Cardiac Arrhythmia – Atrial Fibrillation
Assoc. Prof. PD Mag. Dr. Lukas Fiedler
Specialist in Internal Medicine, Cardiology, and Angiology, Specializing in Rhythmology
Head of the Cardiac Catheterization Laboratory at the Confraternität Private Hospital
Dr. Fiedler, who is most affected by atrial fibrillation, and how does it manifest?
Atrial fibrillation is one of the most common cardiac arrhythmias, in which the atria of the heart beat uncontrollably and too quickly. Typical symptoms include palpitations, rapid heartbeat, shortness of breath, weakness, dizziness, and significant impaired physical performance. Many affected patients do not recognize the danger, and it often takes years before the disease is diagnosed.
When should you see a specialist?
If the symptoms mentioned occur frequently or persist for a long time, a specialist evaluation is recommended.Arrhythmias are diagnosed using an ECG. This examines the heart's electrical activity for irregularities.
What risks are associated with atrial fibrillation?
Atrial fibrillation carries the risk of heart failure and increases the risk of stroke fivefold. The mortality risk is twice as high for women and one and a half times higher for men. Approximately one-quarter of all strokes are caused by atrial fibrillation. Because blood flows more slowly in atrial fibrillation, blood clots can form. If a clot breaks off and blocks blood vessels in the brain, a stroke occurs.
Atrial fibrillation can be treated with medications called antiarrhythmics. Why is this not always the best option?
Antiarrhythmics can have side effects when taken long-term – from mild to very severe. Therefore, their use must be monitored by a doctor. A good alternative is an electrophysiological procedure called ablation. This procedure is intended to quickly restore an irregularly beating heart to its natural rhythm.
How does ablation work?
During this procedure, which is performed under general anesthesia (or local anesthesia), a catheter is inserted into the inferior leg vein via the groin, then through the inferior vena cava and through the atrial septum into the left atrium to isolate the interfering signals. The most common procedure is radiofrequency therapy: it uses heat to destroy the heart tissue responsible for the arrhythmia. A newer technology is pulsed field ablation (PFA), which offers additional options and is intended to increase safety and efficacy. It is a procedure in which short, high-energy electrical pulses are used to specifically destroy heart muscle cells in order to eliminate cardiac arrhythmias. The surrounding tissue is spared. In general, the technology has improved significantly over the last 20 years, and tissue can be visualized in 3D. Today, only a single procedure is often required, whereas previously multiple procedures were necessary.
How successful is ablation?
Ablation offers high success rates with low complication rates (serious complications occur in less than 1 per mille of cases). The procedure significantly reduces symptoms and enables the patient to lead a good, symptom-free life again. The success of the treatment is monitored using a long-term ECG. However, ablation is a procedure that requires extensive training and should only be performed in specialized centers.
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