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Abnormal Heart Rhythm: Treatment

Treatment varies for each type of abnormal heart rhythm. Some need minimal treatment, and others may need medication, interventional treatments or surgery. Your doctor will work with you to find the best treatment to:

  • Control your arrhythmia
  • Restore normal heart rhythm
  • Reduce your risk for related problems

Medications

Medicine is often the first treatment for abnormal heart rhythms.
  • Rate-control medications can slow rapid or fast heart rates. Several options are available. Your doctor will choose the best one for you based on your needs and risks.
    Some of the most common rate-control medications are:
  • Rhythm-control medications also are called anti-arrhythmic or membrane-active drugs. They help the heart return to and maintain its normal rhythm. Several options are available. Your doctor will choose the best one for you based on your needs and risks.
    Some  of these medicines can be started on an outpatient basis. Others, such as Tikosyn, require you to be in the hospital at first, where your care team can closely monitor you and decide on the right dose.
    Some of the most common rhythm-control medications are:
  • Medications to reduce the risk of blood clots and stroke also are called anticoagulant or antiplatelet medicines. Several options are available. Your doctor will choose the best one for you based on your needs and risks.
    The most common anticoagulant used today is Warfarin or Coumadin. It requires close monitoring of your blood to ensure you are getting the right dose.
    Learn more about Warfarin 
    Other common anticoagulants:

Lifestyle changes

Abnormal heart rhythms often are linked with lifestyle behaviors. Making these changes can reduce your risk of having an abnormal rhythm.

  • Stop all tobacco use or exposure (includes smoking tobacco, smokeless tobacco, second-hand smoke inhalation).
  • Control your blood pressure.
  • Control your cholesterol.
  • Drink alcohol only in moderation. (Check with your doctor for specific guidelines. The American Heart Association says a woman should have one or fewer alcoholic beverages per day. A man should have two or fewer alcoholic beverages per day. An alcoholic beverage or drink is defined as 5 oz. of wine, 12 oz. of beer or 1 oz. of hard liquor.)
  • Exercise regularly. (Check with your doctor before beginning an exercise program.)
  • Reduce your caffeine intake.
  • Be careful with cold medications. Some have ingredients that promote cardiac arrhythmias.

Procedures and surgeries

When medications fail to control or convert the abnormal heart rhythm, your doctor may recommend one or more of the following procedures:

  • Electrical cardioversion
  • Permanent pacemaker
  • Implantable cardioverter defibrillator, or ICD
  • Percutaneous catheter ablation (ablation without open chest surgery)
  • Surgical ablation (ablation during open chest surgery or with minimally invasive chest surgery)

Electrical cardioversion

This procedure can reset your heart’s rhythm to a normal pattern. First, you receive a short-acting anesthesia. You are completely asleep and usually breathing on your own during the procedure. Once you are asleep, the doctor delivers a low-voltage shock through electrodes attached to your chest. This helps to restore your normal heart rhythm.

Permanent pacemaker

A pacemaker can deliver electrical pulses to the heart to:

  • Keep the heart from slowing down or stopping
  • Treat symptoms of bradycardia

A pacemaker has two parts: a generator and wires or leads. The generator contains a battery and electrical circuitry. The doctor will implant it in a pocket of tissue under the skin of your upper chest. A pacemaker can have one to three leads. The doctor attaches them to the generator and threads them through veins to the heart.

The doctor can painlessly adjust your pacemaker in the office by using an external programmer. These programmers can transmit information to and from your pacemaker wirelessly or through a wand attached to the programmer and placed on the skin covering your pacemaker.

We also can monitor some pacemakers (but not adjust them) while you are at home. We can check some of the older pacemakers over the phone, using a transtelephonic monitor and wrist or finger bracelets. Other, newer pacemakers have a wireless function, and we can monitor them automatically during the night while you sleep.

Implantable cardioverter defibrillator, or ICD

An ICD has two parts: a generator and wires or leads. The generator contains a battery and electrical circuitry. The doctor will implant it in a pocket of tissue under the skin of your upper chest. It can have one to three leads. The doctor attaches them to the generator and threads them through veins to the heart.

