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Arrhythmia Treatment

Once your medical team determines the cause of your arrhythmia, they’ll work to develop a treatment plan that is personalized to you. This plan may consist of a simple lifestyle change, medication or a specific medical procedure.

Lifestyle

Sometimes there are associations between arrhythmias and other medical conditions or parts of life that can be addressed.  For example, some arrhythmias can be related to caffeine, alcohol, stress, adrenaline-producing activities, dehydration, fatigue or illness. If the “triggers” of an arrhythmia can be identified, sometimes the treatment may be to avoid the trigger, such as reducing alcohol or caffeine intake or getting more sleep. Obesity is a common cause of arrhythmias, both directly and due to the other medical problems it can create, such as sleep apnea, high blood pressure or diabetes. For these individuals, weight loss is an excellent way to help control their arrhythmias. Other medical conditions can sometimes cause arrhythmias, as mentioned above, and treatment of these conditions can result in a reduction or elimination of the arrhythmia problem.

Medications

Medication can be an effective way to treat and prevent an irregular heart rhythm. These medications come in several different categories and include: beta blockers (which reduce the heart’s sensitivity to adrenaline, such as metoprolol, atenolol, nadolol, carvedilol, acebutolol and pindolol); calcium channel blockers (which slow down electrical signals as they travel from the top half to the bottom half of the heart, such as diltiazem and verapamil); and medications called “antiarrhythmics” that directly change the electrical activity of heart cells (such as flecainide, propafenone, sotalol, dofetilide, amiodarone, procainamide and dronedarone). 

Medications that reduce blood clotting (called anticoagulants or “blood thinners”) are prescribed when there is an arrhythmia or heart condition that could result in blood clots or a stroke (such as aspirin, warfarin, Pradaxa, Xarelto or Eliquis).

Procedures & Surgery

The goal of any arrhythmia procedure is to eliminate symptoms and risk so that you can enjoy an improved quality of life. Arrhythmia procedures can vary from a quick, non-invasive outpatient procedure to ones that require hospitalization.  Some examples of electrophysiology procedures include: 

  • Cardioversion is like a quick “reset” of the heart and is very effective for getting the heart back to its normal rhythm. Unfortunately it does not prevent the possibility of future arrhythmias. During this procedure, a quick electrical shock is delivered to the heart using two large sticky pads that are placed on the chest and back. The shock also causes the muscles of the chest to suddenly contract, so it is done under anesthesia to avoid any pain or discomfort.
     
  • Pacemaker is a small electrical device that is implanted under the skin, usually just below the collar bone in the chest, and is attached to one, two, or three small electrical wires that are threaded into a vein and then inside the heart. An electrical pacemaker is usually used to treat an abnormally slow heartbeat that causes symptoms (such as lightheadedness, fatigue, inability to exercise, shortness of breath or fainting), or a very slow heartbeat that could be dangerous.  Sometimes a special 3-wire pacemaker system is used to re-coordinate a heart that is beating in an uncoordinated way.  A new type of extra small pacemaker is being studied, which does not have any wires but instead is a small metal capsule that is implanted inside the heart itself.
     
  • Implantable Defibrillator (ICD) is a different type of electrical device that is implanted under the skin, usually just below the collar bone in the chest — like a pacemaker — with one or more wires that are threaded into the bloodstream and heart. An ICD usually has all the same functions of a pacemaker, so it can also treat slow heart rhythms, but what is special about ICDs is that they have the ability to deliver high energy electrical treatments to jolt the heart out of a life-threatening fast heart rhythm (such as “ventricular tachycardia” or “ventricular fibrillation”).   ICDs are implanted in patients who have survived a cardiac arrest (a fast electrical rhythm that caused them to collapse) or those who have a heart condition that puts them at risk for having this type of life-threatening electrical problem. Such heart conditions include a weak heart (due to heart attacks, virus infections, inflammation of the heart, and other conditions where the heart can become weak – called “cardiomyopathy”), as well as inherited heart conditions that create a risk for arrhythmias (such as hypertrophic cardiomyopathy, long QT syndrome, Brugada syndrome, ARVD/ARVC and many others).  A newer type of ICD is called a “subcutaneous ICD” because both the device and its attached wire are implanted under the skin, and nothing goes into the bloodstream or heart. This type of device can be used for certain situations, and your doctor can discuss the pros and cons of each type of ICD.
     
  • Catheter Ablation is a minimally invasive procedure where several thin wires are threaded into the veins and/or arteries in the groin, and guided inside the heart to perform very detailed electrical testing of the heart. When abnormal electrical spots or short-circuits are identified, very precise heating or freezing techniques can be used to permanently eliminate the problem spots to cure or manage the fast or irregular heartbeat. Catheter ablation can be used to control symptoms, reduce the need for medications and provide a better quality of life for a wide range of electrical problems (arrhythmias). Many different high-tech tools are used during an ablation to give the doctor extremely detailed pictures and images to pinpoint the problem(s) and direct the very precise work that is done inside the beating heart.
     
  • Heart Surgery is used when medications and/or minimally invasive procedures can’t resolve an arrhythmia, when a patient’s heart is unusually shaped or when the individual has another heart condition that causes electrical problems. While surgery is not commonly used for arrhythmia treatment, it is important to know that there are additional options available if needed.