The diagnosis of atrial fibrillation is made by an electrocardiogram. This heart rhythm disturbance which increases the risk of stroke concerns more than 750,000 people in France. As part of Awareness Week on this pathology, in partnership with Action-Coeur and Paroles&Réactions, Professor Estelle Gandjbakhch takes stock in the program Questions aux Experts on Why Doctor about its causes, diagnosis and treatments.
- Atrial fibrillation concerns more than 750,000 people in France
- The diagnosis of this heart rhythm disorder must be confirmed by an electrocardiogram
- Patient care cannot begin before the results of this examination
“It is the examination that makes it possible to make the diagnosis of atrial fibrillation”. For Professor Estelle Gadnjbakhch, the electrocardiogram is the only tool that can validate a suspicion of AF. “This is why, if through monitoring of the heart rate by taking the pulse, we are led to think that we are in the presence of this disease, it is absolutely necessary to go see your doctor, general practitioner or specialist, to do an electrocardiogram”, specifies the cardiologist who practices at the Institute of Cardiology of Pitié-Salpêtrière.
The whole issue with atrial fibrillation, a heart rhythm disorder that can cause blood clots to form in the atrium, which leads to significant risks of embolism and strokes, is in fact the difficulty of detect it when it is sometimes asymptomatic, ie the patients feel absolutely no sign of dysfunction of their heart. However, as soon as the simple measurement of the heartbeat by taking the pulse indicates an anomaly, an electrocardiogram makes it possible to establish a diagnosis easily and quickly.
“It is still necessary that this electrocardiogram be carried out at the time when one has an episode of atrial fibrillation because this one may not be permanent but intermittent”, explains for his part Dr Carole Maupain de la Pitié-Salpêtrière to Paris.
Have recordings of electrocardiograms over several days
This is why there are tools that have been developed to very regularly screen for atrial fibrillation. The objective is to have recordings of electrocardiograms over one or more days. To identify these elements, and for patients in whom atrial fibrillation is suspected, it is possible to offer them to wear a small holster which records their heart rate permanently, which makes it possible to identify atrial fibrillation when it is intermittent.
There are also connected devices, such as connected watches or linked to smartphone applications, which make it possible to perform an electrocardiogram over a long period of time. As these devices are worn permanently, the data are retrieved daily and it is even possible to read them only when palpitations appear.
No treatment before the electrocardiogram
This validation of the diagnosis of atrial fibrillation by an electrocardiogram is all the more important since it is on the basis of this examination that the management of the patient will be organised. “We are not supposed to start a treatment if we have not been able to confirm that we are indeed in the presence of atrial fibrillation by an electrocardiographic trace”, insists Professor Estelle Gandjbakhch.
Why is this examination absolutely necessary when a heart rhythm disorder can be identified by other means, and quite simply by taking a pulse? Because simply “listening” to his heart can be misleading: “tachycardia or palpitations which are symptoms of atrial fibrillation can have other causes”, recalls Professor Gandjbakhch.
Don’t miss the disease
So beware of the risk of missing out on the disease, as well as the risk of seeing it where it does not exist. And this for a key reason: the nature of the processing does not allow for error. The mainstay of treatment for atrial fibrillation is anticoagulant therapy. The patient may also be offered electric shocks that will resynchronize their heartbeat or fibrillation “ablation”, an intervention through a vein to treat the tissues in the atrium that are causing the dysfunction. But since AF is a disease for which there is no cure, which becomes chronic and therefore to be managed over the long term, anticoagulants are prescribed in any case on a long-term basis. And these drugs have side effects, in particular on the hemorrhagic risk related to their use, that they can only be prescribed in the event of absolute certainty on the diagnosis of atrial fibrillation.
Find below the answers of Professor Estelle Gandjbakhch on atrial fibrillation in the program “Questions aux Experts”:
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