Complications must be expected with persistent cardiac arrhythmias, especially if the heart muscle is pre-damaged to such an extent due to organic heart disease such as coronary artery disease, cardiomyopathy, valvular heart disease, or myocarditis that it cannot maintain its normal pumping function as a result of the cardiac arrhythmia, and thus the circulation is impaired.
Types of cardiac arrhythmias
In the most malignant form of ventricular arrhythmia, called ventricular fibrillation, cardiovascular arrest occurs in every case, regardless of the heart‘s muscle strength – and without emergency treatment with an electric shock, cardiac death. Severe circulatory disorders of the heart muscle can also be triggered by cardiac arrhythmias under certain circumstances. In less serious cases, persistent or recurrent cardiac arrhythmias can exacerbate preexisting myocardial insufficiency. A particular form of cardiac arrhythmia, atrial fibrillation, which can be accompanied by a rapid, irregular heartbeat, also promotes the formation of blood clots in the atrial cavities of the heart. If these blood clots reach the brain with the natural blood flow, strokes can occur.
First diagnosis, then treatment
It is usually the family doctor who first takes an electrocardiogram, or ECG, at rest. This involves placing electrodes on the upper body and wiring them to the measuring device – it’s quick and painless. The curve of the recorded heart currents provides initial indications of whether the heart is healthy or whether there is a possible disorder. To obtain even more precise results, the ECG can be repeated under stress on a bicycle ergometer or treadmill, or an ECG can be taken around the clock (24-hour ECG). Sometimes an ultrasound echocardiogram or a catheter examination with contrast imaging of the coronary arteries or the cardiac conduction pathways is necessary for precise clarification. The physician will refer to a cardiologist for this.
Treatment of cardiac arrhythmias
Basically, depending on the type of arrhythmia, there are the following treatment options, which can be used individually or in combination:
- Medication
- Electroshock
- Cardiac catheter ablation
- Automatic defibrillator
- Cardiac surgery
Emergency treatment for acute cardiac arrhythmias.
Acute persistent arrhythmias originating in the ventricle usually respond very well to either electric shock or intravenous drugs. Especially in chronically predamaged hearts, but also, for example, in the setting of an acute myocardial infarction, arrhythmias of this type always represent an emergency situation requiring immediate medical intervention.
Therapy for arrhythmias originating from the atrium
The far less threatening arrhythmias from the atria can usually also be treated successfully by medication or, in individual cases, by electric shock. In addition, for a certain type of arrhythmia from the atria, the anlagen of which are usually already formed at birth, there is the possibility of catheter ablation. With this method, during a cardiac catheterization, conduction structures in the heart that are important for the maintenance of the arrhythmia can be located with electrocatheters and switched off by radiofrequency energy. In most cases, this is associated with a definitive cure.
Treatment of chronic cardiac arrhythmias
In contrast to acute treatment of cardiac arrhythmias, drug therapy of chronic recurrent arrhythmias from the ventricles presents a much greater challenge to the treating physician. The dilemma is that, on the one hand, the occurrence of potentially life-threatening cardiac arrhythmias cannot be predicted, and on the other hand, one hundred percent safe drugs to prevent these arrhythmias are currently not available. Since the mid-1980s, implantable defibrillators have therefore been developed specifically for patients with recurrent, life-threatening ventricular arrhythmias. These multifunctional devices, about the size of a cigarette case, are usually implanted under the pectoral muscle to the left above the heart and, although they cannot prevent arrhythmias, they can deliver an effective electrical shock when they occur.
Insertion of a pacemaker
If an arrhythmia leads to symptoms such as dizziness, collapse, or fainting due to a heartbeat that is too slow, implantation of a pacemaker is the treatment of choice. In contrast to the more complex automatic defibrillators, pure pacemakers can also stimulate the heart via electrodes and thus maintain a minimum beating frequency, but they are not capable of combating even rapid cardiac arrhythmias by delivering electric shocks. In line with their lower technical capabilities, pure pacemakers are also significantly smaller than automatic defibrillators. In individual cases, heart surgery, for example heart valve surgery, bypass surgery or, of course, heart transplantation, can also eliminate or at least favorably influence the problem of arrhythmia.
Preventive measures
If cardiac arrhythmias in a patient are an expression of an organic heart disease, effective therapy of the underlying disease can usually also treat the arrhythmia. Consequently, any measures that are required on the part of the patient to prevent progression of his or her heart disease can also protect him or her from arrhythmias at the same time. These include:
- Dietary measures, abstinence from nicotine.
- Adequate physical activity and weight regulation in coronary heart disease.
- Regular intake of medication
- Observance of the respective doctor’s orders in all forms of heart disease.
Since cardiac arrhythmias often have psychological causes, stress reduction can have a beneficial effect on the course. In the case of cardiac arrhythmias, in turn, which represent an independent problem of the “cardiac electrics”, there is usually no possibility of influence on the part of the patient.
