CARDIOLOGY
ATRIAL FIBRILLATION – DIAGNOSIS AND THERAPIES FROM HEART SPECIALISTS
With around 2 million people affected, atrial fibrillation is the most common persistent cardiac arrhythmia in Germany. Increased life expectancy with an ageing population reinforces this development. If atrial fibrillation remains unrecognised, it can lead to strokes and heart failure. The risk of stroke increases significantly after just a few minutes of atrial fibrillation.
Not every client with atrial fibrillation has an equally increased risk of stroke. The individual risk is assessed by the doctor on the basis of risk characteristics. High blood pressure, heart failure, or diabetes mellitus have an unfavourable effect. Clients over the age of 65 have an increased risk. For some years now, new blood thinners (NOACs) have proven to be safe and well tolerated. For clients with an increased risk of bleeding and an intolerance to blood thinning medication, an atrial appendage occlusion may be useful.
We have summarised our services for the diagnosis and treatment of atrial fibrillation in the following info boxes.
CARDIOLOGY
ATRIAL FIBRILLATION – DIAGNOSIS WITH THE WORLD’S SMALLEST ECG DEVICE
Cardiac arrhythmias often occur only briefly, irregularly, or at long intervals. Diagnosis using a resting or 24-hour holter ECG is difficult. At the ETHIANUM, we offer you the implantation of a mini heart monitor for long-term monitoring. The procedure is minimally invasive and makes monitoring the heart rhythm quicker, easier, and safer for both doctor and client. Only the size of two matches and more than 80 % smaller than conventional heart monitors: the mini ECG system monitors clients at the ETHIANUM continuously and wirelessly for three or more years. If an arrhythmia occurs, we can diagnose and treat it more quickly. The client can lead a completely normal life with the device. Once the cause of the arrhythmia has been found, the device can be removed again in a short, minor operation.
The use of this mini ECG is particularly useful in the diagnosis of atrial fibrillation with all its possible consequences, such as strokes or the monitoring of patients’ rhythm after catheter ablation for atrial fibrillation.
CARDIOLOGY
CATHETER ABLATION – AN IMPORTANT COMPONENT OF ATRIAL FIBRILLATION THERAPY
If symptoms of atrial fibrillation recur, catheter ablation of the cardiac arrhythmia (pulmonary vein isolation) may be useful. It should be noted that changes to the heart occur with increasing duration of atrial fibrillation, which can counteract the long-term success of the therapy.
The ablate-and-pace strategy is the last resort for symptomatic atrial fibrillation recurrences. The client is first implanted with a pacemaker. After some time, the AV node is severed using catheter ablation. This is irreversible. The client is then permanently dependent on their pacemaker. With this radical therapy, however, even the persistently highly symptomatic client can be helped.
Catheter ablation of atrial fibrillation
Catheter ablation of atrial fibrillation is based on the observation that the arrhythmia can often be triggered by atrial premature beats. An intervention usually requires several venous and an arterial vascular access in one or both groins. Common to all strategies is the electrical isolation of all four pulmonary veins (also known as pulmonary vein isolation).
Ablation with the help of 3D software
Modern computer systems are used for HFS ablation of atrial fibrillation in particular. They enable 3-dimensional computer-animated reconstructions of the left atrium including the pulmonary veins. The optimal ablation strategy can then be planned in advance using these 3D models. The cardiac catheters are projected onto the 3D model in real time. This minimises the client’s exposure to X-rays.
Catheter ablation takes around 3 to 4 hours. It is carried out with the administration of painkillers and sedatives. The client is in a light sleep. General anaesthesia is not required for catheter ablation.
Follow-up for catheter ablation
Follow-up for catheter ablation includes close monitoring by the attending physician in the cardiac rhythm outpatient clinic. All clients require blood thinning for several weeks after the procedure. Supplementary administration of antiarrhythmic medication should be considered. The recording of holter ECGs to monitor the success of the treatment is of central importance.
CARDIOLOGY
ELECTROCARDIOVERSION – KEEPING THE HEART IN RHYTHM
During electrocardioversion, two palm-sized electrodes are placed on the chest to deliver a short, targeted electric shock. These electrical impulses can restore the normal heart rhythm (sinus rhythm). Electrocardioversion is a non-invasive therapy. It can be performed easily and without complications.
Procedure
Before a planned electrocardioversion at the ETHIANUM, a transesophageal echocardiography (TEE) is performed to rule out blood clots in the heart. Under brief anesthesia, electrodes are placed on the chest. They emit a short, targeted electric shock synchronized with the client’s heartbeat. This procedure can be repeated if necessary and only takes a few minutes. After the treatment, the client remains hospitalized for monitoring. Vital functions such as blood pressure, heart rate and oxygen saturation are measured regularly. Cardiac activity is monitored by ECG.
