Atrial fibrillation would affect more than 750,000 people in France. As part of the 2021 Week of Action concerning this disease, Why Doctor offers you a series of articles to better understand atrial fibrillation, its symptoms and the treatments to control it. Update with Professor Maxime Guenoun on the management of “FA”.
- Atrial fibrillation poses the problem of its early management before the appearance of characteristic symptoms
- Blood thinners help reduce the risk of blood clots forming in the atrium that can cause a stroke
Not only is atrial fibrillation a disease that can be “silent”, i.e. without symptoms felt, but once detected, most often by “chance” during a medical examination, which also poses the problem of taking it. in charge. This pathology, which results in a disturbance of the heart rhythm linked to a dysfunction of the electrical stimulation of the atria, nevertheless, as soon as it appears, runs a thromboembolic risk. Indeed, the irregularity of the heart rate leads to poor evacuation of blood from the heart with the possible formation of clots which can have serious consequences and in particular cause a cerebrovascular accident.
Hence the question which arises of the treatment to be prescribed when this atrial fibrillation is said to be “subclinical”, i.e. before it manifests itself by identified symptoms from which a certain diagnosis can be made and that it is not documented by conventional means to assess the extent of cardiac arrhythmia.
Prevent the thromboembolic risk
Atrial fibrillation, apart from this irregular heartbeat, can be suspected in the event of palpitations, shortness of breath, fatigue. But these disorders are not necessarily linked to atrial fibrillation and additional examinations, in particular an electrocardiogram, are necessary to establish the diagnosis from which a mode of management can be defined.
“For clinical AF, we know the indications for treatment, an anti-arrhythmic strategy and an anti-coagulant strategy, explains Professor Maxime Guenoun, cardiologist in Marseille, but for subclinical AF, we have no experience for say that if we anti-coagulate we have a reduction in the risk of thromboembolism”.
The only indications available to the medical profession come from an algorithm which gives recommendations on the implementation of an anti-coagulant treatment, a treatment which is not neutral since it generates a haemorrhagic risk in the patient.
The use of anticoagulants is necessary
“But these are recommendations without class criteria. We are waiting for studies which must specify the action to be taken for patients with subclinical AF after 65 years and after 75 years when they are at risk”, specifies the practitioner who adds that if the fibrillation is important, it is in any case a recourse to anti-coagulants which is essential.
Atrial fibrillation concerns more than 750,000 people in France. For these patients, oral anticoagulants are prescribed first-line and these new drugs have many advantages, including “superior efficacy in certain population subtypes compared to VKAs (vitamin K antagonists)”, explains Professor Atul Pathak. They also have the advantage of being practical since “can get rid of the sacrosanct TP and INR assay (prothrombin level and International Normalized Ratio, which are indicators of blood coagulation, editor’s note)”.
Below, the testimony of a patient on atrial fibrillation:
.
