Life and heart rhythm belong together. Since life is full of movement, the heart cannot beat like clockwork either. When we are happy, when we are excited, it beats faster, we know that. But we also know that there are cardiac arrhythmias that are not only annoying, but dangerous. Interview with Professor Thomas Meinertz, MD.
When do you have to start worrying? When do cardiac arrhythmias become dangerous?
Prof. Meinertz: Cardiac arrhythmias can be something completely normal. Virtually everyone has heartbeat irregularities at some point in their lives – often without realizing it. Often, arrhythmias are the result of heart disease, e.g., changes in the heart due to high blood pressure, coronary artery disease, heart valve defects. Rarely, arrhythmias are precursors and warning signs of impending sudden cardiac death. The transition between normal and abnormal can be fluid. Pathological does not always mean dangerous. It is difficult to draw the line in individual cases. Only a physician, an internist or cardiologist, can decide whether cardiac arrhythmias are harmless, less harmless, or life-threatening after a detailed examination of the patient.
So cardiac arrhythmia is not the same as cardiac arrhythmia?
That’s right. A distinction must be made between: harmless cardiac arrhythmias, which can be considered as misfiring of a normal heart, and cardiac arrhythmias caused by a disease of the electrical impulse generators (as examples: AV block and sinus node syndrome). Most common and significant: cardiac arrhythmias that are a consequence of heart disease, and cardiac arrhythmias that are a consequence of other diseases, such as hyperthyroidism. Thus, cardiac arrhythmias are usually – if not congenital – not a disease in their own right, but usually the result of heart disease or other influences that throw the heart out of sync (potassium and magnesium deficiency, alcohol, coffee or nicotine).
What is the best strategy?
The best strategy against arrhythmias is to eliminate factors that promote arrhythmias and to treat the underlying disease that causes the arrhythmia.
In addition, when do cardiac arrhythmias need direct treatment?
In the past, we considered many cardiac arrhythmias to be threatening. In recent years, we have learned that this is not the case. Many arrhythmias do not need to be treated at all. Today, cardiac arrhythmias are treated only when absolutely necessary. But then they should be treated consistently and only by a specialist. The decision to treat is a matter for the cardiologist, and regular follow-up can also be performed by the internist or family physician.
When is treatment necessary?
A cardiac arrhythmia must be treated if it poses a risk of sudden cardiac death, if it can lead to a stroke, if it affects physical performance, if it places a great deal of stress on the patient, for example, by causing dizziness, a feeling of racing heartbeat, or pronounced malaise. Only then is therapy initiated – in most cases initially with medication, and in the case of slow cardiac arrhythmias with a pacemaker.
What can be achieved with medication for cardiac arrhythmias?
These medications can suppress the arrhythmia or at least make it occur less often, for a shorter period of time, or make it more tolerable. Various drugs are available for this purpose. But their effect in individual cases cannot be predicted with certainty. Because patients respond differently to the medications, patience and, in some circumstances, multiple medication changes are needed until the right medication and the right dosage are found.
Atrial fibrillation is the most common cardiac arrhythmia. In Germany alone, 800,000 people suffer from it. What are the treatment options?
Atrial fibrillation is not only the most common cardiac arrhythmia, it is also the cardiac arrhythmia for which spectacular progress has been made in therapy over the past decade. It often makes sense not to treat atrial fibrillation at first, or to treat only the underlying disease that causes atrial fibrillation. The next step is the use of drugs.If medication is unsuccessful or not tolerated and patients suffer significantly from atrial fibrillation, catheter ablation may be considered. This is a procedure in which heart cells are obliterated so that atrial fibrillation can no longer develop.
Where else have major advances been made?
In addition to the successes in treating atrial fibrillation, I see great progress in preventing sudden cardiac death. We can help patients at risk with a defibrillator. The defibrillator is implanted into the heart in a similar way to a pacemaker. It can reliably detect life-threatening cardiac arrhythmias and treat them by delivering an electric shock. This can have a significant impact on the life expectancy of high-risk patients.
How should we manage cardiac arrhythmias?
With composure. One should not let cardiac arrhythmias drive one crazy. One must learn to live with harmless arrhythmias. On the other hand, one must proceed consistently with significant cardiac arrhythmias. Once you have found a doctor you trust, you should follow his or her advice. One should overcome one’s fear of pacemakers or technical devices such as defibrillators. Even with a pacemaker or a defibrillator, one can live well and for a long time without constantly thinking about the arrhythmia.
