Treatment of atrial fibrillation

In the treatment of atrial flutter, not only the age of the patient but also secondary diseases are taken into account. In young patients who do not have any significant concomitant diseases, an attempt is first made to normalize the corresponding point in the stimulus transmission system, which generates irregular impulses, by sclerotherapy. A so-called swallow echo (TEE) is performed before the procedure.

Similar to a gastroscopy, the patient must swallow a tube with a small ultrasound probe at its tip. This is pushed over the oesophagus very close to the atrium to see if there is any blood clot in it. If this is the case, surgery should not be performed, as there is a risk that blood clots could come loose and cause dangerous embolisms or infarctions.

This sclerotherapy is called catheter ablation. It is performed in a special catheter laboratory under sterile conditions. A small wire is pushed forward over the inguinal artery until just before the heart.

The patient is awake, the puncture site is only locally anesthetized. ECGs can be taken from any accessible part of the heart via the catheter. It is therefore possible to find out fairly precisely where in the transmission of the heart stimulus the additional impulses are generated.

The location of the catheter can be made clear by X-ray fluoroscopy. Once the point from which the additional impulses come is found, this point is heated to about 50 degrees. This part of the nerve tract is thus rendered incapable of functioning.

After a short wait, the cardiologists check whether this area will still fire impulses a short time later. If not, the wire is removed again and the puncture site is closed with a pressure bandage. The procedure is successful in over 90% of cases.

Most patients are freed from atrial flutter afterwards. In atypical atrial flutter, it is much more difficult to find the impulse site, as it can be distributed throughout the atrium. If it is found, the area can eventually be sclerosed.

In cases where successful ablation cannot be performed, drug treatment must be tried. The chances of success are much worse than with surgery. If the catheter treatment fails, an attempt can be made to treat the atrial flutter with so-called beta-blockers or antiarrhythmic drugs.

However, the chances of success are lower than with ablative measures. If the catheter technology could not achieve success, it is much more important to start a blood thinning treatment immediately to avoid dangerous embolisms or infarctions. More detailed information on this topic can be found at Treatment of atrial fibrillationFor atrial flutter and atrial fibrillation there is an internal treatment guideline.

It describes the diagnostic options and steps to be taken as well as the treatment of the disease. Anticoagulation is the systematic inhibition of blood clotting. This is necessary in the case of atrial flutter and atrial fibrillation, as blood can quickly coagulate uncontrollably due to the rapid movement of the atrium, and these so-called thrombi can be flushed out into the bloodstream.

They usually enter the head area via arteries and trigger strokes. Unnoticed atrial flutter or fibrillation are the most common causes of strokes. If a regular rhythm could not be established by catheter technology, consistent anticoagulation therapy must be started.

This treatment must be taken for life. The best known preparation is Marcumar. It inhibits vitamin K, which plays a major role in blood clotting.

Marcumar is taken gradually until a certain level is reached in the blood. The amount to be taken varies from person to person. Regular blood tests indicate whether the patient has to take one, half or quarter tablet.

There are now newer drugs that are easier to take (only once a day). However, there is a lack of long-term values and in the case of renal insufficiency, these drugs are also not easily applicable. Under blood thinning it must be noted that the tendency to bleed is increased in patients, so it takes longer for a bleeding wound to close.

Blood thinning must be discontinued, especially before surgery. The Marcumar should be applied approx.5-7 days before the procedure. The patient must then take heparin in an overlapping manner (abdominal injection).

Depending on the procedure and the wound, Marcumar can be started again about 2-5 days after the procedure. In the case of the newer drugs for blood thinning, the manufacturers state that the drug should only be paused on the day before the procedure. The restart can be done immediately after the procedure. Even in the case of dental procedures, such as pulling a tooth, it may be necessary to pause the blood-thinning treatment before the procedure.