Cardiac arrhythmias can be treated with different operations and procedures. Depending on the cause of the arrhythmia, a pacemaker is implanted, an operation is performed on the atrial appendage, or an electrophysiological procedure is initiated.
Overview of cardiac arrhythmia
An adult’s heart beats on average between 60 and 90 times per minute. A resting pulse of more than 100 beats per minute is referred to as an accelerated heartbeat (tachycardia). A heart rate of more than 300 beats per minute is described as ventricular fibrillation, which is equivalent to cardiac arrest and leads to immediate death if not treated by defibrillation within a very short time. A resting pulse of fewer than 60 beats per minute means a slowed heartbeat (bradycardia). However, in athletes or well-trained people a resting pulse of between 50 and 60 beats is normal.
Heartbeats that occur between two normal beats are referred to as extrasystoles. Extrasystoles are usually harmless, occur even in completely healthy people and generally go unnoticed. Sometimes those affected feel stumbling beats or pauses. In most cases, treatment is not necessary.
Causes of cardiac arrhythmia
Cardiac arrhythmia can have its origin in the atria or ventricles and can be triggered by various heart diseases, such as angina pectoris, heart attack, heart valve defects, heart failure and myocarditis. Hyperthyroidism, drugs or certain medication can also cause cardiac arrhythmia. However, it is not uncommon to find no organic cause for the cardiac arrhythmia.
Symptoms of cardiac arrhythmia
Cardiac arrhythmia can manifest itself in various ways. Many sufferers hardly notice it, particularly if the changes in the heartbeat are only minor, such as an occasional faster or slower pulse. Such minor irregularities are often considered harmless.
The situation is different with a highly irregular heartbeat, which can be frightening or even threatening for some people and cause a feeling of insecurity.
Typical symptoms of cardiac arrhythmia:
- Noticeably fast heartbeat (palpitations)
- Irregular heartbeat (tripping and palpitations)
- Chest pain
- Dizziness
- Shortness of breath
- Fatigue or even fainting spells
Diagnosis
The electrocardiogram (ECG) is the most important examination method for cardiac arrhythmia. It is often used to determine the underlying cause of the arrhythmia, such as uncoordinated activity in the electrical conduction (atrial fibrillation), a conduction disturbance from the atrium to the ventricles (AV block) or extra beats (extrasystoles).
Treatment goal
The primary aim in treatment of cardiac arrhythmia is to stabilise the heart rhythm and minimise potential health risks. This can be done by restoring a regular heartbeat (rhythm control) or by controlling the heart rate to prevent rapid heart palpitations.
Cardiac arrhythmias that require treatment include:
Atrial flutter and atrial fibrillation
With atrial fibrillation, there is a significantly increased risk of stroke. The flickering movement of the atrium can cause blood clots to form in the heart, which may be carried into the vessels in the brain. Atrial fibrillation can also lead to heart failure over time.
Ventricular tachycardia
In ventricular tachycardia, excessively fast impulses form in the ventricles. This arrhythmia can be life threatening as it leads to a reduced pumping function of the heart and may turn into ventricular fibrillation.
Ventricular fibrillation
Ventricular fibrillation is an uncontrolled flickering of the ventricles in which the heart muscle can no longer perform an orderly pumping function. Without immediate treatment, often by defibrillation, ventricular fibrillation leads to cardiac arrest and is fatal within minutes.
Bradycardia
Bradycardia is a slow heart rhythm that is often caused by a disturbance of the cardiac conduction system. It can lead to symptoms such as dizziness, fatigue or even loss of consciousness.
Treatment of cardiac arrhythmia
Treatment method
Various medical approaches are used to treat cardiac arrhythmia. These include pacemakers, catheter ablation, electrical cardioversion, antiarrhythmics, defibrillation, atrial appendage surgery and surgical ablation.
Pacemaker
Pacemakers and implanted defibrillators are small electronic devices that monitor the heart rhythm and regulate it if necessary. A pacemaker intervenes if the heartbeat is too slow; an implanted defibrillator delivers a targeted electric shock in an emergency if there is a risk of ventricular fibrillation. A pacemaker can also be used in resynchronisation therapy to synchronise the left and right ventricles. The pacemaker is inserted under local anaesthetic below the collarbone and the electrodes are then carefully pushed forward and fastened to the heart via a vein.
Implantation of a pacemaker is a low-risk surgery and complications rarely occur. Occasionally, the skin wound may become infected, bruising can occur or the probes may become misplaced. To ensure reliable operation, the device is checked approximately every six to twelve months and can be adjusted externally if necessary. The battery has a lifespan of six to ten years and must then be replaced.
Catheter ablation
Catheter ablation is a minimally invasive procedure for the treatment of cardiac arrhythmia such as atrial fibrillation and atrial flutter. Under local anaesthetic, a catheter is pushed through the groin to the heart, where it destroys diseased tissue in order to restore normal heart rhythm. After ablation, it can take a few days to weeks for atrial fibrillation to disappear completely. Other arrhythmia, such as atrial flutter or Wolff-Parkinson-White syndrome, on the other hand, are often corrected immediately after ablation.
