A variety of drugs are available to treat arrhythmias. Because everyone is different, it may take trials of several medications and doses to find the one that works best for you. Several types of drugs are used:
- Anti-arrhythmic drugs – drugs used to convert the arrhythmia to sinus rhythm (normal rhythm) or to prevent an arrhythmia.
- Heart-rate control drugs – drugs used to control the heart-rate.
- Anticoagulant or antiplatelet therapy – drugs, such as warfarin (a "blood-thinner") or aspirin, which reduce the risk of clots forming or strokes.
- Medications used to treat related conditions that may be causing an abnormal heart rhythm.
It is important to know:
- The names of your medications.
- What they are for.
- How often and at what times to take them.
Electrical cardioversion and catheter ablation are invasive therapies used to treat or eliminate irregular heart rhythms. Your doctor will determine the best treatment for you and discuss the benefits and risks of these therapies with you.
In patients with persistent past or irregular arrhythmias (such as atrial fibrillation), a normal rhythm may not be achieved with drug therapy alone. Cardioversion is performed by the doctor in a special procedure room. After administration of a short-acting anesthesia, an electrical impulse is delivered through your chest wall that synchronizes the heart and allows the normal rhythm to restart.
During an ablation, high-frequency electrical energy is delivered through a catheter to a small area of tissue inside of the heart that causes the abnormal heart rhythm. This energy "disconnects" the pathway of the abnormal rhythm. Ablation can be used to treat most SVTs, atrial flutter, and some atrial and ventricular tachycardias. It can also be used to disconnect the electrical pathway between the atria and the ventricles, which may be useful in people with atrial fibrillation. Ablation may be combined with other procedures to achieve optimal treatment.
In patients with frequent, paroxysmal or persistent atrial fibrillation, isolation of the pulmonary veins is a type of ablation that targets areas thought to cause atrial fibrillation. The goal is to create rings of scar that isolate the foci responsible for triggering atrial fibrillation.
These devices are inserted by a cardiologist during a procedure in the electrophysiology lab.
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 batter 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.
A sophisticated device used primarily to treat ventricular tachycardia and ventricular fibrillation, two life-threatening 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. There are several ways the ICD can be used to restore normal heart rhythm:
- Anti-tachycardia pacing (ATP) – when the heart beats too fast, a series of small electrical impulses may be delivered to the heart muscle to restore a normal heart rate and rhythm.
- Cardioversion/Defibrillation – when the heart is beating dangerously fast or irregularly, a shock may be delivered to the heart muscle to restore a normal rhythm.
- Anti-bradycardia pacing – most ICD’s provide back-up pacing to prevent too slow of a heart rhythm.
Biventricular pacemakers and defibrillators are used in patients with heart failure who also have evidence of an uncoordinated or asynchronous contraction of the left ventricle. These devices help to synchronize the contraction of the left ventricle. In addition to the one or two leads used by traditional pacemakers and defibrillators that are placed in the right ventricle and right atrium, bi-ventricular devices utilize an additional lead placed on the back or left side of the left ventricle. To reach this area, the additional lead is typically guided through the coronary sinus, a small vein on the back of the heart.
Patients may require heart surgery for three reasons when treating an arrthythmia:
- A patient may need heart surgery to treat heart disease that may be causing the arrhythmia (see valve surgery or coronary artery bypass surgery).
- The Maze and modified Maze procedures are two surgeries used to correct atrial fibrillation not controlled with medications or non-surgical treatment methods. It is often used when other types of heart surgery such as valve surgery are planned, but in some cases can be performed on its own.
- In some cases, biventricular pacemaker leads may be placed on the heart using minimally invasive or endoscopic techniques.
Risks / Benefits
Arrhythmias may be related to certain lifestyle factors. Here are some ways to change these arrhythmia risk factors:
- If you smoke, stop.
- Limit your intake of alcohol.
- 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 and some over-the-counter medications).
- Avoid ingestion of stimulants. Beware of stimulants used in cough and cold medications and herbal or nutritional supplements. Some such medications contain ingredients that promote irregular heart rhythms. Read the label and ask your doctor or pharmacist what medication would be best for you.
- Control high blood pressure.
- If you are obese or overweight, achieve a desirable weight to decrease risk for arrhythmias such as atrial fibrillation.
- Control blood sugar levels.
- Treat sleep apnea; treatment may decrease your risk for arrhythmia.
- If you notice that your irregular heart rhythm occurs more often with certain activities, you should avoid them.
- Your family may also want to be involved in your care by learning to recognize your symptoms and how to start CPR if needed.
Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.
Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart and Vascular Institute Outcomes.
Cleveland Clinic Heart and Vascular Institute Cardiologists and Surgeons
Choosing a doctor to treat your abnormal heart rhythm depends on where you are in your diagnosis and treatment. The following Heart and Vascular Institute Sections and Departments treat patients with Arrhythmias:
- Section of Electrophysiology and Pacing: cardiology evaluation for medical management or electrophysiology procedures or devices - Call Cardiology Appointments at toll-free 800.223.2273, extension 4-6697 or request an appointment online.
- Department of Thoracic and Cardiovascular Surgery: surgery evaluation for surgical treatment for atrial fibrillation, epicardial lead placement, and in some cases if necessary, lead and device implantation and removal. For more information, please contact us.
- You may also use our MyConsult second opinion consultation using the Internet.
The Heart and Vascular Institute also has specialized centers to treat certain populations of patients:
For younger patients with abnormal heart rhythms:
See: About Us to learn more about the Sydell and Arnold Miller Family Heart & Vascular Institute.
If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
Becoming a Patient
Abnormal Heart Rhythm Conditions
- Atrial Fibrillation
- Ventricular Tachycardia
- All Miller Family Heart & Vascular Institute Treatment Guides
Diagnostic tests are used to diagnose your abnormal heartbeat and the most effective treatment method.
Our webchats and video chats give patients and visitors another opportunity to ask questions and interact with our physicians.
- Abnormal Heart Rhythm webchats and video chats
- All Miller Family Heart & Vascular Institute webchats
- Recovery at home
- Support Groups and Information
- Visit Health Essentials - Read articles on rhythm disorders and healthy living on Health Essentials blog
- Follow Heart & Vascular Institute webchats and news stories on Twitter
- Subscribe to Heart and Vascular eNews
- Heart Rhythm Society
- Cardiac Arrhythmias, Cleveland Clinic Disease Management Project
- ACC/AHA Guidelines
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