Arrhythmias - Treatment

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Arrhythmias - Treatment
Arrhythmias - Treatment
Video: Arrhythmias - Treatment
Video: Arrhythmias | Types, Pathophysiology, Diagnosis, Treatment 2023, February
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Cardiac arrhythmias: therapy

In the case of cardiac arrhythmias, adequate treatment of underlying or accompanying diseases - especially other heart diseases and high blood pressure - comes first. In addition, antiarrhythmic drugs and electrotherapeutic measures are used.

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  • Which drugs are used?
  • Defibrillator, pacemaker & Co.
  • What to watch out for with pacemakers
  • Self-help vagus maneuvers
  • Whom can I ask?
  • How are the costs going to be covered?

Which drugs are used?

Antiarrhythmic drugs (antiarrhythmics) directly or indirectly change the course of the excitation potential in the cells that are involved in the development of cardiac arrhythmias. They are divided into four groups according to their mode of action (Vaughan-Williams classification):

  • Class I: Sodium channel blockers stabilize the resting potential and dampen the conduction of excitation. This suppresses extrasystoles and interrupts the excitation cycle.
  • Class II: Beta blockers reduce the sinus node frequency and delay the transmission of stimuli in the atrioventricular node (AV node, syn. Atrial ventricular node, Aschoff node, Tawara node).
  • Class III: Potassium channel blockers reduce the number of extrasystoles and interrupt the circulatory system.
  • Class IV: Verapamil-type calcium channel blockers slow the sinus node rate and delay the AV node conduction.

Compared to before, antiarrhythmics are used less often. This is due on the one hand to their potential side effects (they can even trigger threatening arrhythmias), and on the other hand to the often superior effectiveness and tolerability of electrotherapeutic measures.

Defibrillator, pacemaker & Co

Many types of cardiac arrhythmias can be successfully treated with electrotherapy. Various methods and devices are available for this.

  • Catheter ablation: A catheter and high-frequency current are used to sclerose (ablate) the arrhythmia focus. The method is particularly suitable for supraventricular tachycardias and atrial flutter, and increasingly also for atrial fibrillation (so-called pulmonary vein isolation).
  • External defibrillation: Arrhythmias can be ended and the electrical activity of the heart can be synchronized with two patch electrodes, which are held on the chest wall and through which a metered current pulse flows. This will cause the heart to start beating normally again. In the event of cardiac arrest caused by ventricular fibrillation, this so-called defibrillation can save lives.

    Automatic external defibrillators (AED) are also increasingly available outside of hospitals (e.g. in airplanes, companies, etc.) and can also be operated by laypeople.

  • Electrical cardioversion: Especially in patients with persistent atrial fibrillation, the normal heart rhythm is restored by an external electric shock or medication. Cardioversion using electrodes attached to the chest wall takes place under anesthesia lasting only a few minutes. This treatment is usually carried out on an outpatient basis, ie the patient can leave the hospital on the same day.
  • Implantable cardiac pacemaker: The artificial cardiac pacemaker corrects disturbances in the electrical conduction system by delivering an electrical impulse to the heart if necessary. The device is a few centimeters tall and contains a battery and electronics. It is used in the heart under local anesthesia. The small operation can usually be carried out without any problems, even on elderly people. The implantation takes about an hour and usually requires a two-day hospital stay.
  • Implantable defibrillator: The electronic defibrillator can be compared to a pacemaker. The device is equipped with one or more cardiac probes and a battery and is only a few centimeters in size. Under anesthesia, the housing is attached (implanted) in the breast area under the skin. A microchip monitors the heartbeat. As soon as ventricular tachycardia or ventricular fibrillation occurs, a current surge is automatically sent via the probe directly to the heart - from 5 to 500 volts as required. In this way, not only a rhythm disturbance, but also a cardiac arrest can be corrected.

What to watch out for with pacemakers

It is important that those affected inform every doctor and dentist that they are carrying an electrotherapy device. Although most medical and dental procedures are unlikely to affect the device's function, some require certain precautionary measures to be taken to minimize interference. Special care should be taken with magnetic resonance (MR) exams. These are only possible with MR-compatible devices (defibrillators, pacemakers, etc.).

Note The electrotherapeutic devices occasionally trigger an alarm in the security gate at the airport, whereby the function of the device is only rarely disturbed. Therefore, the security staff should always be informed beforehand.

Self-help vagus maneuvers

Some people can end their tachycardias easily and safely themselves through so-called vagus maneuvers. Certain measures activate the vagus nerve and thus the autonomic nervous system and thus normalize the heart rhythm, for example:

  • Massage of a carotid artery (carotid pressure): Rotating finger pressure on the carotid artery (carotid artery) below the angle of the jaw,
  • Pressure on the closed eyes,
  • drink some big sips of cold water,
  • Valsalva maneuver: Forceful exhalation for about ten seconds against the closed mouth and nostril opening while simultaneously using the abdominal press (exerting pressure on the abdominal cavity by simultaneously tensing the abdominal and pelvic floor muscles and diaphragm).

Note These self-help measures should be discussed or practiced with the doctor. However, the effectiveness of such measures is only slight.

Whom can I ask?

Arrhythmias can be harmless or a sign of another disease. If left untreated, severe forms can lead to the development or worsening of heart failure in the long term or increase the risk of stroke and cardiovascular arrest. Therefore, in the event of complaints, the family doctor should be consulted immediately.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Medical aids & aids
  • Health Professions AZ
  • and via the online guide to reimbursement of social insurance costs.

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