by Antonella Sparvoli
One in four people suffer from it at least once in their life. It is a cardiac pathology that should not be underestimated, which can be mitigated with personalized care
Atrial fibrillation is the most common of the fast arrhythmias (tachyarrhythmias) of the heart. It can be felt with palpitations, but also with shortness of breath and dizziness. One in four people is destined to have at least one episode in their life, even if only a few have to live with it. It is estimated that about 2% of the population suffers from it, the most affected are the elderly: 1 in 10 after the age of 80.
Unlike ventricular fibrillation, which can be lethal if cardiopulmonary resuscitation maneuvers are not implemented immediately, atrial fibrillation is not life threatening, but it should not be underestimated not only for the discomfort it can bring – explains Riccardo Cappato, director of the Irccs MultiMedica Center for Clinical Arrhythmology and Electrophysiology and President of the European Society of Cardiac Arrhythmias —. But because it is responsible for about 30% of ischemic strokes. The reason is that the irregular heartbeat increases the likelihood of blood clots forming in the heart which can then travel to the brain, blocking an artery and causing stroke.
The episode of atrial fibrillation is unpredictable and has a variable duration. The cardiac activity that generates complex and abnormal atrial fibrillation – continues Cappato -. The impulses that start it can start from different areas of the heart, crossing it irregularly in terms of duration and path. In other arrhythmias we know how to identify the precise point of the heart from which they arise and on which to possibly intervene with targeted procedures (transcatheter ablation), not yet in atrial fibrillation. However, its recognition is immediate: the electrocardiographic tracing shows a clearly irregular and typical activity.
It is not easy to resolve atrial fibrillation but you can try to mitigate it with personalized treatments depending on the presentation modality. The therapy is based on the prescription of antiarrhythmic drugs which can be associated with anticoagulants which aim to reduce the risk of stroke. However, these sometimes cannot be prescribed, for example if there are factors that increase the risk of bleeding.
In these patients – explains Giuseppe Augello, head of Electrophysiology and Cardiostimulation at the Citt Studi Clinical Institute in Milan – a percutaneous closure of the left auricle can be performed, an operation recommended above all for those who are relatively young and have more than five years of life expectancy. In practice, it is a question of inserting a device through a femoral catheter which closes the mouth of the left auricle, a small space in the left atrium where about 90% of the thrombi originate which then cause the stroke: closing the auricular clot formation is prevented.
As for the antiarrhythmics – resumes Cappato – they give relief from the crises which, in cases of particular aggression, can occur more than 10-15 times a day. The problem that when you stop taking it, the discomfort comes back Another strategy is transcatheter ablation, a minimally invasive procedure that aims to destroy the cardiac tissue responsible for triggering and maintaining the arrhythmia. The problem is that we do not know how to identify the precise point of the heart from which atrial fibrillation arises and on which to intervene – the expert points out -. For this we proceed empirically, isolating some segments where it is hypothesized that arrhythmia may “lurk”. If the prediction is correct, the pathology finds itself like a lion trapped in a cage, unable to unleash its action through the heart. But the chances of being able to “cage the lion” are very variable and more procedures may be necessary. The success rate of the first surgery around 50%, 70% after the second and 85% after the third.
In the future, however, the chances of permanently resolving this arrhythmia may improve. For this to happen, it is essential to be able to identify the exact trigger point or points. To take a precise and clear picture of fibrillation, we are working on very sophisticated technology, developing a chip which, inserted into the heart in a specific position, can constantly monitor cardiac activity for months, recording the crucial moments of the triggering. of arrhythmia, those few seconds in which fibrillation vulnerable. The hope is finally to understand where the fibrillation originates in order to carry out the ablation in a targeted way, considerably increasing its effectiveness concludes the expert.
August 25, 2023 (change August 25, 2023 | 12:49)
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