Catheter ablation is a long-term effective alternative to antiarrhythmic drugs and offers a high chance of success, particularly in atrial flutter (80%-95%). Catheter ablation is considered a low-risk intervention with a low risk of serious complications. Possible risks include bleeding at the injection site, pericarditis, infection or a new arrhythmia. In rare cases, serious complications such as pericardial effusion or stroke may occur.
Surgical ablation
Surgical ablation has the same goal as catheter ablation and also works through targeted obliteration of the affected areas of the heart. It is performed in a minimally invasive manner via small incisions in the chest and is often combined with closure of the left atrial appendage or other operations, such as bypass or heart valve surgery.
Electrical cardioversion
Electrical cardioversion is a proven method for treating cardiac arrhythmia such as atrial fibrillation and atrial flutter. Under short anaesthesia, two electrodes are placed on the chest in order to restore the heart rhythm through targeted electric shocks. In contrast to defibrillation, which is used in an emergency, cardioversion is a planned and gentle intervention.
With a success rate of more than 90%, the method is highly effective and can be easily repeated in the event of a relapse or supplemented with other treatment options, such as a pacemaker. Complications are rare and usually mild and include, for example, reddening of the skin or a slight feeling of muscle soreness in the chest area.
Chemical cardioversion (antiarrhythmics)
Drug-based cardioversion is a non-invasive method for treatment of cardiac arrhythmia, such as atrial fibrillation or atrial flutter. Antiarrhythmics are used to stabilise the heart rhythm and bring it back to its normal rhythm. Frequently used active ingredients include amiodarone, flecainide or propafenone. Chemical cardioversion is often carried out in hospital under medical supervision, as the medication can have side effects and the heart must be continuously monitored. One of the challenges of drug therapy is that the effect of the medication diminishes over time in many patients.
Left atrial appendage surgery
Closure or removal of the left atrial appendage is a complementary treatment option for patients with atrial fibrillation. The intervention aims to reduce the risk of blood clots and stroke, and to spare the patient the long-term use of blood-thinning medication.
With atrial fibrillation, most blood clots that increase the risk of stroke originate in the left atrium, the atrial appendage. Closure or removal the left atrial appendage can prevent the formation of blood clots in this part of the heart, significantly reducing the risk of stroke.
A distinction is made between surgical closure of the atrial appendage and a catheter closure. In the catheter procedure, a small ‘umbrella’ (e.g. Watchman or Amplatzer) is inserted into the atrial appendage via the groin to close it. This significantly reduces the risk of stroke, but patients who have already survived a heart attack or stroke generally cannot do without platelet inhibitors following a catheter closure. Surgical closure of the atrial appendage, on the other hand, can be performed minimally invasively using an AtriClip®, or by removal of the atrial appendage. This method is particularly effective and usually means that blood-thinning medication can be avoided.
Surgery on the atrial appendage is usually very successful in reducing the risk of stroke in patients with atrial fibrillation, and can therefore be a sensible alternative to long-term use of blood thinners.
Preparation and precautions
Preparation for the treatment of cardiac arrhythmia consists of choosing the most appropriate treatment method for the patient and the specific type of arrhythmia. First, a comprehensive diagnosis is performed, often including an ECG, stress tests and, if necessary, an electrophysiological examination (EPU). These cardiological examinations help to precisely determine the type and origin of the cardiac arrhythmia and thus to find the best possible treatment.
Aftercare and recovery
Regardless of the chosen treatment method for a cardiac arrhythmia, regular follow-up checks are crucial to ensure the success of the treatment, to detect side effects and to identify possible new cardiac arrhythmia at an early stage.
Potential complications
Although most treatment for cardiac arrhythmia is considered low risk, various complications can still occur depending on the method used. These are often mild and manifest, for example, as mild skin irritation or a small bruise at the injection site. With more invasive interventions, there is a low risk of bleeding or infection and, in rare cases, of more serious complications such as pericarditis or tamponade. Individual advice from the attending cardiologist helps to weigh up the risk accurately and to find the safest and most effective treatment method.
Prevention of cardiac arrhythmia
A balanced diet and a healthy lifestyle make a significant contribution to heart health. Fruit and vegetables should be on the daily diet, supplemented by sufficient fluids. Sweets, fatty foods and meat should be consumed only in moderation. Regular exercise is also important – at least 30 minutes of endurance sports, such as cycling, jogging or swimming support the heart. Cessation of smoking is also crucial, as tobacco consumption puts a strain on the cardiovascular system. Long-term stress also has a negative effect on health. Relaxation techniques such as meditation, autogenic training or progressive muscle relaxation can help to reduce stress.
