What is atrial fibrillation?

Atrial fibrillation is the most common heart rhythm disorder affecting humans. In a healthy heart rhythm, the stimulation takes place via the sinus node as the “clock generator” of the heart. From the sinus node, the electrical stimulus spreads throughout the heart, starting at the atria. This results in a rhythmic pumping movement of the heart muscle, in which first the atria contract and relax, then the ventricles. The blood is transported to all organs in a fluid movement.

With sinus rhythm, there is a steady stimulation of the heart.

Patients suffering from atrial fibrillation have a disturbed stimulation process. There is a chaotic stimulation in the atrium and constantly circling currents develop. There is no rhythmic heartbeat because the “clock generator”, the sinus node, no longer determines the stimulation. Stimuli arrive in the ventricles at very irregular intervals. This means that the heart can no longer pump efficiently, which can lead to a wide range of symptoms.

In atrial fibrillation, there are many chaotic foci of stimulation.

Persistent and paroxysmal atrial fibrillation

Atrial fibrillation is divided into two types. First is persistent atrial fibrillation.
We speak of persistent atrial fibrillation when the fibrillation lasts longer than seven days and does not stop spontaneously. This type of atrial fibrillation can be easily diagnosed with the help of a classic ECG recording and can be treated with medication or cardioversion.

The second type is paroxysmal, or episodic atrial fibrillation. It is characterised by symptoms such as shortness of breath, dizziness, chest pain or sudden sweating. Some patients, on the other hand, do not experience any symptoms, which makes this disease unpredictable. It is triggered by stress or exertion, especially in patients with additional heart disease. Alcohol consumption and large meals can also trigger atrial fibrillation.
Often, paroxysmal atrial fibrillation is long gone by the time you go to the doctor for a classic ECG scan. Therefore, a long-term ECG is usually necessary for diagnosis, in which an ECG recording is made over several days with the help of portable devices.

What are the risks of atrial fibrillation?

Typical symptoms of atrial fibrillation are shortness of breath, reduced exercise capacity and dizziness or even fainting. These symptoms not only reduce the patient’s quality of life, but can also lead to accidents with serious injuries. Sudden attacks of weakness or fainting can lead to uncontrolled falls and related injuries.
However, the course of atrial fibrillation disease can also be symptom-free, which does not make the disease any less dangerous. The impaired pumping function of the heart promotes the formation of blood clots, so-called thrombi, in the atrium of the heart. If these become detached and enter the aterial bloodstream, this can lead to embolisms, a sudden blockage of a blood vessel. This occlusion in turn triggers an infarction in the organ affected. An infarction describes the undersupply of an organ with blood over a longer period of time, causing sudden death of tissue.

The risk of cerebral infarction or stroke is particularly high. Patients with atrial fibrillation are five times more likely to have strokes than healthy people and have a much more severe course.
It should be noted that it does not have to be persistent atrial fibrillation. Short episodes are sufficient for a thrombus to form and are therefore particularly dangerous, not least because diagnosis is much more difficult.

Patients with atrial fibrillation have a 5 times higher risk of stroke.

Case numbers and hidden numbers

Atrial fibrillation has long since become a widespread disease in Germany. More and more people suffer from atrial fibrillation, often unnoticed. The chance of developing atrial fibrillation is particularly high in old age. This, in combination with the demographic development in Germany, is the reason for the increasing number of cases. Men are more likely to develop the disease than women.

About 5% of the German population suffers from atrial fibrillation. That corresponds to about 4,000,000 people. However, only about 1,600,000 people, which is less than half of those affected, have been diagnosed. Often, atrial fibrillation remains asymptomatic and thus undetected. Sudden ischaemic strokes, supposedly without cause, are the result.

That is why it is advisable to specifically look for atrial fibrillation in old age, and do a so-called screening. Experts advise taking an ECG for 72 hours, even if no symptoms of atrial fibrillation are known or no abnormalities were seen in the resting ECG. In this way, a reliable risk profile can be created for each patient.

Based on this risk profile, which should also take into account other risk factors such as blood pressure, obesity and previous illnesses, the number of possible patients has risen to over 20,000,000 in Germany alone.

Numbers of cases and undetected cases in %. One circle corresponds to one % of the total population.

How is atrial fibrillation treated?

Due to the frequency of the disease, a variety of treatment methods have been established today.
Depending on the severity of the course, the symptoms and the general parameters of the patient (age, sex, previous illnesses, …), an individual treatment can be chosen.
As a rule, anticoagulant drugs, colloquially known as “blood thinners”, and rhythm-maintaining drugs are prescribed. The aim of blood thinners is to prevent blood clots from forming and thus minimise the risk of a stroke. The rhythm-maintaining drugs are intended to bring order back into the chaotic stimulations of the heart and, in the best case, enable a regular heart rhythm.
The patient himself can also minimise the risk of atrial fibrillation by changing his lifestyle. Limiting alcohol and cigarette consumption, getting plenty of exercise and reducing any excess weight are particularly important and effective.

