How Cardiac Arrhythmias Are Treated

If you have been diagnosed with a cardiac arrhythmia, treatment will depend on what type you have and how serious it is. If it's not causing major symptoms and you're not in danger of developing a worse arrhythmia or a complication, you probably won't need any treatment. However, if your symptoms are severe and/or your doctor is concerned that your arrhythmia may turn into something more sinister, he or she may recommend a treatment that's appropriate for your needs.

In general, there are two reasons your doctor might want to place you on medication for a cardiac arrhythmia. First, the arrhythmia might be causing you to have symptoms, such as palpitations or lightheadedness, and treatment may be important to relieve those symptoms. Or, second, the arrhythmia may be causing you harm or threatening to do so.

Antiarrhythmic Drugs

Antiarrhythmic drugs are medications that change the electrical properties of cardiac tissue, and by doing so, change the way your heart's electrical signal spreads across your heart. Since the tachycardias (arrhythmias that cause a rapid heart rate) are usually related to abnormalities in the electrical signal, drugs that alter your heart's electrical signal can often improve those arrhythmias. Antiarrhythmic drugs are often effective, or at least partially effective, in treating most varieties of tachycardias.

Unfortunately, the antiarrhythmic drugs as a group tend to cause a fair number of side effects of one kind or another, and as a consequence, they can be difficult to take. Each antiarrhythmic drug has its own unique toxicity profile, and before prescribing any of these drugs, it is vital that your doctor carefully explains the possible problems that may occur with the selected drug.

However, there is one unfortunate problem that is common to virtually all the antiarrhythmic drugs: Sometimes these drugs make the arrhythmia worse instead of better. This feature of antiarrhythmic drugs—called proarrhythmia—turns out to be an inherent property of drugs that change the heart's electrical signal. Simply put, when you do anything to change the way the electrical signal spreads across the heart, it is possible that the change will make a tachycardia better, or it can make it worse.

Commonly used antiarrhythmic drugs include Cordarone or Pacerone (amiodarone), Betapace (sotalol), Rhythmol (propafenone), and Multaq (dronedarone). Amiodarone is by far the most effective antiarrhythmic drug and is also less likely to cause proarrhythmia than other drugs. Unfortunately, the other kinds of toxicities seen with amiodarone, like lung or liver damage, can be particularly nasty, and this drug should only be used, like all antiarrhythmic drugs, when absolutely necessary.

The bottom line is that doctors are—and ought to be—reluctant to prescribe antiarrhythmic drugs. These drugs should be used only when an arrhythmia is producing significant symptoms or is posing a threat to your cardiovascular health.

AV Nodal Blocking Drugs

The medications known as AV nodal blocking drugs—beta blockers, calcium channel blockers, and digoxin—work by slowing your heart's electrical signal as it passes through the AV node on its way from the atria to the ventricles. This makes AV nodal blocking drugs particularly useful in treating supraventricular tachycardias (SVT). Some forms of SVT, specifically AV nodal reentrant tachycardia and the tachycardias caused by bypass tracts, require the AV node to conduct the electrical signal efficiently, and if the AV node can be made to conduct the electrical signal more slowly, the SVT simply stops.

For the SVT known as atrial fibrillation, AV nodal blocking drugs do not stop the arrhythmia, but they do slow your heart rate to help eliminate symptoms. In fact, controlling your heart rate with AV nodal blocking drugs is often the best way to manage atrial fibrillation.

Examples of beta blockers include Sectral (acebutolol), Tenormin (atenolol), Zebeta (bisoprolol), Lopressor or Toprol-XL (metoprolol), Corgard (nadolol), Bystolic (nebivolol), and Inderal LA or InnoPran XL (propranolol). These can cause side effects like depression, slow heart rate, fatigue, Raynaud's syndrome, sexual dysfunction, shortness of breath, and airway spasms.

