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Vibrating arrhythmia (fibrillation of auricles) – the violation of a rhythm of heart which is followed by frequent, chaotic excitement and reduction of auricles or twitching, fibrillation of separate groups of predserdny muscle fibers. Heart rate at vibrating arrhythmia reaches 350-600 in a minute. At the long paroxysm of vibrating arrhythmia (exceeding 48 hours) the risk of a tromboobrazovaniye and an ischemic stroke increases. At a constant form of vibrating arrhythmia sharp progressing of chronic insufficiency of blood circulation can be observed.

Vibrating arrhythmia

Vibrating arrhythmia (fibrillation of auricles) – the violation of a rhythm of heart which is followed by frequent, chaotic excitement and reduction of auricles or twitching, fibrillation of separate groups of predserdny muscle fibers. Heart rate at vibrating arrhythmia reaches 350-600 in a minute. At the long paroxysm of vibrating arrhythmia (exceeding 48 hours) the risk of a tromboobrazovaniye and an ischemic stroke increases. At a constant form of vibrating arrhythmia sharp progressing of chronic insufficiency of blood circulation can be observed.

Vibrating arrhythmia is one of the most frequent options of violations of a rhythm and makes up to 30% of hospitalization concerning arrhythmias. Prevalence of vibrating arrhythmia increases in compliance with age; it occurs at 1% of patients up to 60 years and at more than 6% of patients after 60 years.

Classification of vibrating arrhythmia

The basis of modern approach to classification of vibrating arrhythmia included character of a clinical current, etiologichesky factors and electrophysiological mechanisms.

Allocate constant (chronic), persistiruyushchy and passing (paroksizmalny) forms of vibrating arrhythmia. At a paroksizmalny form the attack proceeds no more than 7 days, usually – less than 24 hours. Persistiruyushchy and chronic vibrating arrhythmia more than 7 days last, the chronic form is defined by inefficiency of the electric cardioversion. Paroksizmalny and persistiruyushchy forms of vibrating arrhythmia can be recidivous.

Distinguish for the first time the revealed attack of vibrating arrhythmia and recuring (the second and the subsequent episodes of fibrillation of auricles). Vibrating arrhythmia can proceed on two types of predserdny violations of a rhythm: blinking and trembling of auricles.

When blinking (fibrillation) of auricles separate groups of muscle fibers therefore there is no coordinate reduction of an auricle are reduced. In atrioventricular connection a significant amount of electric impulses concentrates: part of them is late, others extend to a myocardium of ventricles, forcing them to be reduced with a different rhythm. On the frequency of reductions of ventricles forms of vibrating arrhythmia differ takhisistolichesky (ventricular reductions 90 and more in min.), normosistolichesky (ventricular reductions from 60 to 90 in min.), bradisistolichesky (ventricular reductions less than 60 in min.).

During a paroxysm of vibrating arrhythmia there is no forcing of blood in ventricles (predserdny additive). Auricles are reduced inefficiently therefore in a diastola ventricles are filled with the blood which is freely flowing down in them not completely therefore periodically there is no emission of blood in system of an aorta.

Trembling of auricles are speeded up (to 200-400 in min.) reductions of auricles with preservation of the correct coordinate predserdny rhythm. Reductions of a myocardium when trembling auricles follow one after another almost without interruption, the diastolic pause is almost absent, auricles do not relax, being the most part of time in a condition of a systole. Filling of auricles with blood is complicated, and, therefore, also intake of blood in ventricles decreases.

On predserdno-ventricular connections to ventricles the 2nd, 3rd or 4th impulses can arrive every, providing the correct ventricular rhythm, is the correct trembling of auricles. At violation of predserdno-ventricular conductivity chaotic reduction of ventricles is noted, i.e. irregular shape of trembling of auricles develops.

Reasons of vibrating arrhythmia

Both cardiac pathology, and diseases of other bodies can lead to development of vibrating arrhythmia. Most often vibrating arrhythmia accompanies the course of a myocardial infarction, a cardiosclerosis, rheumatic heart diseases, myocarditis, cardiomyopathies, an arterial hypertension, heavy heart failure. Sometimes fibrillation of auricles arises at a thyrotoxicosis, adrenomimetikama intoxications, warm glycosides, alcohol, can be provoked by psychological overloads, a gipokaliyemiya.

