Electrotherapy | Cardiac arrhythmia therapy

Electrotherapy

The electrotherapy of cardiac arrhythmias involves the use of pacemaker systems. On the other hand, this also includes defibrillation and high-frequency current ablation

Pacemaker

A pacemaker (PM) is a medical electrical device that can accelerate the heart rate when the heartbeat is too slow, i.e. bradycardia. In the meantime, however, devices are also in use that are implanted as antitachycardic systems and function like a built-in defibrillator. In addition, there are systems that combine both functions, i.e. they can intervene in the heart rhythm both when the heartbeat is too fast and too slow.

For pacemakers there is a letter code, the NBG code: Among other things, it provides information about the localization location, the operating mode and the frequency adaptation. Various types of sensors are used to determine, for example, the patient’s respiratory minute volume (volume and number of breaths per minute, this value correlates with physical exertion and, in turn, with the required heart rate). The required heart rate calculated by the sensor is compared with the actual heart rate measured by a built-in ECG. If the actual frequency (cardiac arrhythmia) falls below or exceeds the calculated physiological heart rate ranges, the pacemaker emits small electric shocks and can thus influence the frequency. In addition to the respiratory minute volume, modern pacemaker systems measure many other values in order to achieve the most accurate adjustment of the calculated value.

Defibrillation

Defibrillation is used, for example, for ventricular flutter and ventricular fibrillation. The aim of defibrillation is to bring the uncoordinated working cells of the heart’s stimulation system back into harmony and to subordinate them to the rhythm of the sinus node (natural pulse pacemaker).

High frequency current ablation

In high-frequency ablation, undesired tissue is sclerosed and ablated using high current doses.For this purpose, a so-called cardiac mapping is carried out beforehand, i.e. a “map” of the heart is generated on the computer to record the exact location of the cells that are the focus of the arrhythmia, i.e. “always play in between” (see note on defibrillator). This minimally invasive procedure is now used in many different forms of arrhythmia, e.g. in WPW syndrome or atrial reentry tachycardia.