Arrhythmia Treatment Options
Once, serious abnormal heart rhythms or arrhythmia (ah-RITH-me-ah) required open-heart surgery to treat. Fortunately, this is rarely the case today. Thanks to advances in medicines and medical devices, there are now safer and much more comfortable treatment options for abnormal heart rhythms.
A cardiologist who specializes in electrical problems of the heart (an electrophysiologist) can guide you toward the treatment option that best fits your condition and personal situation.
There are currently three paths of treatment:
Medicines can slow down a heart that's beating too fast. They also can change an abnormal heart rhythm to a normal, steady rhythm. Medicines that do this are called antiarrhythmics. Currently, no medicine can reliably speed up a slow heart rate.
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Pacemakers or Implantable Cardioverter Defibrillators (ICDs)
These are small battery-powered devices that are placed under the skin of your chest or abdomen to help control abnormal heart rhythms. Through wires that thread from the device to the heart, small painless electrical pulses or shocks are applied directly to the heart to help control life-threatening arrhythmias and make the heart beat (contract) in a more normal rhythm.
Pacemakers may be used when the heart beats too slowly (bradycardia) or has other abnormal rhythms (arrhythmias). In some cases, special cardiac pacemakers also are used to treat the symptoms of heart failure. For example, an electrophysiologist may use special pacemakers for cardiac resynchronization therapy to strengthen the force of the hearts contractions in patients with congestive heart failure, enlarged and/or weakened heart muscles, or a significant electrical delay in the lower pumping chambers of the heart.
An implantable cardioverter defibrillator (ICD) may be used to treat patients whose lower heart chambers (ventricles) quiver ineffectively (fibrillation) or beat too quickly (tachycardia). They are also used in patients who are at risk of these conditions due to previous cardiac arrest, heart failure or ineffective drug therapy for abnormal heart rhythms (arrhythmia).
An ICD continually monitors the heart’s rhythms and electrical patterns. When it detects a heartbeat that is irregular or too rapid, it delivers a low energy shock that resets the heart to a more normal rate and electrical pattern (cardioversion).
Pacemakers and ICDs are designed to last a lifetime, but they do require periodic maintenance. Batteries may last between six to 15 years depending on the device. Also, the insulated wires that lead from the device to the heart (the leads) must sometimes be replaced using an advanced procedure called laser lead extraction.
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Catheter ablation (ab-LA-shun) is a medical procedure that treats some types of arrhythmia by destroying small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start. Mills-Peninsula’s Cardiac Electrophysiology Clinic is one of the few such community hospital clinics that can offer both traditional catheter ablation and stereotaxis robotic navigation technology catheter ablation.
During catheter ablation, a series of catheters (thin, flexible wires) are put into a blood vessel in the arm, groin (upper thigh), or neck. Using live X-rays, the electrophysiologist carefully guides the wires into the heart through the blood vessel.
The difference between traditional catheter ablation and stereotaxis is in how the catheters are guided. In traditional catheter ablation, the doctor wears a heavy lead apron and stands next to the patient pushing the catheters into place. In stereotaxis, the doctor stands in a control room and uses magnets and computers to gently pull catheters that are as soft and pliable as wet noodles into place next to the delicate heart. As a result, the risk of the most serious catheter ablation complication -- heart perforation -- is virtually eliminated and less radiation is needed to view the heart because the procedure can be performed more quickly.
In both procedures, once the catheters are in place, a special machine sends energy to the heart through one of the catheters to destroy the problem tissue and stop any bleeding (cauterize) at the same time.
Catheter ablation often involves radiofrequency (RF) energy. This type of energy uses radio waves to produce heat that destroys the heart tissue safely.
Both procedures have a similar recovery time. Typically patients stay in the hospital 24 hours or less and can return to their normal activities within a few days.
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