Treatment of Cardiac Arrhythmias

Ass. Prof. Dr. Günter Stix

One in four over 40 will be affected

Palpitations, stumbling, irregular pulse, feelings of fear: "The cardiac arrhythmia atrial fibrillation is spreading like an epidemic," reports cardiologist Prof. Günter Stix of the Medical University Vienna, who works as a leading specialist in cardiac arrhythmias in the private hospital Confraternität.

It is the most common form of arrhythmia with an increasing incidence, especially in elderly patients. The causes are in many cases the lifestyle: "High blood pressure, little exercise, high salt consumption." Atrial fibrillation can be life threatening or make other diseases worse. In addition, it increases the risk of suffering a stroke and weakens the performance of the heart in heart failure.

Diagnosis

Echocardiography is the most important imaging test that shows the size of the chambers of the heart, the atria, the nature and function of the heart muscle and the heart valves. For some structural diseases of the heart and myocarditis, a CMR (cardiac MRI) is also done, a cardio-CT is used to visualize the pulmonary veins and if circulatory disorders are suspected due to a vascular anomaly.

Treatment

There are several options for treating recurrent atrial fibrillation, starting with lifestyle changes. Medication and power surges are also at the beginning of therapy to restore a normal rhythm. "However, the drug therapy is not permanently effective," explains Prof. Stix: "After about six months, it no longer helps half of the patients."

This is why "ablation" is becoming more and more important: It is a special procedure with the help of a cardiac catheter, in which the structures in the heart that cause the fibrillation are heated with high-frequency current, sclerosed and stripped. In most cases, high-frequency current impulses are used for this purpose, less often also cold, ultrasonic or laser processes. The disturbed electrical excitation pattern can no longer spread. "60 to 70 percent of patients have no further episodes of atrial fibrillation afterwards," says Prof. Stix.

Catheter ablations are used to bring a heart that is abnormally fast and sometimes irregularly beating back into its natural rhythm. After an ablation, the heart often returns to its natural rhythm permanently. The success of the treatment can be checked using a long-term ECG.