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Heart experts explain about arrhythmias
If sudden cardiac death occurs, life-threatening cardiac arrhythmias have often been identified beforehand. Therapy and the precise risk assessment for cardiac arrhythmias often pose a difficult task for cardiologists, because sudden cardiac death cannot be predicted in most cases. Heart experts explain how patients with cardiac arrhythmias can best protect themselves.
A team of experts from the German Society for Cardiology (DGK) advises on the most effective methods of how people with cardiac arrhythmias can protect themselves from sudden cardiac death. In such patients, wearing a defibrillator vest (“defi vest”) was often recommended. However, a recent study in the New England Journal of Medcine showed that these vests are of little use. The DGK experts provide information on more effective methods.
Defibrillator vests are of little use
A recent study looked at whether a portable cardioverter defibrillator in the form of a vest can reduce the frequency of sudden deaths during a high-risk period. The research came to the conclusion that such a vest does not significantly contribute to a reduced death rate in patients with a recent myocardial infarction. This can partly be due to the patient's motivation, Professor Dr. Thomas Deneke in a press release from the DGK. As has been shown, many do not wear the vest at all or only insufficiently. "Modern telemedicine aftercare after intensive patient training could possibly improve this," said Deneke.
Identify risk patients
"Today, modern imaging techniques such as MRI can be used to try to identify those patients who are at high risk of sudden cardiac death," write the cardiac specialists. Programmed ventricular stimulation, in which the ventricles are electrically stimulated by means of a catheter, could also reveal an increased risk of sudden cardiac death in patients after a heart attack.
The implantable defibrillator
According to the DGK, an implantable defibrillator (ICD) is the first choice of therapy for patients who have survived a sudden cardiac death. Similar to the pacemaker, the ICD is a device that constantly monitors the heart's rhythm. In the case of rhythm disorders that require treatment, this can initiate various options for treating the arrhythmia.
Is catheter ablation the better alternative?
As the DGK specialists report, there are several studies that show that catheter ablation is more effective than any drug treatment in suppressing recurrent cardiac arrhythmias in patients with arrhythmias after a heart attack. With catheter ablations, pathological areas of excitation on the heart muscle tissue are obliterated with the help of a catheter. In many patients, the heart permanently returns to a natural rhythm.
Also suitable for patients without a heart attack?
"In patients without changes to the coronary arteries, ie without a previous heart attack, it seems that the success of ablation when it is carried out in experienced expert centers is also very good," explains Deneke. Catheter ablation could replace an ICD in ventricular tachycardia, especially in those patients in whom the pumping function of the left ventricle is not severely restricted, the professor said. In principle, this method is currently intended as an additional therapy to the ICD, because there have been no studies to date that show that catheter ablation leads to an improved prognosis, according to the heart specialist. (vb).