“All arrhythmias are potentially dangerous”: how to tell if the heart has “failed” Arrhythmia specialist Shabanov talked about a new method of treating arrhythmias

Why does arrhythmia usually develop?

– Arrhythmias are divided into congenital and acquired. The first is formed in the womb and is explained by genetic anomalies. But they are quite rare. And the latter is acquired by us already throughout life under the influence of a combination of factors, including past viral diseases and an adynamic lifestyle, and overweight and the development of chronic diseases of the endocrine system, kidneys and lungs. . They accumulate and lead to the fact that the resource of the heart at some point cannot withstand their influence – a heart rhythm pathology occurs. Generally, arrhythmias are responsible for 15% of heart diseases. They may occur spontaneously in a healthy person from time to time, but in this case they do not pose a serious danger.

There are also types of arrhythmias, the cause of which lies in cicatricial changes in the heart muscle after myocardial infarction and surgical interventions.

– That is, in the anatomical changes of the heart?

– Yes. When part of myocardial infarction occurs (death of part of the heart muscle), a scar is formed in this place. Its structure is heterogeneous – some cells die, and some are alive. At this junction, semi-living tissue itself can produce pathological arrhythmias.

This is how I usually explain to patients: imagine a clear lake into which we both throw a stone – and we see how the wave goes and makes equal circles and reaches the other shore. Our heart normally contracts as follows: the electrical impulse passed, the heart contracted, and the blood circulated freely throughout the body.

Now let’s imagine another body of water in which large heterogeneous stones, rocks come out. In the same way we throw a stone, the wave is gone and it started to break against these obstacles, they split into many waves, they started to form whirlpools, whirlpools between these stones. This is what happens when our heart’s normal wave of contraction hits the scar tissue. This does not happen in all patients who have had a heart attack. But for some, such “vortices” cause the development of dangerous ventricular tachycardia, followed by ventricular fibrillation, that is, cardiac arrest.

– Ventricular tachycardia turned out to be the most dangerous type of arrhythmia?

– I would treat all arrhythmias as potentially dangerous. If the heart is already beating incorrectly, attention should be paid to it and at least the cause should be investigated. And then, as much as possible, it is necessary to fight and eliminate this cause, because any irregular rhythm wears out the heart and sooner or later leads to a decrease in its pumping function.

However, as soon as they appear, many arrhythmias do not pose any threat to life – it all depends on where the focus of the arrhythmia is located in the heart.

If this is sinus tachyarrhythmia, for example: yes, the heart beats at 120 beats per minute, and even more often, it is unpleasant, but you can live with it, there is nothing to be afraid of, you can even stop such an arrhythmia on your own by taking deep breaths or drinking cold water. There is also a drug therapy that gives you control over the condition. However, if such a non-life-threatening rhythm disorder significantly reduces the patient’s quality of life, is psychologically tiring, and causes regular panic, a more radical surgical treatment may be recommended.

– But are there any life-threatening rhythm disorders?

– Yes, we can talk about life-threatening situations in cases of ventricular arrhythmia.

To clarify, you should dig a little deeper in anatomy. Our heart has four chambers, consisting of two atria and two ventricles. The main contributors to blood circulation are the ventricles: they contract and push blood out for further distribution throughout the body. And if ventricular tachycardia or ventricular fibrillation, the deadliest of the arrhythmias, occurs, it can lead to cardiac arrest and death at any time.

But how many rhythm nuances, so many types of diagnosis. And each needs to be dealt with individually to discuss how to continue living with the patient and what to do with it.

Somewhere you can calmly take the situation and just observe yourself, somewhere you need to start medication and somewhere you need to have an operation immediately. However, in all cases, the surgeon does not decide alone without the patient. There are patients who are very afraid of surgery, then they may be offered long-term medical treatment, while others, on the contrary, want the result quickly, immediately and permanently, even insist on surgery – then we recommend surgical treatment methods.

Is it possible to detect arrhythmia on your own? What symptoms indicate that it’s time to get an EKG?

