Frequency and dangers of atrial fibrillation
Due to the prevalence of hypertension as well as the increasingly rising life expectancy, the prevalence of atrial fibrillation continues to rise – with a corresponding burden for patients. The greatest danger for patients with atrial fibrillation is stroke, since uncoordinated contraction of the atria leads to the formation of clots that can embolize into the brain. The modern “new” anticoagulants (NOACs) have now established themselves as standard therapy for the prevention of such an event. However, prudent and differentiated use of these drugs is necessary to achieve maximum safety and effectiveness for patients. For this purpose, we are available for consultation both internally and externally, as well as in numerous advanced training courses. For patients with a contraindication to anticoagulation, we offer interventional atrial appendage closure after interdisciplinary discussion.
The second major problem in atrial fibrillation is the arrhythmia itself. The discomfort caused by the irregular, often rapid pulse impairs the quality of life.
Treatment options
In our specialty consultations, we work with resident physicians to create a personalized treatment strategy for each patient. After an initial attempt at rhythm control with medication, and in some cases even before that, catheter ablation has established itself as the method of choice for treating atrial fibrillation. In paroxysmal atrial fibrillation and absence of structural heart disease, 70-90% of patients can be successfully treated. In patients with heart failure, it has even been shown that catheter ablation of atrial fibrillation can increase the probability of survival. In principle, the earlier the treatment, the higher the chances of success. Our center uses state-of-the-art methods using CT (Fig. 1) and MRI, fusion techniques with moving fluoroscopic images, and 3D mapping systems.
Atrial fibrillation can also be treated surgically at the open heart (“Cox-Maze Procedure”). The atria are opened and closed again by means of incisions, which prevents the development as well as the spread of atrial fibrillation. Today, an appropriate scar pattern can also be applied using ablation forceps with radiofrequency energy or cold. Surgical ablation is mainly performed in patients with atrial fibrillation who are undergoing cardiac surgery. After unsuccessful catheter ablation, such a procedure can be performed via mini-thoracotomy without opening the chest at the open atrium, even without concomitant surgery. This procedure is usually combined with closure of the left atrial ear to reduce the risk of stroke. Careful selection of the right patients by an interdisciplinary heart team is also of great importance here.
The frequency of ventricular arrhythmias is also increasing – especially in patients after myocardial infarction and severely impaired pump function. If drug therapy fails, catheter ablation is also used here. In young patients without structural heart changes, catheter ablation is increasingly used as the primary treatment. Catheter ablation of ventricular tachycardia is predominantly performed on endovascular (“from the inside”), but may also be necessary from epicardial. In this case, the pericardium is punctured from the outside under the sternum, and the catheters are navigated inside the pericardium.