Management of Irregular Heart Rhythms in Women
Treatment options include:
Medications – antiarrhythmic drugs are medications used to convert the arrhythmia to a normal sinus rhythm or to prevent an arrhythmia. Other medications may include heart-rate control drugs; anticoagulant or antiplatelet drugs such as warfarin (a "blood thinner") or aspirin, which reduce the risk of blood clots or stroke.
Concerns for women: Because women have a longer QT interval than men. some medications that are used in men to treat irregular heart rhythms prolong the QT interval even more. These medications include: Quinidine, Sotolol, Dofetilide and Amiodarone. These medications may increase a woman's risk of developing a life-threatening arrhythmia (torsades de pointes) more than in men who take these medications. Women who take these medications should follow their’ doctor’s and dietitian’s dietary guidelines for potassium and avoid becoming low in potassium, which enhances the arrhythmia affect¹.
The biggest concern for all patients with atrial fibrillation is preventing blood clots or stroke. Warfarin (also called Coumadin) is most often used to prevent strokes in patients. According to the The Canadian Registry of Atrial Fibrillation (CARAF), women were half as likely to be prescribed warfarin as compared to men, although they would benefit from it as much².
Lifestyle changes– arrhythmias may be related to certain lifestyle factors. Here are some ways to change these factors:
- If you smoke, stop. Learn More
- Limit your intake of alcohol. Learn More
- Limit or stop using caffeine. Some people are sensitive to caffeine and may notice more symptoms when using caffeinated products (such as tea, coffee, colas, chocolate and some over-the-counter medications).
- Avoid certain stimulants. Beware of stimulants used in cough and cold medications and herbal or nutritional supplements. Some of these substances contain ingredients that cause irregular heart rhythms. Read the label and ask your doctor or pharmacist what medication would be best for you.
Invasive Therapies – the following invasive therapies may be used to treat or eliminate irregular heart rhythms. Your doctor will discuss the benefits and risks of these therapies and whether they are appropriate treatments for your condition.
- Electrical cardioversion – in patients with persistent arrhythmias (such as atrial fibrillation), a normal rhythm may not be achieved with drug therapy alone. After administering a short-acting anesthesia, an electrical shock is delivered to your chest wall that synchronizes the heart and allows the normal rhythm to restart.
- Catheter ablation – during ablation, energy is delivered through a catheter to tiny areas of the heart muscle. This energy can either "disconnect" the pathway of the abnormal rhythm; block the abnormal pulses and promote normal conduction of impulses; or disconnect the electrical pathway between the atria and the ventricles.
- Pulmonary vein antrum isolation (PVI) – This procedure is used to treat atrial fibrillation. During PVI, special catheters are inserted into the heart (catheters are inserted into the right atrium and into the left atrium). Intracardiac echocardiography is used to visualize the left atrium during the procedure. One catheter in the left atrium is used to map or locate the abnormal impulses coming from the pulmonary veins. The other catheter is used to deliver the radio frequency energy to ablate, or create lesions outside the pulmonary veins. The procedure is repeated for all four pulmonary veins. The lesions form a circumferential scar around the pulmonary veins. The scar blocks any impulses firing from within the pulmonary veins, thereby "disconnecting" the pathway of the abnormal rhythm and potentially curing atrial fibrillation.
Electrical devices – a small device may be implanted under the skin that can detect an irregular heart rhythm and/or treat it. Your doctor will discuss the benefits and risks of implantable devices and whether they are an appropriate treatment for your condition.
- Permanent pacemaker – a device that sends small electrical impulses to the heart muscle to maintain a normal heart rate. The pacemaker has a pulse generator (which houses a battery and a tiny computer) and leads (wires) that send impulses from the pulse generator to the heart muscle, as well as sense the heart's electrical activity. Pacemakers are mostly used to prevent the heart from beating too slowly. Newer pacemakers have many sophisticated features that are designed to help with the management of arrhythmias, optimize heart-rate-related functions and improve synchronization.
- Implantable cardioverter-defibrillator (ICD) – a sophisticated electronic device used primarily to treat ventricular tachycardia and ventricular fibrillation, two life-threatening abnormal heart rhythms. The ICD constantly monitors the heart rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle to cause the heart to beat in a normal rhythm again.
Heart surgery – The Maze, modified Maze and minimally invasive ablation surgeries are used to correct atrial fibrillation that is not controlled with medications or non-surgical treatment methods. Arrhythmia surgery also may be recommended if you need surgery to correct other forms of heart disease (such as valve disease or coronary artery disease).
Treatment also includes regular follow-up with a physician. While women have specific concerns related to irregular heart rhythms, communication with your physician will ensure safe and effective treatment.
- Wolbrette D. Differences in the Proarrhythmic Potential of QT-prolonging Drugs. Current Women's Health Reports 2002, 2:105-109.
- Karin H. Humphries, Charles R. Kerr, Stuart J. Connolly, George Klein, John A. Boone, Martin Green, Robert Sheldon, Mario Talajic, Paul Dorian, and David Newman. New-Onset Atrial Fibrillation : Sex Differences in Presentation, Treatment, and Outcome. Circulation 2001 103: 2365 - 2370.
- Bailey MS, Curtis AB. The Effects of Hormones on Arrhythmias in Women. Current Women's Health Reports 2002, 2:83-88.
- Blacks, Women Less Likely to Get Implantable Defibrillators, www.dukenews.duke.edu/2000/11/blackwomenheartn17.html.