Also idiopathic vibrating arrhythmia which reasons remain not revealed even at the most careful inspection meets.

Symptoms of vibrating arrhythmia

Displays of vibrating arrhythmia depend on its form (bradisistolichesky or takhisistolichesky, paroksizmalny or constant), on a condition of a myocardium, the valvate device, specific features of mentality of the patient. The takhisistolichesky form of vibrating arrhythmia is much heavier transferred. At the same time patients feel tachycardia, the short wind amplifying at a physical tension, pain and interruption in heart.

Usually at first vibrating arrhythmia proceeds pristupoobrazno, progressing of paroxysms (their duration and frequency) are individual. At some patients after 2-3 attacks of blinking of auricles the persistiruyushchy or chronic form is established, at others – during life rare, short paroxysms without tendency to progressing are noted.

Emergence of a paroxysm of vibrating arrhythmia can be felt differently. Some patients can not notice it and learn about existence of arrhythmia only at medical examination. In typical cases vibrating arrhythmia is felt as chaotic serdtsebiyeniye, perspiration, weakness, a shiver, fear, a polyuria. At excessively high heart rate dizziness, faints, Morganyi-Adams-Stokes's attacks can be observed. Symptoms of vibrating arrhythmia disappear practically at once after restoration of a sinusovy warm rhythm. The patients suffering from a constant form of vibrating arrhythmia cease to notice it over time.

At an auskultation of heart are listened chaotic tone of various loudness. Arrhythmic pulse decides on the different amplitude of pulse waves. At vibrating arrhythmia deficiency of pulse is defined – the number of minute reductions of heart exceeds number of pulse waves). Deficiency of pulse is caused by that circumstance that not at each warm reduction there is an emission of blood in an aorta. Patients with trembling of auricles feel heartbeat, short wind, sometimes discomfort in heart, a pulsation of veins of a neck.

Complications of vibrating arrhythmia

The most frequent complications of vibrating arrhythmia are a thrombembolia and heart failure. At the mitralny stenosis complicated by vibrating arrhythmia obstruction of the left atrioventricular opening vnutripredserdny blood clot can lead to a stop of warm activity and sudden death.

Intracardial blood clots can get to system of arteries of a big circle of blood circulation, causing a thrombembolia of various bodies; from them 2/3 with current of blood come to cerebral vessels. Every 6th ischemic stroke develops at patients with vibrating arrhythmia. Patients are most subject to a cerebral and peripheral thrombembolia 65 years are more senior; the patients who already had earlier a thrombembolia of any localization; having diabetes, system arterial hypertension, stagnant heart failure.

Heart failure at vibrating arrhythmia develops at the patients having heart diseases and violation of a sokratimost of ventricles. Heart failure at a mitralny stenosis and a hypertrophic cardiomyopathy can be shown by cardiac asthma and hypostasis of lungs. Development of sharp left ventricular insufficiency is connected with violation of depletion of the left departments of heart that causes sharp increase in pressure in pulmonary capillaries and veins.

To one of the heaviest displays of heart failure at vibrating arrhythmia can serve development of aritmogenny shock owing to inadequately low warm emission. It is in certain cases possible transition of vibrating arrhythmia to fibrillation of ventricles and cardiac arrest. Most often at vibrating arrhythmia chronic heart failure develops, progressing up to an arhythmic dilatatsionny cardiomyopathy.

Diagnosis of vibrating arrhythmia

Usually vibrating arrhythmia is diagnosed already at fizikalny inspection. At a palpation of peripheral pulse the characteristic disorder rhythm, filling and tension is defined. At an auskultation of heart unevenness of warm tones, essential fluctuations of their loudness is listened (the loudness of the I tone following a diastolic pause changes depending on the size of diastolic filling of ventricles). Patients with the revealed changes go for consultation of the cardiologist.

Confirmation or specification of the diagnosis of vibrating arrhythmia is possible by means of data of an electrocardiographic research. When blinking auricles on the ECG there are no teeth P registering reductions of auricles, and the ventricular QRS complexes settle down chaotically. When trembling auricles on the place of a tooth P predserdny waves are defined.

By means of daily monitoring of the ECG, it is controlled onto a heart rhythm, the form of vibrating arrhythmia, duration of paroxysms, their communication with loadings etc. is specified. Tests with physical activity (a veloergometriya, the tredmil-test) are carried out for identification of symptoms of ischemia of a myocardium and at selection of antiarrhytmic medicines.

