Heler Romero, a 70-year-old woman suffering from atrial fibrillation, is ready for the next procedure. The cardiologist is still sitting in the control room, in a blue cassock, in a surgical uniform, surrounded by computer screens with curves and numbers. He talks about diseases: stroke, heart failure, dementia, depression. “These are the most serious consequences that atrial fibrillation can have,” said Maria Heimsuchung, chief physician at the Pankowski Charity Clinic. He will soon be standing next to the operating table, which can be seen through a large glass panel. He heals the woman’s heart, catheter and cold – electrophysiological examination, abbreviated EPU.
Atrial fibrillation is a common disease. The risk for a European to become infected at some point in their lives is high. It is around 27 percent. “It’s a lifelong risk,” says Romero. “It affects every third person statistically.” As you get older, you are more likely to develop this most common type of cardiac arrhythmia.
People with disabilities often feel weak, self-propelled, quickly exhausted, short of breath, and dizzy. Others feel restless, noticing that there is something wrong with their pulse, that it is too high and rising for no apparent reason. There may even be seizures, confusion, fainting. Long-term ECG brings clarity.
“However, a group of patients who are not very small will not notice anything at all and have no symptoms. One third of all cases are expected, “says Jürgen Meyhöfer, chief physician of the cardiology, who joined his team at the control room. “Nevertheless, we generally consider atrial fibrillation to be a very serious disease because it reduces life expectancy and quality of life.”
May cause serious damage. Mainly from moves. According to the German Heart Foundation, at least 20 percent of these cerebral infarctions are caused by atrial fibrillation. “The flow rate changes at the heart,” Meyhöfer describes the problem. The hall no longer shrinks like a healthy person. “Blood flows more slowly, forming clots that can enter the brain and clog blood vessels.”
Atrial fibrillation: do genes play a role?
The rhythm is often disrupted because the veins send out electrical impulses that they shouldn’t actually do: the so-called pulmonary veins. They carry oxygen-rich blood from the lungs to the heart. The first stop is the left hall. If cells from the electrically active heart are lost there, they send out fatal signals.
This is especially true for younger patients without previous illnesses. “With age, several diseases often appear,” says Meyhöfer. High blood pressure, diabetes or heart failure increase the risk of atrial fibrillation. External influences, such as smoking or excessive alcohol consumption, may play a role, intensify or trigger the effect.
Genetic predisposition can also support cardiac arrhythmia. This is indicated, among other things, by an analysis from the USA, the results of which were published in 2004. The researchers followed 2,243 people for 20 years, all of whom were descendants of what is known as the Framingam Heart Study, a long-term study. They were twice as likely to have atrial fibrillation as usual if at least one parent had the same disease.
Effective treatment is possible, initially with drugs and, if these no longer work, with EPU. Following the same procedure in a 70-year-old patient in Maria Heimsuchung, the pulmonary veins are blocked at literally four points that are electrically active when they should not be. “They will be isolated,” says Romero. The chief physician inserts the catheter into a vein through the groin. Attached to it is a folded balloon that can be opened and filled with coolant. The icy cold is blocking the guilty cell. If all goes well.
Heler Romero moves the computer mouse back and forth, and a 3D image of the heart, which belongs to a patient they had on the operating table, 50 years old, appears on the screen in front of him, a relatively young clinical picture. Heart shines yellow, green, purple, red. Yellow represents electrical activity. They measured this with a probe, which was also inserted through a catheter.
Romero runs the image, the yellow wave spreading like a small tsunami. “We had to stop the wave here,” the doctor says, using the mouse to draw a circle around the place, which should now be red. Red means: no electrical impulses. Electrophysiologists also achieve the same effect as heat as cold. If it doesn’t work out the first time, he’ll try it this way. However, in 80 percent of cases, the first attempt is successful.
“It’s a very common procedure now,” says Chief Medical Officer Meyhöfer. At the Visitation of Mary, they have just begun. In the hospital, they transformed the area for electrophysiology, installing an X-ray machine that rotates around the patient to see her heart from different positions. The recording runs continuously.
Romero and his team wore lead vests, including a lead apron, to protect them from radiation. The patient has now arrived and is connected to an ECG. He will sleep soon after applying the anesthetic. The infusion is already running.
Electrophysiology treats four patients a week here. “We want to double the number in the future,” says Meyhöfer. Although some Berlin hospitals now offer this type of therapy, there is a need and the demand is high. And she could go upstairs. Because of Long Covid.
In a large study, the researchers accompanied more than 150,000 former members of the US military after surviving a coronavirus infection. They compared the collected health data with people who were not infected with Sars-CoV-2. Cases of atrial fibrillation have risen sharply in patients with Long Covid, by approximately 70 to 85 percent.
But even without the late aftermath of a pandemic, the trend has been clear for 50 years. In the 1970s, it was mainly heart attacks that cardiologists had to treat in this country. Even then, renowned cardiac specialist Eugene Braunwald from the USA warned that atrial fibrillation would become the main problem. He should be right. “The frequency,” says Heler Romero, “has increased significantly.”
One explanation lies in demographic change. In 1970, the average life expectancy in Germany was 67.2 years for men and 73.4 years for women, by 2020 the statistical average had risen to 78.9 and 83.6 years. From the age of 65, the probability of atrial fibrillation increases significantly – with all possible consequences. Even those that a medical layman would not initially associate with cardiovascular disease. For example: dementia.
Atrial fibrillation can cause dementia
“Dementia in connection with atrial fibrillation is now being studied more intensively,” says Romero. This can be triggered by microembolism: blood clots that are too small to cause a stroke, but block smaller blood vessels in the brain, leading to memory problems. “Clots form in the left atrium,” says the chief physician. And that’s exactly where he’s headed with a catheter.
The large screen above the patient shows an X-ray film showing Romero placing a probe on the heart that measures electrical impulses and sends data to the control room. The computer assembles them into 3D hearts, yellow, green, purple, red. The nurse monitors the progress, checks the curves, reads the measured values and passes the information to Romero via headphones. “My co-pilot,” says the doctor.
Meanwhile, he pierced a small hole in the septum and inserted a balloon through the catheter from the right into the left atrium with millimeter accuracy to the target. Now it opens, balloon, introduces coolant, the temperature drops rapidly. This can be seen in the corner of the screen: minus 40 degrees, minus 45, minus 55. The clock counts seconds to 180. The strike is over at this point of the heart.
“In 20 minutes, it will be checked again if the intervention was successful,” says Meyhöfer. “If so, we assume the problem is permanently resolved.” The electrophysiological examination takes one to two hours. A long time for which Romero and his team must remain highly concentrated. In which they also perform hard physical work. Your X-ray protection weighs twelve kilograms. Now they take off their lead armor, take the vest and apron to the locker room.
The patient is taken out of the infirmary. He is conscious. She didn’t notice anything about the operation. But the result feels. A pleasant feeling with every heartbeat.