Arrhythmia Treatment
How Are Irregular Heart Rhythms Treated?

Arrhythmia Treatments

Contents

• How Are Arrhythmias Treated?
• Treatment With Drugs
• Non-Surgical Therapies
• Surgical Intervention
• Vagal Maneuvers

Arrhythmia Guide
Heart Arrhythmia

How Are Arrhythmias Treated?

Most arrhythmias can be treated with medication, although some may require non-surgical treatments while others need surgical intervention. Different types of arrhythmia require different treatments. Once you receive an arrhythmia diagnosis from your doctor he will work with you to find the best solution for your condition. For some this may mean no treatment, for others it can mean taking daily medications while others may require surgery and the implantation of a pacemaker. A doctor will only usually recommend treatment if the arrhythmia increases your risk of congestive heart failure, stroke or sudden cardiac arrest – or, if the condition causes serious symptoms of arrhythmia such as dizziness, chest pain or fainting.

Treatment With Drugs

Common arrhythmias are usually treated with medications which either slow down or regulate the heart rate, depending on the type of arrhythmia present. Drugs used to slow down a heart that is beating too fast (tachycardia) or correct an irregular heart rhythm are called antiarrhythmics. You may be injected these drugs in an emergency situation or told to take them as pills indefinitely. Currently there are no medications which can help to speed up a slow heart rate. If the heart rate is dangerously slow, it will require a pacemaker. Apart from antiarrhythmics, other medications such as beta blockers (metoprolol and atenolol) or calcium-channel blockers (such as diltiazem and verapamil) may be prescribed. Additionally, those with atrial fibrillation (AF) may be given anticoagulants or antiplatelet drugs. This is because AF increases the chance of blood clots, one of the main causes of ischemic stroke. As most drugs have potential side effects the doctor will weigh the risks and benefits carefully. The effects of the drugs will be monitored by either a Holter Monitor or electrophysiologic study. These studies can monitor how well the medications are controlling your symptoms under various conditions.

Non-Surgical Therapies

There have been great developments in non-surgical treatments for arrhythmias. These techniques include ablation and electrical Cardioversion. Both procedures help to restore the heart's natural rhythm and can reduce or even cure symptoms completely. This may eliminate the further need for either medications or surgical implants.

Catheter Ablation
This treatment is now commonly used to treat many types of rapid heartbeat (tachycardia) including AF, atrial tachycardia, atrial flutters and some ventricular tachycardias. It will also be used in some cases where medications have failed to control symptoms. This procedure involves heart catheterization where a long thin tube is inserted into a vein in the groin or arm and guided towards the heart. Once in place a special machine sends energy through the tube to destroy (ablate) the area of heart tissue that is generating the extra impulses. The area of tissue destroyed is very small, less than 1cm wide and does not affect the function of the heart. A harmless tiny scar covers the wound and a normal rhythm is restored. This procedure is low risk and has a high success rate. It is carried out under local anesthetic and many people end up being cured of their tachycardia and leaving their medications behind.

Electrical Cardioversion
Cardioversion is a medical term to describe the restoration of normal heart rhythm. This can be done chemically with drugs or electrically with an electric shock. It is used to treat AF, ventricular tachycardia, and ventricular fibrillation (VF). VF is the most serious type of arrhythmia and can only be treated by electrical shock. If your doctor recommends electric shock this procedure will be carried out in hospital (image). Electric currents are applied with a pad to the chest to shock the heart cells into contracting at the same time. This should stop abnormal electrical signals and a normal heartbeat should resume. 90 percent of cases are successful. About 50 percent of people who have this procedure relapse within a year so it may have to be repeated.

Surgical Intervention

In addition to medications and non-surgical procedures, there are several types of surgeries a doctor can perform to resume a normal heartbeat. Implanting a pacemaker under the skin of the chest can help treat a slow heartbeat. More serious arrhythmias which carry the risk of sudden cardiac arrest may require an implantable cardioverter defibrillator. And in some cases of atrial fibrillation, maze surgery may be an option. See pictures of the human body to locate the heart.

Pacemakers
Pacemakers (image) are small battery powered devices that are implanted under the chest skin. A pacemaker sends small electrical impulses to the heart when it detects an abnormal heart rhythm. This prompts the heart to beat at a normal pace. Today most pacemakers not only 'pace' the heart but also have an inbuilt demand sensor which can speed up or slow down the heartbeat in response to physical activity. Pacemakers can remain in place for many years before the battery runs out.

Implantable Cardioverter Defibrillator (ICD)
An implantable cardioverter defibrillator (ICD) is slightly larger than a pacemaker and is also implanted under the skin of the chest. All ICD's have inbuilt pacemakers which mean they can monitor and correct the heart's rhythm. However they also have the ability to deliver a high energy shock to the heart when they detect a more serious or sustained arrhythmia. They are usually prescribed to patients with severe heart damage after a heart attack or those at risk of the most dangerous types of arrhythmia which cause sudden heart failure.

Maze Surgery
This treatment is usually prescribed for people with chronic AF and where medications or pacemakers have failed to work. It is a major surgery where the chest bone is cut open and the heart is exposed. The surgeon makes a series of cuts in the heart to create a maze pattern that directs the electrical impulses into the ventricles and blocks extra impulses.

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Vagal Maneuvers

These are simple home techniques which can stop or slow down some types of supraventricular arrhythmias. Always discuss any treatment with your doctor first. Vagal maneuvers include:
1. Gagging.
2. Holding your breath and bearing down.
3. Coughing.
4. Immersing your face in very cold water.
5. Placing your fingers on your eyelids and pressing down gently.

Related Articles on Treating Arrhythmias

For more on palpitations, see the following:

• Causes of Arrhythmias
• Arrhythmia Prevention
• Arrhythmia Risk Factors

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