How are cardiac arrhythmias treated?

Medication is a common treatment for an unstable heart rhythm, but it isn’t always effective and is never a cure. Another alternative is cardiac ablation.

Options such as cardioversion or medication may alleviate symptoms of cardiac arrythmia. A procedure that often cures the problem is cardiac ablation, which creates a lesion in the heart area that fires abnormal electrical impulses.

Arrhythmia means an irregularity of the heartbeat. There are many different kinds with the severity ranging from nothing to worry about to potentially fatal. The treatment depends on how bad the arrhythmia is and what the risk is to your health. Normal hearts always have some degree of arrhythmia. After seeing the doctor and having very simple testing done, this may be the ultimate diagnosis. In this case, the best treatment is "do nothing." Most of the time, the medications that would be used will have side effects that are worse that your problem. Some arrhythmias are very bothersome but not dangerous. Mostly, these are treated with simple medications. It is always important to have the side effects be less than the problem itself! Some arrhythmias are treated with more complex medications and these usually require a cardiac electrophysiologist to make the right decision and to monitor the medications carefully. There are types of arrhythmias that can be cured through an invasive cardiac procedure called an electrophysiology study (EPS). This sounds scary, but it really isn't. It is done by inserting skinny little wires through big main blood vessels (usually in your groin) and then finding the spots in the heart that are causing the problem and putting little tiny burns to destroy these spots. This doesn't hurt and, depending on the arrhythmia, can be very, very effective. Finally, there is a group of arrhythmias that require implantation of either a pacemaker or an implanted defibrillator. This is always done with a cardiac electrophysiologist and is a decision that is made very thoughtfully. If your arrhythmia requires this treatment, it is the right thing to do and is usually quite effective.

Arrhythmia—which simply means an abnormality of the heart rhythm—may range from the completely benign to the immediately life-threatening. Likewise, the treatment of arrhythmias may involve doing nothing, treating with medications, treating with catheter ablation or cardioversion, or treating with implantable pacemakers or defibrillators.

Catheter ablation involves placing small plastic tubes into the veins in your leg and advancing them into the heart where energy—either burning or freezing energy—may be used to destroy the tissue inside the heart that is producing the arrhythmia. Cardioversion is the process where a patient is temporarily put to sleep and then energy is directed through heart (from patches applied to the skin) to stop an arrhythmia and restore normal rhythm.

Pacemakers are used to keep the heart from beating too slowly. Defibrillators do everything a pacemaker does, but also can treat life-threatening heart rhythms where the lower chambers of the heart are beating dangerously fast. Your physician and you should discuss in details the indications, risks, potential benefits and other options for treatment of your specific arrhythmia issue.

Cardiac arrhythmias can be treated in a variety of ways, depending on three factors—how they make you feel, how serious they are, and the risk related to the treatment. There are many arrhythmias and each has a variety of treatment options that considers the three factors listed above.

In general, options include medicines, implantable devices like pacemakers and defibrillators, and catheter-based heart procedures (called electrophysiology studies) that can be used to diagnose and identify the location in the heart from where the arrhythmia arises—heat can be delivered to the specific location(s) through one of our catheters until the target sites no longer function, suppressing or curing the arrhythmia. This does not injure the heart or impair its overall function at all.

Each specific treatment option has its own risk and benefits and should be discussed with a heart doctor. Cardiac electrophysiologists are heart doctors that specialize in the treatment of arrhythmias.

Cardiac arrhythmias, or cardiac rhythm disturbances, may be treated with medications that help restore heartbeat to normal rhythm as a first step. In some circumstances, that medication regimen may also include blood thinners to prevent blood clots from forming in the heart.

Additionally, it's possible that the doctor may try to “shock” the heart out of the abnormal rhythm. This is called a cardioversion, and it is a procedure where medication would be given so that no pain or awareness would be experienced during the short procedure.

If medications or cardioversion cannot maintain a normal heart rhythm, the doctor may recommend a treatment such as a pacemaker, an ablation or a combination of therapies. An ablation is when an electrophysiologist attempts to disrupt, or ablate, the abnormal electrical signals and allow the heart to use the normal pathways instead. This procedure can take several hours but is performed through a blood vessel in the groin with special instruments and devices and does not require heart surgery.

When these less invasive methods are not working, or if doctors feel like the heart might not respond to them, surgery may be recommended.

Surgery for atrial rhythm problems is called the Maze procedure. This is similar to the ablation, but uses different ways to disrupt the abnormal electrical channels. One way is to cut them, freeze them or even make small burns to create scars over the abnormal areas so that the heart will use the normal electrical pathways instead. Doing this requires direct vision of the heart, and therefore a surgical incision is made on the chest cavity. Sometimes cameras are used to allow smaller incisions.

In people who have atrial fibrillation in addition to other forms of heart disease, the Maze procedure is frequently performed along with other open heart surgical procedures, such as mitral valve repair or replacement.

This content originally appeared online in "The Patient Guide to Heart, Lung, and Esophageal Surgery" from the Society of Thoracic Surgery.