Only certain calcium channel blockers are beneficial for treating arrhythmias, including Cardizem or Tiazac (diltiazem), and Calan or Verelan (verapamil). Potential side effects include swollen feet, constipation, diarrhea, and low blood pressure.

Anticoagulants

If you're at risk for developing blood clots, which can then lead to a stroke, your doctor may prescribe an anticoagulant (blood thinner). These medications keep your blood from clotting and stop clots you already have from getting bigger, though they can't reduce the size of existing blood clots. If you've had a stroke or you have atrial fibrillation, there's a good chance your doctor will put you on an anticoagulant. Common side effects of anticoagulants include bloating, gas, diarrhea, nausea, vomiting, and not feeling hungry.

Drugs That Reduce the Risk of Sudden Cardiac Arrest

A few drugs are thought to reduce the risk of sudden cardiac arrest, presumably by reducing the risk of ventricular tachycardia or ventricular fibrillation, the arrhythmias that produce cardiac arrest. Research shows that beta blockers seem to reduce the risk of sudden cardiac arrest by blocking the effect of adrenaline on the heart muscle, thus reducing the chances of developing fatal arrhythmias. All patients who have survived heart attacks or who have heart failure should be taking beta blockers.

Other drugs that your doctor may prescribe if you are at risk for sudden cardiac arrest include angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and the antiarrhythmic drug amiodarone.

Some types of arrhythmias may require an implantable device to help regulate your heart's rhythm.

Pacemaker

If your heartbeat is too slow or too irregular, your doctor may recommend a pacemaker, a battery-operated device that keeps your heart beating at a steady, regular pace. It's placed under your skin near your collarbone, where it's then connected with a wire to your heart. The pacemaker then generates electrical impulses that help your heart beat normally, preventing arrhythmias.

Implantable Cardioverter Defibrillator (ICD)

If you've had a sudden cardiac arrest, been diagnosed with ventricular tachycardia or ventricular fibrillation, or you're at risk for developing either of these arrhythmias, your doctor may recommend an implantable cardioverter defibrillator (ICD). These devices can prevent sudden death from cardiac arrest, which is the main reason they're used. Like a pacemaker, an ICD is also battery powered and also placed under your skin near your collarbone. Wires with electrodes at the tips are attached to your heart and the ICD monitors your heart continually. Unlike a pacemaker, an ICD only kicks in when it detects an abnormal rhythm, sending a shock or a pacing treatment to your heart to get it back to normal. Since ICDs don't prevent arrhythmias, you will likely have to take medications as well.

There are special procedures or surgeries that may be used to treat your arrhythmia. Again, these treatments depend on the type and the severity of your arrhythmia.

Ablation

Some arrhythmias are caused by localized abnormalities within the heart’s electrical system. In these cases, an ablation procedure may be able to disrupt the electrical abnormality. An ablation may also be used as a treatment option if you can't tolerate medications or they aren't working. The goal of this procedure usually is to get rid of the arrhythmia altogether.

While ablation procedures can be performed in the operating room during open-heart surgery, by far the most common form of ablation is accomplished during a specialized form of cardiac catheterization called an electrophysiology study (EPS). 

These studies are performed by cardiac electrophysiologists—cardiologists with special training in the treatment of cardiac arrhythmias. An EPS may be done as a diagnostic procedure when it's important to tease out very precisely the mechanism of your arrhythmia and often to decide whether an ablation procedure would be likely to cure the arrhythmia. Today, many electrophysiology studies combine the diagnostic test with an ablation procedure.

During an ablation procedure, specialized catheters with electrodes at the tip are positioned at various locations inside your heart, and the entire cardiac electrical system is studied and mapped. If an abnormal area is identified that is responsible for producing your arrhythmia, the tip of the catheter is guided to that abnormal area, and an ablation is performed through the catheter. The ablation is accomplished by transmitting some form of energy through the catheter (heat energy, freezing energy, or radiofrequency energy) in order to damage (ablate) the tissue at the tip of the catheter. This creates a block in the electrical pathway that's causing your arrhythmia.

