Heart rhythm and the symptoms and treatments of common disorders

Expert advice on irregular heart rhythm: Prof. Dr. Thomas F. Lüscher shares information about the latest treatment options of heart rhythm disorders.
Prof. Dr. Thomas F. Lüscher is a leading cardiologist whose practices include the University Hospital Zürich and the DoubleCheck clinic for private health checks. In this interview, he shares his knowledge of heart rhythm disorders. 

Many patients suffer from atrial fibrillation. What do the symptoms look like?

Patients do often not notice atrial fibrillation. Mostly, patients have a very high pulse with over 150 bpm and the pulse is arrhythmic.

It can occur recurrently, which is called paroxysmal. Sometimes, patients suffer severe symptoms such as diziness and stenocardia. However, they often don‘t notice, especially if the pulse is rather slow.

If you notice an arrhythmic, irregular or too fast pulse, you should consult a doctor as soon as possible, who can do ECG and make a diagnosis.

What makes atrial fibrillation problematic?

Atrial fibrillation can cause blood clots (thrombus) in the heart, which in turn can occlude cerebral ateries causing a cerebral stroke.

Older patients and patients with high blood pressure or diabetes have an especially high risk of suffering from a stroke.

Anticoagulation drugs can be given to patients to reduce the risk of such an event.

What is the most successful way to treat atrial fibrillation?

One approach is to treat heart rhythm disorders with drugs. Among these, beta blockers are prescribed. If these don‘t help, electroconversion can be performed, which knocks the heart back into its original rhythm.

Most of the time, drugs have to be taken for a longer time period, since patients who have experienced an episode of atrial fibrillation are very likely to experience another one. For example, beta blockers are given, which can decrease the heart rate.

What is your opinion of the new anticoagulative drugs that are replacing warfarin, etc?

I think the controversial discussion was mainly conducted by the media. Among experts, we agree that these are real developments as a result of much-needed innovation.

Previously, the most commonly prescribed anticoagulative drugs like warfarin or marcumar inhibt the vitamin K metabolism (they are known as vitamin K antagonists).

Achieving a stable level of anticoagulation with these drugs can take up to two weeks. Additionally, these drugs have severe interactions with other substances, especially with rheumatic drugs which as well as anticoagulative drugs often have to be prescribed for older patients.

Also, the vitamin K antagonists have to be stopped long time prior to surgery.

To get a stable level of anticoagulation, patients have to see their doctor as often as every day to get repeated blood tests done.

The new substances solely inhibt factor X or II of the coagulative system. There is no need for blood tests. Generally, there are less incidents of bleeding under this therapy.

The only disadvantages in my eyes are the high price, and the fact that they can‘t be used for patients with renal dysfunction. 

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