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.

Prescriptions

In general, there are two reasons your healthcare provider 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. Second, the arrhythmia may be causing you harm or may be threatening to do so, as certain arrhythmias can increase your risk of cardiac arrest, heart attack, and stroke.

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 tachycardia (arrhythmia that causes a rapid heart rate) is 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 healthcare provider 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 toxicities seen with amiodarone, like lung, thyroid, opthalmic, or liver damage, can be particularly nasty, and this drug should only be used, like all antiarrhythmic drugs, only when absolutely necessary.

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.

Examples of beta blockers include Sectral (acebutolol), Tenormin (atenolol), Zebeta (bisoprolol), Lopressor or Toprol-XL (metoprolol), Corgard (nadolol), and Inderal LA or InnoPran XL (propranolol). These can cause side effects like depression, slow heart rate, fatigue, Raynaud's syndrome, sexual dysfunction, 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 headache, constipation, diarrhea, and low blood pressure.

Anticoagulants

Depending on your individual risk for developing blood clots, which can then lead to a stroke, your healthcare provider may prescribe an anticoagulant (blood thinner). These medications keep your blood from clotting and stop clots you already have from getting bigger. Of course, taking an anticoagulant does increase the risk of bleeding, so individualized discussion with your practitioner is key, and decisions may need to be revisited as your health changes.

There are many oral options for anticoagulant therapy, such as warfarin, apixaban, dabigatran, edoxaban, and rivaroxaban. Those on anticoagulant therapy will need yearly blood tests to monitor for liver and kidney function, or frequent (at least monthly) blood tests if taking warfarin to be sure it's in the correct range.

Drugs That Reduce Cardiac Risk

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. A meta-analysis of 30 randomized trials with 24,779 patients suggests that beta blockers reduce the risk of sudden cardiac death by 31%. The protective mechanism of beta blockers involves slowing down the heart rate by blocking the effect of adrenaline on the heart muscle, thus reducing the chances of developing fatal arrhythmias. Almost all patients who have survived heart attacks or who have heart failure should be taking beta blockers.

Other drugs that your healthcare provider 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.

Implantable Devices

Some types of arrhythmias may require an implantable device to help regulate your heart's rhythm or provide an electric shock if needed.

Pacemaker

If your heartbeat is irregular, your healthcare provider 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 generates electrical impulses that prevent your heart from beating too slowly or too quickly.

After your pacemaker is implanted, you may need to spend a few nights in the hospital so that healthcare providers can monitor its performance. Within a few days, you should be able to return to most of your daily activities.

Certain electronic devices that emit strong electro-magnetic fields may interfere with your pacemaker. As an added precaution, experts recommend avoiding close contact (less than 6 inches from pacemaker) or prolonged contact with devices such as cell phones, e-cigarettes, body fat percent scales, MP3 headphones, and metal detectors, and you should avoid carrying these in any pockets near your chest.

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 healthcare provider 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. Certain electronic devices can also interfere with your ICD and prevent it from working properly. You may not realize that this disruption has occurred, either. In addition to cell phones, headphones, and e-cigarettes, those who have an ICD should also minimize their exposure to:

• Metal detectors for security
• MP3 players and radios
• Electric fences used to contain pets
• Portable car battery chargers
• Medical alert systems and fall detection pendants

Specialist-Driven Procedures

Several procedures or surgeries may be used to treat your arrhythmia or prevent them from recurring. 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 and location 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 EPS study, 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.

For people with supraventricular tachycardias, the success rate is 90% to 95%.

Cardioversion

For certain types of arrhythmias like atrial fibrillation and ventricular fibrillation, electrical 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 back into a normal rhythm. This procedure is typically scheduled in advance, although it can also be used under emergency circumstances to bring a rapid heart rate under control.

There is a risk involved with cardioversion; it is possible that the procedure can knock a blood clot loose in your left atrium that may travel to your brain and result in a stroke. To prevent this, your practitioner may prescribe warfarin to be taken 2 to 3 weeks before your cardioversion.

Maze Procedure

If you're not responding to other treatments for arrhythmias or you're having heart surgery for another reason, your healthcare provider 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.

People who undergo a maze procedure are generally required to stay in the hospital for a few nights afterwards. It's common for people to initially have some pain in their chest, ribs, or shoulders as they begin to recover, but most people feel back to normal within 3 to 6 months. There are risks associated with maze procedures, as is the case with any open-heart surgery. Risks include infection, blood clots, heart attack, and the onset of other arrhythmias that may require a pacemaker. Approximately 1% to 2% of people die during this surgery.

Coronary Bypass

In cases of severe coronary artery disease causing arrhythmia, your healthcare provider may recommend a coronary bypass to improve the blood supply to your heart. During this procedure, a blood vessel grafted from your chest, leg, or arm is used to connect your aorta to your coronary artery, creating a new channel for blood to flow through. Once the surgery is complete, you will have to spend a few days in the intensive care unit (ICU) where practitioners will continuously monitor your heart rate and blood pressure.

There are potential complications to be aware of with this procedure. First, there is a possibility that you may develop atrial fibrillation, and this may increase your risk of stroke. There is also an estimated 1% to 2% risk for each potential complication (arrythmia, heart attack, stroke, infection, and death) involved with coronary bypass surgery.

Lifestyle Changes

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

Choose Heart-Healthy Foods

A heart-healthy diet is widely considered the cornerstone of cardiovascular disease (CVD) prevention. Studies show that diets high in animal protein, saturated fat, and simple carbohydrates increase your risk of CVD, while certain heart-healthy foods can reduce inflammation and plaque buildup in the arteries.

