced in the atrium.

Anticoagulants require periodic controls, since a lower level can cause the formation of clots and an excessive level, spontaneous internal bleeding.

Some types of arrhythmias, such as paroxysmal tachycardias or atrial flutter are definitively solved by radiofrequency ablation. This procedure is a great advance in the treatment of arrhythmias, as it solves more than 90% of cases. Only in less than 5% of patients do they reappear.

After an electrophysiological study, introducing an electrocatheter into the cardiac cavities, the focus of myocardial tissue causing the arrhythmia is destroyed. It is a very safe, relatively simple and fast procedure.

It definitively eliminates a large number of arrhythmias that would otherwise be difficult to solve or would need to be treated with drugs for life.

The procedure is performed by puncturing a vein in the groin. It requires local anesthesia and the patient is discharged in a few hours.

Cryoablation is an advanced technique for treating non-persistent (paroxysmal) atrial fibrillation. The greatest benefit of this technique is that the treatment is performed by freezing, in a single energy impact, and in a faster and more effective way.

The procedure has already been successfully performed by our experts on numerous occasions. Until now, the conventional method applied point-to-point radiofrequency impacts throughout the perimeter of the pulmonary veins, where the arrhythmia originates.

The application of the cold is achieved by introducing, by means of a catheter, a balloon filled with nitrous oxide (a chemical compound used as a source of cold) that reaches the intersection of the pulmonary veins with the left atrium in order to isolate and prevent the propagation of the anomalous electrical impulse.

Pacemakers are small electronic devices capable of analyzing the heart's rhythm and treating arrhythmias by means of electrical stimuli. Their function is to supply the functions of the cardiac excitation and conduction system. They are generally implanted under local anesthesia during almost the entire procedure.

Recovery from the procedure is rapid and allows discharge from the hospital in two or three days. When the batteries run out, approximately every six years, it is necessary to replace the pacemaker.

The Clinic has a system for remote control of pacemakers that sends daily information about the technical data of the devices from the patients' homes. In this way, the disease is better controlled.

The program monitors the functioning of the devices implanted in the patients and transmits the technical data to the cardiologists via cell phone on a daily basis.

In some patients with severe, potentially lethal arrhythmias, it is necessary to implant an implantable automatic defibrillator, which restores normal heart rhythm by automatically applying electrical shocks.

The defibrillator controls the heart rhythm permanently. When it detects an arrhythmia, it uses different treatments by means of electrical impulses to suppress it.

Depending on the severity of the arrhythmia, the defibrillator automatically applies softer treatments (antitachycardia stimulation) or more radical ones (cardioversion by electric shock), which can occasionally be perceived by the carrier. Sometimes the defibrillator is associated with cardiac resynchronization therapy, thus improving the insufficiency that sometimes the patient also suffers.

The Clinic has a system for remote control of defibrillators that sends daily information from the patient's home.

In the Clinic we perform the technique called HeartPort. With this procedure, access to the heart is achieved through small lateral incisions instead of performing a sternotomy (opening of the chest through the sternum). This allows a quick recovery and avoids less aesthetic scars.

In addition, we have the resources and experience necessary to perform atrial fibrillation surgery without the use of the heart-lung machine, with the consequent reduction in operating time and surgical complications.

Atrial fibrillation surgery emerged almost twenty years ago to restore sinus rhythm in patients undergoing surgery for some cardiac pathology (mitral valve disease, coronary disease, etc.).

The technique, called "labyrinth" because of its complexity, performed various lines of scars with scalpel and sutures, distributed through the atria. A unique path is created by which the electrical impulse flows from the sinus node to the atrial-ventricular node, avoiding the electrical stimuli that cause AF.

Where do we treat it?

IN NAVARRE AND MADRID

OUR MEDICAL TEAM

Specialists from the Department of Cardiology

The Department of Cardiology of the Clinica Universidad de Navarra is a center of reference in different diagnostic techniques and coronary treatments.

We have been the first center in Europe to place a pacemaker by means of a catheterization without the need to open the chest, for cases of severe heart failure.

The Cardiology Department of the Clinic collaborates with the Radiology and Cardiac Surgery Departments to achieve a quick and precise diagnosis of the patient.

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Why at the Clinica?

  • Specialized Arrhythmia Unit of national reference.
  • Unit of Hemodynamics and Interventionist Cardiology equipped with the best technology.
  • Cardiac Imaging Unit to achieve the highest diagnostic accuracy.

Our team of professionals

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