Cardiac arrhythmia: the most important questions

Life and heart rhythm belong together. Since life is full of movement, even the heart can not beat like a clockwork. If we are happy when we get upset, it will beat faster, we know that. But we also know that there are cardiac arrhythmias that are not only annoying but dangerous.
Interview with Professor dr. med. Thomas Meinertz

When do you have to start worrying? When do cardiac arrhythmias become dangerous?

Prof. Meinertz: Cardiac arrhythmias can be something completely normal. Virtually every person has irregularities of the heartbeat at some point in his life - often without realizing it. Often, cardiac arrhythmias are the result of heart disease, eg. B. changes in the heart due to hypertension, coronary heart disease, heart valve defects.

Rarely, cardiac arrhythmias are precursors and warning signs of impending sudden cardiac death. The transition between normal and pathological can be fluid. Pathological does not always mean dangerous. The border is difficult to pull in individual cases.

Whether cardiac arrhythmias are harmless, less harmless or life-threatening, only the doctor, an internist or cardiologist, after a detailed examination of the patient decide.

Heart rhythm disorder is not the same as cardiac arrhythmia?

That's the way it is. A distinction is made between: harmless cardiac arrhythmias, which can be considered as misfires of a normal heart and cardiac arrhythmia, which are caused by a disease of the electrical impulse generators (as examples: AV block and the sinus node syndrome).

Most frequently and most significantly: cardiac arrhythmias resulting from heart disease and cardiac arrhythmias resulting from other diseases, such as hyperthyroidism.

Cardiac arrhythmias are therefore usually - if they are not congenital - no own disease, but usually the result of heart disease or other influences that bring the heart out of rhythm (potassium and magnesium deficiency, alcohol, coffee or nicotine).

What is the best strategy?

The best strategy for cardiac arrhythmias is to eliminate factors that promote cardiac arrhythmias and to treat the underlying disease that causes cardiac arrhythmia.

When should cardiac arrhythmia also be treated directly?

We used to think that many cardiac arrhythmias were threatening. In recent years, it has been learned that this is not the case. Many cardiac arrhythmias need not 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 for a treatment is a matter for the cardiologist, the regular follow-up can also be done by the internist or family doctor.

When is the treatment necessary?

Cardiac arrhythmia must be treated if it presents a risk of sudden cardiac death, if it can lead to a stroke, if it affects physical performance, if it puts a lot of strain on the patient, for example due to dizziness, or the feeling of Tachycardia or marked discomfort. Only then is a therapy initiated - in most cases initially with medication, in slow cardiac arrhythmias with a pacemaker.

What can be achieved with drugs for arrhythmia?

These medications can suppress the cardiac arrhythmia, or at least make it less frequent, shorter, or more bearable. There are various medications available. But their effect on a case by case basis is not foreseeable.

Because patients respond differently to medication, it takes patience and sometimes multiple medication changes to find the right drug and dosage.

Atrial fibrillation is the most common cardiac arrhythmia. In Germany alone 800, 000 people suffer from it. What treatment options are there?

Atrial fibrillation is not only the most common cardiac arrhythmia, it is also the cardiac arrhythmia that has made spectacular advances in therapy over the last decade. Often it is useful not to treat atrial fibrillation initially, or to treat only the underlying disease that causes the atrial fibrillation.

The next step is the use of medication. If medication is unsuccessful or intolerable and patients suffer from atrial fibrillation, catheter ablation may be considered. It is a process that causes heart cells to become so desolate that atrial fibrillation can no longer occur.

Where else have great progress been made?

In addition to the successes in the treatment of atrial fibrillation, I see great progress in the prevention of sudden cardiac death. We can help vulnerable patients with a defibrillator.

The defibrillator is implanted in the heart much like a pacemaker. He can reliably detect life-threatening cardiac arrhythmias and treat them by delivering electroshock. As a result, the life expectancy of high-risk patients can be significantly influenced.

How to deal with cardiac arrhythmias

With serenity. Do not let crazy heartbeat disturb you. With harmless arrhythmias you have to learn to live. On the other hand, one must proceed consistently with significant cardiac arrhythmias. Here you should, after having found a doctor whom you trust, whose advice follows.

The fear of pacemakers or technical devices such as defibrillators should be overcome. Even with a pacemaker or with a defibrillator, you can live well and long, without constantly thinking of the arrhythmia.

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