In recent years, ablation procedures have become quite advanced, and typically employ sophisticated computerized mapping systems that utilize both 3D imaging and electrical mapping to pinpoint the appropriate site for ablation. It usually takes a few hours and you need a day or two of recovery time in the hospital.

Ablation works 60 percent to 80 percent of the time for people with more problematic arrhythmias such as atrial fibrillation, atrial tachycardia, and ventricular tachycardia. For people with supraventricular tachycardias, the success rate is 90 percent to 95 percent.

Cardioversion

For certain types of arrhythmias like atrial fibrillation and ventricular fibrillation, cardioversion may be a treatment option. In this procedure, your heart is electrically shocked with paddles or patches on your chest from a defibrillator. The shock can force your heart go back into a normal rhythm.

Maze Procedure

If you're not responding to other treatments for arrhythmias or you're having heart surgery for another reason, your doctor may recommend a maze procedure. This involves making incisions in the upper part of your heart (the atria) that scar over and prevent electrical impulses from creating the arrhythmia since the impulses can't go through scar tissue.

Coronary Bypass

In cases of severe coronary artery disease that's causing your arrhythmia, your doctor may recommend a coronary bypass, which can improve the blood supply to your heart.

Making some lifestyle changes can help keep your heart healthy and reduce your risk of developing heart disease.

Eat a Heart-Healthy Diet

Make sure your diet is full of a variety of whole grains, fruits, and vegetables and that it's low in salt, cholesterol, and fat. Switch to low-fat or fat-free milk and eat lean meats, poultry, and fish.

Keep Moving

Exercise keeps your heart healthy. Try to get some every day or set a goal to increase your activity and work toward it.

Watch Your Weight

Being overweight or obese increases your risk of heart disease because you are working your heart harder. Eating a healthy diet and increasing your exercise can help you get to and maintain a healthy weight.

Break the Smoking Habit

If you're a smoker, work on quitting. This is the healthiest decision you can make for your entire body, not to mention your heart.

Maintain Healthy Blood Pressure and Cholesterol Levels

Implement the above lifestyle changes and make sure to take any medications you've been prescribed for high blood pressure and/or cholesterol.

Manage Your Stress

Stress can contribute to arrhythmias, Make sure you take time to do activities you enjoy. Learn some relaxation techniques. Work out your frustrations with exercise.

Moderate Alcohol

Your doctor may not want you to drink alcohol since it can make your heart beat faster, but if you do, make sure you're doing it in moderation. Healthy amounts of alcohol are up to one drink per day for women and men over the age of 65 and up to two drinks per day for men under 65.

Keep Your Appointments

Even if you're feeling well, make sure you keep your doctor appointments and all of your other follow-up care. Take your medications as directed and let your doctor know if you're having any symptoms or bothersome side effects.

There are other treatments that can help treat arrhythmias or the stress that can make them worse. These include:

Vagal Maneuvers

If you have a supraventricular tachycardia, easy exercises known as vagal maneuvers may help to slow it down or even stop it. These maneuvers work by affecting the vagus nerve, which controls your heartbeat, and include:

• Gagging
• Coughing
• Dunking your face in ice water
• Holding your breath while trying to forcefully exhale
• Placing your fingers on your eyelids and gently pressing down

Talk to your doctor about using vagal maneuvers since they may not be a good treatment option for you.

Acupuncture

Though more research is needed, studies have shown that acupuncture may be a safe and helpful treatment for certain arrhythmias, particularly paroxysmal supraventricular tachycardia, ventricular premature beat, sinus tachycardia, and atrial fibrillation. Additionally, acupuncture has few risks, so this could be worth a try.

Stress Reduction Therapies

Since stress is a factor that can make your arrhythmia worse, you may be trying to reduce the amount of stress you feel. Here are some methods to help:

• Yoga
• Meditation
• Relaxation techniques such as deep breathing, progressive muscle relaxation, and visualization