Atrial fibrillation expert wanted in Germany/Europe.
September 7, 2011 | 15,00 EUR | answered by Dr. med. Ralf Berg
For about four years, I have been suffering from atrial fibrillation, which has been treated from the beginning by a good cardiologist. Originally, the atrial fibrillation was caused by an overactive thyroid gland. The overactive thyroid gland has since been successfully treated (radioactive). However, the heart rhythm disturbances or atrial fibrillation continue to occur.
Currently, I am taking medication as prescribed by my doctor (daily: 1/2 tablet of Acetylsalicylic acid 100mg, Concor COR 2.5mg, and Tambocor 100mg).
As I have learned, apart from medication, atrial fibrillation can be treated surgically with a procedure called catheter ablation or endoscopic ablation, with varying success rates. My cardiologist has recommended the more invasive of these two procedures, which has been successfully performed for a few years at a clinic in Stuttgart, due to my "young" age and condition. I am fully convinced that this approach will be successful for me, especially since the performing clinic is very reputable and the success rate is reportedly over 80% - albeit at the cost of a relatively "larger" procedure.
To get a second opinion on the therapy, I went to a university hospital for an examination (see report in attachment; please treat confidentially and discreetly). However, the university hospital practices the less invasive catheter ablation. This procedure is gentler, but has a much lower success rate and allegedly a slightly higher risk than the former therapy. Naturally, the university hospital has recommended their procedure, catheter ablation, to me.
Additionally, I strongly suspect that atrial fibrillation can also be permanently cured through a consistently changed lifestyle. If this is medically possible, I would change my lifestyle accordingly. The question is whether this suspicion is even possible from a medical perspective or just a "layman's assumption."
So far, no doctor has engaged in a discussion about the issue. Everyone wants to sell their own treatment, especially since I am privately insured. At this point, a clear and well-founded statement from a neutral expert is extremely important for me to make a solid decision.
For this reason, I am interested in the neutral opinion of a renowned, experienced specialist. What do you think about the aforementioned treatment options? Can you please recommend me a leading expert in treating atrial fibrillation, a kind of "atrial fibrillation pope" in Germany or Europe?
Thank you and kind regards.
Dear Mr. K,
You are quite right, as Prof. Grönemeyer (neurosurgeon, brother of the famous singer) once formulated in a lecture: The patient who goes directly to the specialist has basically already decided on a disease. A sentence from one of my medical colleagues, from whom I have learned a lot, has also stuck with me:
He said: Remember, the general practitioner is the patient's public defender against the claims of the specialists.
Well, it's not really that bad. You have already informed yourself about the different paths: 1. medicamentous or 2. surgical 2a as catheter ablation or 2b as endoscopic catheter ablation.
Now to your questions:
1. Can a different lifestyle influence the occurrence of paroxysmal atrial fibrillation?
Answer: Not really, especially not in your case. In the report from the University of Heidelberg, it can be well justified that despite the fibrillation episodes, neither an organic nor a structural change in the heart can be detected in you. That is, the atrium is neither enlarged nor are there pathological values in the contraction, the heart function is good. The second cause for AFib can be incorrectly "wired" excitation centers around the pulmonary veins, which can take control away from the actual pacemaker, the sinus node located in the atrial wall.
This brings us to question 2: Which method should I use to treat my illness? First, there is the conservative medication approach: substances are administered and dosed until the electrical activity is slowed down enough that these palpitations do not occur or occur only rarely. This therapy is not without risks, as we know that in individual cases, more severe heart rhythm disorders can be triggered by the measure. The operative risk naturally does not apply to this variant.
I am not sure how extensively the nature of the surgical procedure has already been explained to you. To avoid any misunderstandings, I will briefly explain the differences and similarities of the two methods once again.
The classic catheter ablation is the older of the methods. Without direct sight, a catheter is usually advanced into the left atrium via the femoral artery. Electrodes are systematically stimulated in this area until ideally the AFib can be triggered. Then the tissue around this area is isolated with electricity by creating a scar around this area, thus creating electrical isolation from the rest of the heart muscle tissue. Since it is known that most "false pacemakers" are located around the junction of the pulmonary veins, this is called pulmonary vein isolation. The main difference with the endoscopic method is that an optic can be introduced in addition to control the result, and can potentially "burn" again at some points. Hence the higher success rate there.
Question 3 what to do?
Since in your case, because of the absence of organic causes, the likelihood is high that it is an electrical "misfire" and you are disturbed by the heart racing, I would advocate for the ablation.
Since the endoscopic method is relatively new and the University of Freiburg only performs the classic ablation, I cannot say much about that. Atrial fibrillation is the most common heart rhythm disorder, so there are many centers.
In my opinion, there is no "Pope" but many bishops, of whom I would like to mention two to you. Prof. Meinertz at UKE Eppendorf in Hamburg, who also has personal experience with this disease, and Prof. Götte in Münster, who has initiated and leads the Competence Network Atrial Fibrillation. (University of Münster)
I hope you can make use of my information and come to a decision that is right for you.
Sincerely, Dr. R. Berg