An ICD is both a pacemaker and a defibrillator. It can treat very fast, abnormal heart rhythms by delivering electrical pulses (pacing) or electrical shocks (defibrillation) to the heart. Like a standard pacemaker, it also can detect very slow heart rates and deliver pacing.

Your doctor can painlessly adjust your ICD in the office using an external programmer. We also can monitor (but not adjust) some ICDs during the night while you sleep at home.

Learn more about Cardiac Device Management.

Closure Devices

Left atrial appendage closure:

Some patients with atrial fibrillation are not good candidates for medications to control stroke risk. Others may have a history of strokes or emboli related to their atrial fibrillation, despite appropriate treatment with blood thinners. These patients may be candidates for the left atrial appendage closure procedure. The doctor makes two small punctures, inserting two thin plastic tubes called catheters. One will go from the groin, through the vein, into your heart.  The other goes from your chest area into the sac around your heart to help the doctor make a loop over your left atrial appendage and close it off permanently. This section of your heart is where most blood clots related to atrial fibrillation form. Tying it off may lessen the risk of clot formation.

Learn more about this procedure.

Catheter ablation

Your doctor may use a catheter ablation to change the abnormal electrical pathways that cause arrhythmias. The doctor inserts a long, thin catheter, plastic tube into your heart, near the abnormal electrical pathway. The doctor then delivers energy to the pathway, which heats it up, creating fibrous tissue in the pathway. This can disable the pathway and either cure the arrhythmia or make it easier to control with medicine. The most common form of energy delivered during catheter ablation is radiofrequency energy.

Catheter ablation can be used to treat

  • Supraventricular tachycardia
  • Atrial fibrillation
  • Atrial Flutter
  • AV node reentrant tachycardia
  • AV reentrant tachycardia 
  • Atrial tachycardia
  • Premature ventricular contractions
  • Ventricular tachycardia
  • Ventricular fibrillation

Pulmonary vein antral isolation ablation

This procedure is a special type of catheter ablation for treating atrial fibrillation or AF. The most common place for AF to start is inside one or more of the four blood vessels that enter the left atrium from the lungs (pulmonary veins). To prevent abnormal electrical impulses from leaving these veins and entering the left atrium, the doctor heats up an area around the openings to one or more of these veins. This causes fibrous tissue, which can permanently trap the abnormal impulses inside the pulmonary veins. It helps restore the normal heart rhythm and prevent AF or make it easier to control.

AV node ablation

The doctor may use this procedure when atrial fibrillation or AF causes rapid heart rates that can’t be controlled with medicines or other types of ablation. Through a catheter, the doctor heats up small areas directly on the AV node. This causes fibrous tissue, which prevents the transmission of the rapid electrical AF impulses from reaching the lower heart chambers. After AV node ablation, the heart must rely on much slower electrical impulses, below the AV node, to make the heart beat. Because these electrical impulses are almost always too slow, the doctor must implant a pacemaker to maintain a normal heart rate.

Surgical ablation

When other treatments don’t control your heart rhythm disorder, you may need surgery. These are the primary surgeries offered for some atrial arrhythmias, primary atrial fibrillation.

Maze procedure: Endocardial ablation

This requires open-heart surgery, and you will be on a coronary bypass machine. The doctor may use small incisions, radiofrequency energy or extremely cold temperatures to create fibrous tissue on the endocardium or inner lining of the atria. The fibrous tissue prevents abnormal electrical impulses from traveling across these areas. The fibrous tissue directs the heart’s electrical impulses through a controlled path or maze. This procedure can help restore a regular heart rhythm, prevent fast atrial arrhythmias such as AF and make it easier treat the arrhythmias with medicine.

Keyhole procedure: Off-pump epicardial ablation

The doctor makes very small incisions in the chest and inserts instruments that cause fibrous tissue on the upper chambers. This procedure does not require open heart surgery or the coronary bypass machine. It can help restore a regular heart rhythm, prevent fast atrial arrhythmias such as AF, and make it easier treat the arrhythmias with medicine. This surgery results in less pain, a shorter hospitalization, faster recovery and smaller scars than traditional surgery. Not all patients are good candidates for this procedure.