Current Heart Research Protect against sudden cardiac death with sclerotherapy

Measure against arrhythmia: With sclerotherapy for sudden cardiac death

A regular, strong heartbeat is the basis of a healthy cardiovascular system. In cardiac arrhythmia, the frequency of the heartbeat gets out of sync and it threatens complaints that can range depending on the extent to the death of those affected. Not all arrhythmias can be prevented by drug therapies. As health experts now report, in many cases, however, a sclerotherapy may be useful.

Often without warning

The term "second heart death" (or even second death or sudden cardiac death) describes the sudden occurrence of fatal cardiac arrhythmias. Usually comes a sudden cardiac death without warning. But some patients announce the event. For example, chest pain, palpitations, shortness of breath or dizziness may indicate an impending second-death. Such symptoms can occur several hours before the event, sometimes days to weeks before. The direct trigger of sudden cardiac death is usually ventricular fibrillation. Health experts are now reporting a therapy to prevent ventricular arrhythmias such as ventricular fibrillation.

In case of a sudden cardiac arrest, the heart can be beaten with the help of electric shocks. (Image: pressmaster / fotolia.com)

The most dangerous cardiac arrhythmias

Preventing the occurrence of ventricular arrhythmias, such as ventricular fibrillation and ventricular tachycardia, is important because it is the most dangerous cardiac arrhythmia.

It comes to frenzied fast, sometimes chaotic contractions of the heart muscle, which can lead to sudden cardiac death within a very short time, reports the German Society for Cardiology - Cardiovascular Research e.V. in a recent release.

But: "Cardiac arrhythmia in the heart chambers can be prevented only to a limited extent by medical therapies," said Prof. Dr. med. Thomas Deneke (Bad Neustadt an der Saale), spokesman of the working group Rhythmology of the German Society of Cardiology at the DGK-Herztagen in Berlin.

Cardioverter Defibrillator: Lifesaving and risky

People with an increased risk of developing ventricular arrhythmias due to heart disease such as coronary heart disease (CHD), heart attack, myocarditis, or severe heart failure are treated with an implantable cardioverter-defibrillator (ICD).

The ICD delivers an electrical shock to the heart when ventricular arrhythmias occur and stops the uncoordinated and ineffective contractions of the heart muscle.

"This therapeutic strategy is life-saving, but it can also be a dark side. From registry data, we now know that ICD shocks are in turn an independent risk factor for mortality, "said Prof. Deneke.

"This insight has several consequences. On the one hand, when programming the devices, care must be taken that they actually only deliver surges to the heart when this is unavoidable. On the other hand, an optimal management of patients should be sought, which avoids the occurrence of these ventricular arrhythmias from the outset. "

Prospects of success are dependent on different factors

"Interventional sclerotherapy, catheter ablation, has now been established as a more effective method," explained Prof. Deneke.

In an ablation, those areas of the heart muscle from which the disturbing impulses emanate are "scorched" by means of suitable radiofrequency high-energy catheters..

"Those individuals who are eligible for catheter ablation and the prospects of success depend on different individual factors, especially the underlying heart disease. In experienced centers, arrhythmias disappear completely after ablation in more than 80 percent of patients treated, "says the expert.

Extrasystoles in large numbers can weaken the heart muscle

Candidates for catheter-assisted ablation to prevent such ventricular arrhythmias are patients with various diseases of the heart.

"In the majority of cases, it is an ischemic cardiomyopathy, ie the result of a heart attack or multiple heart attacks, but also many other diseases that are associated with scarring of the heart muscle," said Prof. Deneke.

"Another indication for catheter ablation is extrasystoles, which is a high number of 'extra hits' due to the presence of 'false spark plugs'. Such patients are good candidates for catheter ablation after excluding other heart disease as a potential cause of their condition. "

Individual extrasystoles are usually harmless in completely healthy persons and are not noticed at all. However, in large numbers - at more than 10,000 to 15,000 per day - they can lead to a weakening of the heart muscle in the medium term, which ultimately manifests itself in heart failure.

In addition, extrasystoles are also perceived very clearly by some patients and can thus contribute to a significant reduction in the quality of life.

Ablation instead of implanted defi?

Typically, catheter ablation does not replace the implantation of a defibrillator, but supplements it. On the one hand, in most cases, ICD implantation already occurs before any ablation is considered, and on the other hand, an ICD provides additional security.

"Whether an ablation may also be useful before or even instead of an ICD implantation is currently being investigated using studies," says Prof. Deneke.

Depending on the type of underlying disorder, catheter ablation may be performed from the inside (endocardial) or from the outside (epicardial). The endocardial intervention is the more common and simpler, as it allows the catheter to be advanced from the groin into the heart via the vasculature.

For epicardial surgery, which is performed only in a few specialized centers in Germany, the catheter must be brought to the heart after puncture of the pericardium by a puncture below the breastbone from the outside.

As part of the procedure, a so-called mapping, an electrophysiological mapping, so an inventory with the help of special electrode catheters that record the electrical excitation properties of the heart.

If possible, the investigators will try to trigger cardiac arrhythmia and perform the mapping during the ongoing cardiac arrhythmia.

However, this procedure is too stressful or dangerous for many patients, so that the mechanism and starting point of the ventricular tachycardia often has to be inferred from the rest findings in normal heart rhythm. (Ad)