Fibrillazione atriale
Definizione
La fibrillazione atriale è l’aritmia più frequente e può arrivare ad avere una prevalenza del 10% nelle persone di età avanzata. Si raccomanda lo screening della fibrillazione atriale in tutti i pazienti con più di 65 anni d’età, mediante la palpazione del polso periferico. Se il polso è irregolare si effettua un ECG per confermare la diagnosi. Alcuni pazienti sono completamente asintomatici; altri invece, possono presentare: cardiopalmo aritmico, dispnea, angor o astenia. Può comparire in corso di stress emozionali, dopo una chirurgia, in corso di intossicazione etilica acuta, ipossia o ipercapnia. Si osserva anche in pazienti con cardiopatia, soprattutto valvulopatia mitralica e, in soggetti con tireotossicosi. Bisogna tenere in conto altri possibili fattori scatenanti, come il tromboembolismo polmonare.
Fisiopatologia
La fibrillazione atriale è provocata da una ipereccitabilità degli atri e mantenuta da disturbi di conduzione delle vie senoatriali. Può essere scatenata da una extrasistole atriale precoce o al contrario da un episodio di bradicardia sinusale. La fibrillazione atriale riduce la portata cardiaca del 20-25%.
Eziologia
Forma idiopatica: la fibrillazione atriale compare, a volte sotto forma parossistica recidivante, in soggetti che non hanno alcuna cardiopatia.
Cardiopatie: tutte le cardiopatie possono complicarsi con fibrillazione atriale, in particolare i vizi valvolari mitralici, le comunicazioni interatriale, le coronaropatie.
Infezioni: soprattutto respiratorie.
Traumi: intervento chirurgico, soprattutto intratoracico, traumi toracici.
Ipertiroidismo.
Disturbi del ritmo: sindrome di bradicardia-tachicardia, sindrome di Wolff-Parkinson-White.
Sintomi
- Fibrillazione atriale permanente: spesso silente, talvolta palpitazioni, senso di affaticamento, dispnea da sforzo.
- Fibrillazione parossistica: palpitazioni, dolori retrosternali di tipo anginoso da insufficienza coronarica funzionale; lipotimia, talvolta anche sincope.
- Esame clinico: il polso radiale è irregolare, alcune sistoli cardiache sono insufficienti per essere percepite alla periferia. Si constata una differenza fra pulsazioni cardiache ascoltate il numero delle pulsazioni palpate (polso deficitario). La pressione arteriosa è variabile e difficile da misurare.
Diagnosi
All’ECG è caratterizzata da un’attività atriale molto rapida e disorganizzata, in cui sono assenti le onde p, che vengono sostituite da ondulazioni della linea di base con una frequenza compresa fra 350 e 600 bpm. La risposta ventricolare è completamente irregolare, essendo questa una caratteristica fondamentale della fibrillazione atriale.
Terapia
La terapia ha quattro obiettivi:
- Ripristino del ritmo sinusale mediante cardioversione elettrica farmacologica. La cardioversione può essere elettrica o farmacologica. I farmaci più utilizzati per la cardioversione della fibrillazione atriale sono gli antiaritmici di classe IC.
- Controllo della frequenza ventricolare. Con questo obiettivo possono essere utilizzati la digossina, i beta- bloccanti o i calcio-antagonisti, che sono invece assolutamente controindicati nella fibrillazione atriale con Wolff-Parkinson-White (WPW).
- Prevenzione delle recidive. In caso venga ristabilito il ritmo sinusale mediante cardioversione, si può utilizzare un farmaco antiaritmico di classe IC o amiodarone per prevenire le recidive. L’amiodarone è il farmaco più efficace nel prevenire le ricadute, ma il suo utilizzo a lungo termine si associa effetti collaterali frequenti. Quanto maggiore sia il diametro dell’atrio sinistro più difficile è mantenere il ritmo sinusale. Un’altra alternativa consiste nell’ablazione circonferenziale delle vene polmonari mediante cateterismo, una tecnica particolarmente utile nei pazienti in cui la fibrillazione atriale è originata da generate da foci automatici localizzati intorno alle vene polmonari. Tale tecnica ha un’efficace elevata e previene le recidive in un 80% dei casi.
Ti potrebbero interessare:
- Cardiopatie congenite
- Angina pectoris
- Stenosi mitralica
- Amiodarone: A Cosa Serve, Dosaggio e Modo d’Uso Corretto
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