– If the patient feels that the heart is somehow beating incorrectly and unusually, suddenly “runs” or there are some pauses in contraction, failures in which the patient begins to hear and feel himself, this may indicate an arrhythmia. In this case, you need to see a cardiologist.

However, it is important to note that there are also asymptomatic arrhythmias. Patients at the initial stage of the disease may not feel rhythm disturbances at all, including dangerous ones that can become life-threatening in the future. Therefore, in order to detect arrhythmia in a timely manner, you must undergo an annual medical examination, which necessarily includes an electrocardiogram record.

EKG can identify the type of arrhythmia. In some cases, Holter monitoring (ECG over a day) will be required. It is very rare to find out all the nuances of the issue of arrhythmia and the causes of its occurrence, an electrophysiological study in an operating room will be needed. Then we can already see the focus of this complex arrhythmia, map it out, and cauterize it right away.

— What approaches are used in the treatment of arrhythmia in Russia?

“Just like in the rest of the world. The first stage is usually drug therapy. If that doesn’t help enough, radiofrequency catheter ablation (RFA) can be used – a minimally invasive surgical method, very high effective and low complication rate. Without incisions – through puncture of a large vessel – we use a special ultrasound probe to enter the cavity of a beating heart, combine the data of ultrasound and X-ray units (angiographies) and reconstruct a 3D model of the heart on the monitor in the operating room We then find and completely eliminate areas that create life-threatening arrhythmias. done using a catheter.

If necessary, various types of pacemakers are inserted. Such operations are now carried out in many medical centers in different regions of Russia. In the most difficult cases, patients go to federal medical centers, specifically us at the Meshalkin National Center for Medical Research. We are Russia’s leading center in the treatment of patients using these technologies, so our doctors perform the most RFA surgeries in Russia every year.

– What are the future expectations after the operation? Will the patient be able to exercise, for example?

– Of course, damage occurs and scars occur during another surgery or heart attack, as well as during ablation. We just homogenize. That is, by continuing our history with the reservoir, we create an entire island based on the heterogeneous protruding stones that already exist in it, so that small eddies do not form. Yes, the wave will hit our island, but it will behave predictably. In other words, we create the right homogeneous scar in the right place.

After such a complex high-tech treatment, our patients can indeed lead a mobile and even sports lifestyle without fear for their lives. Of course, in agreement with the cardiologist.

And their acquaintances and neighbors may never know that the patient is in such a life-threatening condition.

– Current research showedthat pulsed field ablation may be effective in the treatment of arrhythmias. How does it work?

– As a matter of fact, two main methods and two types of energies have been used so far to eliminate the focus of arrhythmia in the heart muscle: This is a proven radiofrequency ablation (heat-assisted destruction) and cryoablation (burning). micro-section of tissue with deep freezing). But recently, a new method has appeared, which is not based on the destruction of “washing out” myocardial cells, but on blocking their electrical conductivity with the help of an electric field. The cells of the heart remain alive, communication between them is “turned off” in the area that gives the wrong rhythm.

— Has a similar method been used in Russia? How promising is it?

– The Americans were the first to turn to this idea, they developed equipment for transcatheter introduction of such a current into the heart and began to experimentally study the method. However, in Siberia, we have always had a lot of talented inventors, nugget, who did their job for the sake of an idea under any circumstance.

And so, with a slight delay, engineers from Tomsk, neighboring Novosibirsk, developed a similar technology called electroporation and created their own equipment for use in the heart. Let me emphasize: this is not borrowing technology, not copying equipment, but the development of a parallel author.

But while clinical trials of the method continued on both sides of the ocean, it wasn’t applied everywhere. In Russia, all electroporation experience is concentrated in Novosibirsk, in one center – our NMITs. EN Meshalkin. We have performed more than 30 surgeries so far. The preliminary results are impressive – the method is quite effective, economically inexpensive, and most importantly – it is less traumatic, eliminates the risk of damage to nearby tissues and organs (for example, the esophagus), and the operation takes only 30 minutes instead of 2 hours. So he has every chance to enter clinical practice in the future.