What treatments are available for cardiac arrhythmia?

There are several different types of treatments for cardiac arrhythmias.

Blood Clot Prevention

Some cardiac arrhythmic conditions run the risk of inducing stroke (such as A Fib). Thus, blood-thinning mediations may be recommended such as warfarin, dabigatran, heparin and aspirin.

Rate Control (Beta and Calcium Channel Blockers)

Medication

Rate control medicine may also be prescribed to reduce the heart beat rate of the ventricles. These medications are recommended for most individuals with A Fib. While they may not bring the heart beat to a normal level, they significantly reduce the work the heart has to do. Heart rate is typically controlled with beta blockers (such as metoprolol and atenolol), calcium channel blockers (diltiazem and verapamil) and digitalis (digoxin).

Cardio sinus massage

This form of massage is provided by a trained professional. It involves putting pressure on the neck where the carotid artery divides into two sections, causing it to release chemicals that slow down the heart.

Rhythm Control Procedures

Medications

Rhythm controlling medications include the new generations; amiodarone, sotalol, flecainide, propafenone, dofetilide, ibutilide and older therapies; quinidine, procainamide, disopyramide.

Cardioversion

The procedure entails shocking the heart using electrodes placed on the chest and possibly the back. The electrodes are attached to the cardioversion machine which records the heart’s electrical activity and in response sends electrical impulses to the heart. The doctor then sends one or more additional low-energy follow up shocks to return the heart to a normal rhythm. This procedure is done under anesthesia so the patient does not feel any pain. Heart rhythm and blood pressure are monitored following the procedure for a few hours. Risks related to cardioversion include worsening arrhythmias, and causing the release of a blood clot. However, anticlotting medication can be taken prior to and after the treatment to reduce the risk.

Catheter ablation

Catheter ablation is the scarring of a section of the heart that may be causing the abnormal heart beat.  This treatment is often used when certain arrhythmias cannot be controlled by medicine or there is a high risk for ventricular fibrillation or atrial fibrillation.

The scar can be made in several ways:

•       Radiofrequency ablation: Uses high-energy radiofrequency signals
•       Cryoablation: Uses extremely cold temperatures
•       Laser ablation: Uses laser light

Catheter ablation is performed while the patient is awake, but sedated. An opening will be made in the arm, groin or upper thigh into a blood vessel Catheters (flexible tubes) are then threaded through the blood vessel to the targeted area in the heart using x ray imaging. Alternatively, the doctors may locate the area using electrodes at the ends of the catheters to determine the origin of the abnormal heartbeat.  Once the tip of the catheter is on the correct area, a machine will send either radiofrequency waves, cold temperatures or laser light through the catheter to create a scar to block electrical signals from passing through the area. The catheter is then removed and the patient is monitored for the next few hours. There are some risks with this method such as bleeding, infection, blood vessel damage, arrhythmias, blood clots and cancer (from radiation).

Pacemaker

In some cases of catheter ablation, the physician may destroy the AV node, the location where the electrical signals pass from the atria to the ventricles. Following this treatment, a pacemaker will be implanted under the collarbone with electrodes to the heart to maintain normal heart rhythm.

Implantable cardioverter-defibrillator

Implantable cardioverter-defibrillators or ICDs may be used if the patient is at a high risk of experiencing irregular or fast heart beat in the ventricles, particularly in cases of ventricular tachycardia, ventricular fibrillation or after sudden cardiac arrest. ICDs are battery-powered implantable devices that are placed under the skin by the collarbone. Electrodes run from the device to the heart and monitor heart rhythm. If an abnormal heart rhythm is detected, the device shocks the heart to return it to a normal rhythm.

Maze Surgery

Maze surgery is typically only done when the patient is getting open heart surgery for another condition. This treatment involves placing cuts and burns in the atria to prevent the spreading of disorganized electrical signals.

Other Treatments

Vagal maneuvers

These maneuvers are performed to stop episodes of SVT currently in progress. Maneuvers include

•       Holding one’s breath and straining
•       Dunking one’s face in cold water
•       Coughing