First thing first, it's best to avoid pro-inflammatory foods, including items that are high in saturated and trans fat, sugar, salt, and cholesterol. Experts recommend cutting out red meat, along with processed and fast-foods. Instead, opt for plenty of vegetables, whole grains, legumes, fruits, nuts/seeds, low-fat dairy, and lean meats such as poultry and fish. It's okay to use extra virgin olive oil when cooking or sprinkled over a salad too.

If you're still not sure where to begin, look to the Mediterranean diet; many staples of this diet are known for their anti-inflammatory properties. Consulting with a dietitian is also beneficial for many people. If you choose to take this route, be sure to contact your insurance provider, as they may even cover the visit.

Keep Moving

The Department of Health and Human Services (HHS) recommends fitting at least 150 minutes of moderately intense aerobic exercise into your schedule each week. This may take the form of walking or jogging, swimming, cycling, dancing, or even gardening.

The HHS also recommends incorporating weights or resistance training at least two days per week. That said, your healthcare provider may advise against heavy lifting if you have had a permanent pacemaker or ICD implanted or you have had an invasive heart surgery.

Above all, you should avoid spending too much time being sedentary, even if much of your day is spent at a desk. A little exercise is better than none. If you haven't been exercising lately, its best to start with light activity and gradually increase it.

Watch Your Weight

Obesity is closely associated with a number of conditions that increase cardiovascular risk, including type 2 diabetes, high blood pressure, high cholesterol, and inflammation. These conditions are driving factors for heart attack, cardiac arrest, coronary artery disease, stroke, arrhythmias, and sudden death.

Eating a healthy diet and increasing your physical activity can help you reach and maintain a healthy weight. If lifestyle changes are not enough, talk to your healthcare provider about medications or surgery.

Stop Smoking

Cigarette smoking is a major risk factor for cardiovascular disease. According to the CDC, more than 650,000 people die each year in the United States as a result of CVD. In at least 20% of these cases, the person's CVD was directly attributed to cigarette smoking.

Quitting cigarettes may be one of the best things you can do for yourself to prevent CVD. It's never too late either; after four years of not smoking, your risk of having a stroke is reduced to that of a person who never smoked at all.

Understandably, quitting cold turkey is easier said than done. Nicotine replacement in the form of patches, lozenges, and gum are available therapies that may minimize withdrawal symptoms and help you stave off cravings. Many people find that the support of a community is especially beneficial, and a plethora of support groups exist for this purpose.

The FDA has also approved two medications for treating tobacco dependence: bupropion (Zyban) and varenicline (Chantix).

Maintain Blood Pressure and Cholesterol

Keeping your blood pressure and cholesterol under control is crucial for protecting against heart disease. If you have been prescribed any medications for high blood pressure and/or cholesterol, it's important to stay on top of them. Along with eating a heart-healthy diet, exercising routinely, and avoiding cigarettes, there are several other lifestyle modifications you can make to help keep your blood pressure and cholesterol under control.

Manage Your Stress

Emotional and environmental stress can contribute to heart disease by increasing blood pressure and cholesterol and contributing to the buildup of arterial plaque. Many people also choose to compensate for stress with activities that harm the heart, like smoking, binge drinking, or overeating.

To minimize the physical and emotional toll of stress, learn healthier coping mechanisms and/or seek effective treatment, such as cognitive behavioral therapy. This form of psychological therapy is particularly effective in treating anxiety and depression in people with cardiovascular disease.

You may also consider some stress reduction techniques like yoga, visualization, breathing exercises, meditation, or muscle relaxation.

Moderate Alcohol

Your healthcare provider may not want you to drink alcohol since it can trigger an arrhythmia. Not to mention, heavy drinking is closely linked to hypertension, coronary heart disease, stroke, and more.

If you choose to drink nonetheless, do so in moderation. A moderate amount of alcohol is considered to be one drink per day for women and up to two drinks per day for men.

Keep Your Appointments

Even if you're feeling well, make sure you keep your healthcare provider appointments and all of your other follow-up care. Better yet, optimize your appointments by preparing a list of questions or concerns you may have in advance.

Don't hesitate to tell your practitioner if you are having trouble obtaining your medicine or if the medication is causing bothersome symptoms. It's important that you take your medication consistently and exactly as directed. If for some reason you can't, your healthcare provider should know.

Complementary Medicine (CAM)

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:

• Dunking your face in ice water or applying an ice-cold, wet towel to the face for 15 seconds to trigger the diving reflex
• Holding your breath while trying to forcefully exhale for 10-30 seconds (valsalva maneuver)

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

Acupuncture

Acupuncture has traditionally been used to reduce stress and restore balance to the central nervous system. The benefits of this treatment do not stop there though. While more research is needed, studies have shown that acupuncture may be a safe and helpful additional treatment for certain arrhythmias, particularly atrial fibrillation after conversion to sinus (normal) rhythm.

A Word From Verywell

Arrhythmias are relatively common and can happen at any age. They generally aren't life-threatening and often don't require treatment. Still, you may feel concerned if your symptoms are noticeable or frequent, or if you are at a greater risk of heart disease or stroke. Upon reaching a diagnosis, your healthcare provider will recommend a treatment plan to keep your heart rate under control and lower your cardiovascular risk. Meanwhile, adopting healthy lifestyle changes can have a positive effect on your overall health and ultimately bring you peace of mind.