How Are Arrhythmias Treated?

Common arrhythmia treatments include medicines, medical procedures, and surgery. Treatment is needed when an arrhythmia causes serious symptoms, such as dizziness, chest pain, or fainting.

Treatment also is needed if an arrhythmia increases your risk for complications, such as heart failure, stroke, or sudden cardiac arrest.

Medicines

Medicines can be used to speed up a heart that’s beating too slow or slow down a heart that’s beating too fast. They also can be used to convert an abnormal heart rhythm to a normal, steady rhythm. Medicines that do this are called antiarrhythmics.

Some of the medicines used to slow a fast heart rate are beta blockers (such as metoprolol and atenolol), calcium channel blockers (such as diltiazem and verapamil), and digoxin (digitalis). These medicines often are used to slow the heart rate in people who have atrial fibrillation.

Some of the medicines used to restore an abnormal heartbeat to a normal rhythm are amiodarone, sotalol, flecainide, propafenone, dofetilide, ibutilide, quinidine, procainamide, and disopyramide. These medicines often have side effects. Some of the side effects can make an arrhythmia worse or even cause a different kind of arrhythmia.

People who have atrial fibrillation and some other arrhythmias often are treated with anticoagulants, or blood thinners, to reduce the risk of blood clots forming. Aspirin, warfarin (Coumadin^®), and heparin are commonly used blood thinners.

Medicines also can control an underlying medical condition, such as heart disease or a thyroid condition, that might be causing an arrhythmia.

Medical Procedures

Some arrhythmias are treated with a pacemaker. A pacemaker is a small device that's placed under the skin of your chest or abdomen to help control abnormal heart rhythms.

This device uses electrical pulses to prompt the heart to beat at a normal rate. Most pacemakers contain a sensor that activates the device only when the heartbeat is abnormal.

Some arrhythmias are treated with a jolt of electricity delivered to the heart. This type of treatment is called cardioversion or defibrillation, depending on which type of arrhythmia is being treated.

Some people who are at risk for ventricular fibrillation are treated with a device called an implantable cardioverter defibrillator (ICD). Like a pacemaker, an ICD is a small device that’s placed under the skin in the chest. This device uses electrical pulses or shocks to help control life-threatening arrhythmias.

An ICD continuously monitors the heartbeat. If it senses a dangerous ventricular arrhythmia, it sends an electric shock to the heart to restore a normal heartbeat.

A procedure called catheter ablation is sometimes used to treat certain types of arrhythmia when medicines don’t work.

During this procedure, a long, thin, flexible tube is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is guided to your heart through the blood vessel. A special machine sends energy through the tube to your heart.

This energy finds and destroys small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start. Catheter ablation usually is done in a hospital as part of an electrophysiology study.

Surgery

Sometimes, an arrhythmia is treated with surgery. This often occurs when surgery is already being done for another reason, such as repair of a heart valve.

One type of surgery for atrial fibrillation is called "maze" surgery. In this operation, the surgeon makes small cuts or burns in the atria that prevent the spread of disorganized electrical signals.

If coronary heart disease is causing arrhythmias, coronary artery bypass grafting may be recommended. This surgery improves blood supply to the heart muscle.

Other Treatments

Vagal maneuvers are another arrhythmia treatment. These simple exercises sometimes can stop or slow down certain types of supraventricular arrhythmias. They do this by affecting the vagus nerve, which helps control the heart rate.

Some vagal maneuvers include:

• Gagging
• Holding your breath and bearing down (Valsalva maneuver)
• Immersing your face in ice-cold water
• Coughing
• Putting your fingers on your eyelids and pressing down gently

Vagal maneuvers aren't an appropriate treatment for everyone. Discuss with your doctor whether vagal maneuvers are an option for you.