The echocardiography allows to determine the sizes of cavities of heart, intracardial blood clots, signs of defeat of valves, a pericardium, cardiomyopathy, to carry out assessment of diastolic and systolic function of the left ventricle. helps with making decision on purpose of antitrombotichesky and antiarrhytmic therapy. Detailed visualization of heart can be reached by means of heart MPT or MCKT.

The Chrespishchevodny electrophysiological research (ChPEKG) is conducted for the purpose of definition of the mechanism of development of vibrating arrhythmia that especially important to patients to whom carrying out a kateterny ablation or implantation of a pacemaker (the artificial driver of a rhythm) is planned.

Treatment of vibrating arrhythmia

The choice of medical tactics at various forms of vibrating arrhythmia is directed to restoration and maintenance of a sinusovy rhythm, prevention of repeated attacks of fibrillation of auricles, control of heart rate, prevention of tromboembolichesky complications. For knocking over of paroxysms of vibrating arrhythmia application of a novokainamid (intravenously and inside), a hinidina (inside), an amiodarona (intravenously and inside) and a propafenona (inside) under control of level HELL and electrocardiograms is effective.

Less expressed result is yielded by use of digoxin, propranolol and verapamil which, however, reducing heart rate, promote improvement of health of patients (reduction of short wind, weakness, feelings of heartbeat). In the absence of the expected positive effect from medicinal therapy resort to the electric cardioversion (drawing pulse electric discharge on area of heart for restoration of a warm rhythm) stopping paroxysms of vibrating arrhythmia in 90% of cases.

At the vibrating arrhythmia proceeding over 48 hours danger of a tromboobrazovaniye therefore for the purpose of the prevention of tromboembolichesky complications it is appointed sharply increases. For prevention of repeated development of attacks of vibrating arrhythmia after restoration of a sinusovy rhythm antiarhythmic medicines are appointed: , , etc.

At establishment of a chronic form of vibrating arrhythmia constant reception of adrenoblokator (an atenolol, a metoprolol, a bisoprolol), digoxin, antagonists of calcium (a diltiazem, verapamil) and a varfarina is appointed (under control of indicators of a koagulogramma - a protrombinovy index or MNO). At vibrating arrhythmia it is necessary treatment of the main disease which led to development of violation of a rhythm.

The method which is considerably eliminating vibrating arrhythmia is carrying out radio-frequency isolation of pulmonary veins during which the center of ektopichesky excitement located in mouths of pulmonary veins is isolated from auricles. Radio-frequency isolation of the mouth of pulmonary veins is an invasive technique which efficiency makes about 60%.

At often repeating attacks of vibrating arrhythmia or at its constant form performance of RChA of heart - a radio-frequency ablation ("cauterization" by means of an electrode) atrioventricular knot with creation of full cross AV-blockade and implantation of a constant electropacemaker is possible.

The forecast at vibrating arrhythmia

As the main predictive criteria at vibrating arrhythmia serve the reasons and complications of violation of a rhythm. The vibrating arrhythmia caused by heart diseases, severe damages of a myocardium (a krupnoochagovy myocardial infarction, an extensive or diffusion cardiosclerosis, a dilatatsionny cardiomyopathy) quickly leads to development of heart failure.

Predictively the tromboembolichesky complications caused by vibrating arrhythmia are adverse. Vibrating arrhythmia increases the lethality connected with heart diseases by 1,7 times.

In the absence of heavy cardiac pathology and satisfactory a condition of a myocardium of ventricles the forecast more favorable though frequent emergence of paroxysms of vibrating arrhythmia significantly reduces quality of life of patients. At idiopathic vibrating arrhythmia the health usually is not broken, people feel almost healthy and can perform any work.

Prevention of vibrating arrhythmia

The purpose of primary prevention is active treatment of the diseases potentially dangerous in the development plan for vibrating arrhythmia (arterial hypertension and heart failure).

Measures of secondary prevention of vibrating arrhythmia are directed to observance of recommendations about antirecurrent medicinal therapy, carrying out cardiac intervention, to restriction of physical and mental activities, abstention from reception of alcohol.

Vibrating arrhythmia - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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