Avoid heart rhythm disorders

I am repeatedly asked:
Can heart rhythm disorders be effectively prevented?

Unfortunately, there is no quick answer to this question – as with so many things in life. Or is there? It depends.

The range of cardiac arrhythmias is extensive and varied. Finding patterns in them and making adequate prognoses is difficult and requires extensive specialist knowledge and many years of experience.
In the vast majority of cases, medical prognoses are based on statistical probabilities for the course of a health disorder or

Let’s take the example of a coronavirus infection in the past pandemic with the SARS-CoV-2 virus. How likely was it for each individual to experience a severe case with a stay in the intensive care unit, long-term ventilation, or even death?
At the very beginning of the pandemic, it was almost impossible to make a reasonable prediction. It was only through the analysis of the disease patterns of thousands of corona patients that the prediction became more accurate not only for the population as a whole, but especially for the individual risk groups. And this also applied to the rapidly emerging virus variants along the Greek alphabet.

Generally speaking, people who are older, have an immune deficiency, diabetes mellitus, severe cardiovascular disease, or who are overweight, etc., are at greater risk of complications than those without these risk factors.For most other cardiac arrhythmias, the risk of danger can never be predicted with 100% certainty, but at least statistically – taking into account the individual risk profile – it can be narrowed down.

So much for the difficulty of labeling cardiac arrhythmias as “lapalie” or “danger” from the outset. That’s why my advice for occasional arrhythmias – even before the actual prevention – is to document and classify them. There are now great tools for this, such as smart watches with an ECG function – electrocardiogram, long-term ECG and much more. The rapid growth of telemedicine has experienced a huge boom precisely because of the diagnosis of cardiac arrhythmias.

Is there some kind of prophylaxis for cardiac arrhythmias?

I am often asked for my opinion on the prognosis of cardiac arrhythmias. Without an “event” ECG, a documentation of the arrhythmia, nothing can be done, to put it bluntly. It’s a bit like going to the technical inspection authority for your car but not taking it with you. Even the ECG alone does not tell the whole story: only with the medical history and additional findings does the picture round off.

Is there a kind of prophylaxis for cardiac arrhythmias?

For isolated extra beats in the atria or ventricles, it is certainly enough to know that the perceived “palpitations” are harmless.
However, if the arrhythmia is accompanied by symptoms such as dizziness, shortness of breath, chest pain or even faintings, it is high time for further diagnostic tests.
Nevertheless, I have to go even further here: there are frequent reports of resuscitations and deaths among completely symptom-free athletes at fun runs (those who suffer a cardiac arrest during training do not make it into the headlines or the statistics). Even among competitive athletes, there are repeated examples of heart failure (in fact, almost always due to ventricular fibrillation). Or we may find signs of a potentially dangerous congenital heart rhythm disorder on the ECG of a completely healthy patient during a routine medical examination.

So the question arises:

Could we detect these cases earlier in order to effectively prevent them?

The answer: difficult, logistically complex and extremely expensive. Actually, every person needs a regular ECG from birth… and a long-term ECG… and a stress ECG… and an echocardiogram… and a laboratory examination… and a detailed anamnesis… and physical examination… So it’s a question of hyper-caring and quite fitting with the discussion of the “transparent human”.

But at least for young competitive athletes, there has been an elaborate program in Italy, for example, since the 1980s – with ECG, echocardiography, anamnesis and physical examination. For this small population group, the consistent exclusion of suspect patients from competitive sports has led to an 89% reduction in mortality (sudden cardiac death) from 1982, when the program was initiated, to 2004. As expected, mortality in the general population remained unchanged during the same period. However, little is known about the other side of the coin: hundreds, perhaps thousands, have had to give up their sports shoes, scrap their racing bike or saw up their surfboard due to a false positive in this program …

For us “normal people” outside of competitive sports, we will have to continue living with statistical probabilities for quite some time and also with the fact that life is not without risk.

RHYTHMOLOGICUM

Heart- and Rhythm Centre

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20251 Hamburg/ Germany
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+49 (0)40|468 58 38 – 0
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info@rhythmologicum.com

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