Pacemaker

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.

Invasive Therapies

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.

Electrical cardioversion

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.

Catheter ablation

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.

Pulmonary vein isolation

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.

Devices

These devices are inserted by a cardiologist during a procedure in the electrophysiology lab.

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 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.

Implantable cardioverter-defibrillator (ICD)

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 (B-V) pacemakers and defibrillators(also called cardiac resynchronization therapy or CRT)

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.

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