If drug therapy is not possible, e.g. due to pre-existing conditions of the cardiovascular system or the non-response of active substances, technological therapies can also be used.
By means of so-called catheter ablations, the origins of the uncontrolled excitations of the heart can be neutralised and switched off. One such device is the RF liveGEN generator.
This treatment method has a success rate of 50-70% for the first treatment, with a strong upward trend thanks to increasingly advanced technologies.

How is atrial fibrillation diagnosed?

If atrial fibrillation is suspected, a medical history is usually taken to ask about the typical symptoms of atrial fibrillation. A quick check of the pulse can also give indications of atrial fibrillation. However, a definite diagnosis can only be made by measuring the resting ECG.
The ECG of a patient with atrial fibrillation shows a typical unrhythmic course.

Resting ECG of a healthy person
Resting ECG of a healthy person
Resting ECG of a person with persistent atrial fibrillation
Resting ECG of a person with persistent atrial fibrillation

However, this diagnosis by resting ECG can only be made in the case of a persistent condition. The diagnosis of paroxysmal atrial fibrillation can be much more difficult. Some patients only have atrial fibrillation for a few minutes a week. To record the fibrillation, a so-called long-term ECG must be made.
For this purpose, a portable ECG device is attached to the patient, which is worn for at least 24 hours, but normally for 3 – 7 days. In this way, even short fibrillation episodes can be reliably detected and a reliable diagnosis can be made. Such long-term ECGs are called Holter ECGs in the language of medical terminology.

Holter ECG devices

Until a few years ago, common Holter ECG devices were about the size of a calculator and had up to 12 cables. The quality of life was significantly reduced because the device was worn either on the belt or around the neck. Sleeping peacefully was hardly possible.
In addition, these devices could not be overlooked due to their size, and cables hung all over the body, restricting freedom of movement. Sport or showering during a long-term ECG recording was almost unthinkable.

In recent years, however, significant technological progress has been made in the recording of long-term ECGs.

The liveECG – A new era of the Holter ECG

livetec has taken a big step into the future of Holter ECG with the liveECG – long-term-EKG-recorder. The liveECG is completely wireless, weighs only 32g, is about the size of a business card and is only about 1cm thick.

You can wear it under your clothes without it being noticeable and move around freely. It can also be used for sports. For showering, you can take the device off your chest for a short time and then put it back on without interrupting the recording.

The operation is so simple that you don’t necessarily need a doctor to put it on. For example, it is possible to start a contactless examination with the liveECG by sending it to the patient by post and he or she applies it themselves. After a few days, the patient can send it back to the doctor and wait for the result.

By clicking on the image you accept Vimeo’s privacy policy.


1 https://www.kardiologie-saalkreis.de/wp-content/uploads/2014/03/Samstag-003-Rezidive-Afib-Teutschenthal-2014-Kopie.pdf

2 https://dzhk.de/aktuelles/news/artikel/volkskrankheit-vorhofflimmern-expertengruppe-veroeffentlicht-empfehlungen-zum-screening-nach-einem/

3 https://www.aerzteblatt.de/nachrichten/sw/Vorhofflimmern?s=&p=1&n=1&nid=76111

4 https://www.aerzteblatt.de/nachrichten/sw/Vorhofflimmern?s=&p=1&n=1&nid=57000

5 https://leitlinien.dgk.org/files/21_2016_pocket_leitlinien_vorhofflimmern.pdf

6 https://www.gbe-bund.de/gbe/!pkg_olap_tables.prc_set_orientation?p_uid=gast&p_aid=30966864&p_sprache=D&p_help=2&p_indnr=594&p_ansnr=76514596&p_version=2&D.000=3&D.001=3&D.002=3&D.003=3&D.972=3&D.946=2&D.100=1&D.011=3

7 https://www.iges.com/presse/2015/weissbuch-schlaganfall/index_ger.html#:~:text=September%202015%20(IGES%20Institut)%20%E2%80%93,Unsicherheiten%20bei%20Patienten%20und%20%C3%84rzten.

8 https://www.medtronic.com/de-de/c/schoenstes-herzklopfen/schoenstes-herzklopfen-informationen-fuer-patienten/vorhofflimmern.html

9 https://www.kompetenznetz-vorhofflimmern.de/sites/default/files/redaktion/dateien/2020/AFNET_Patientenbrosch%C3%BCre_Neuauflage%202018_final_20180220_0.pdf

10 https://refubium.fu-berlin.de/bitstream/handle/fub188/27955/F_Liebner_Diss.pdf?sequence=1&isAllowed=y

11 https: //schlaganfallbegleitung.de/video/vorhofflimmern