Arrhythmias

Arrhythmias Treatment

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Common arrhythmia treatments include medicines, surgery to implant devices that control your heartbeat, and other procedures to treat problems with electrical signals in your heart. You may also need to make healthy lifestyle changes to help lower your risk of conditions that can make your arrhythmia worse, such as high blood pressure and other types of heart disease.

How are arrhythmias treated? 

You may need one or more medicines to treat a slow, fast, or irregular heartbeat. Sometimes medicines are used together with other treatments. If your dose is too high, medicines to treat arrhythmias can make your arrhythmia worse. This happens more often in women than in men. Talk to your doctor if your symptoms get worse. 

Medicine to treat a slow heartbeat (such as atropine) may be given by emergency medical services (EMS) or in the emergency room (ER). Atropine may cause difficulty swallowing. 

Medicines to treat a fast heartbeat include:

  • Adenosine, which can cause some chest pain, flushing, shortness of breath, and atrial fibrillation and may be given by EMS or in the ER
  • Beta blockers, which can cause fatigue, stomach or sleep problems, and sexual dysfunction, and can make some conduction disorders worse
  • Calcium channel blockers, which can cause digestive trouble, swollen feet, or low blood pressure
  • Digoxin, which is used to treat atrial fibrillation, and can cause nausea, vomiting, and diarrhea
  • Potassium channel blockers, which can cause low blood pressure, problems with your thyroid levels, lung conditions, or another type of arrhythmia
  • Sodium channel blockers, which raise the risk of sudden cardiac arrest in people who have heart disease

Procedures and devices

If medicines do not treat your arrhythmia adequately, you may need one of the following procedures or devices.

Cardioversion

Cardioversion is a procedure that uses external electric shocks to restore a normal heart rhythm.

Cardioversion is called defibrillation when it is done in an emergency to prevent death when irregular heartbeats in the lower chambers of your heart, the ventricles, threatens to, or actually causes, cardiac arrest. Your doctor may also schedule cardioversion as a way to treat arrhythmias in the upper chambers of your heart, called atrial fibrillation.

Scheduled cardioversion procedures may be done in a hospital or other healthcare facility by cardiologists, the doctors who specialize in the heart. While the procedure takes only a few minutes, it requires that you arrive a few hours before the procedure. To prepare, you will be given anesthesia through an intravenous (IV) line in your arm to make you fall asleep, and you will have electrodes placed on your chest and possibly your back. These electrodes will be attached to the cardioversion machine. The machine records your heart’s electrical activity and sends the needed electrical shocks to your heart. When ready, the doctor will send one or more brief, low-energy shocks to your heart to restore a normal rhythm. You will not feel any pain from the shocks.

You will need to stay for a few hours after your procedure. During this time, your healthcare team will monitor your heart rhythm and blood pressure closely and watch for complications. You will need a ride home because of the medicines or anesthesia you received. You may have some redness or soreness where the electrodes were placed. You also may have slight bruising where the IV line was inserted in your arm.

Although uncommon, cardioversion has some risks. It can cause or worsen life-threatening arrhythmias that will need to be treated. This procedure can cause blood clots to break away and travel from the heart to other tissues or organs and cause a stroke or other problems. Taking anticlotting medicines before and after cardioversion can reduce this risk.

Catheter ablation

Catheter ablation is a procedure to stop abnormal electrical signals from moving through your heart and causing an irregular heartbeat.

Doctors perform catheter ablation in a hospital. Ablation is done through a  procedure called cardiac catheterization that passes flexible tubes, or catheters, through your blood vessels until they reach your heart. Some catheters have wire electrodes that record and locate the source of your abnormal heartbeats. Other catheters can deliver treatments. Your doctor will aim the tip of a special catheter at the small area of heart tissue. A machine will send either radiofrequency (RF) waves, extremely cold temperatures, or laser light through the catheter tip to create a scar on the heart. The scar prevents abnormal electrical signals from causing irregular heartbeat.

Catheter ablation has some risks both during the procedure and during recovery, including:

  • Bleeding
  • Infection
  • Blood vessel damage
  • Heart damage
  • Arrhythmias
  • Blood clots

There also may be a very slight risk of cancer from radiation used during catheter ablation. Talk to your doctor and the technicians performing the ablation about whether you are or could be pregnant.

Implantable cardioverter defibrillators (ICDs)

Defibrillators are devices that restore a normal heartbeat by sending an electric pulse or shock to the heart. They are used to prevent or correct an arrhythmia, a heartbeat that is uneven or that is too slow or too fast. Defibrillators can also restore a heartbeat if the heart suddenly stops.

Different types of defibrillators work in different ways. ICDs can prevent sudden death among people who have a high risk of a life-threatening arrhythmia. They are surgically placed inside your body. It can take time and effort to get used to living with a defibrillator, and it is important to be aware of possible risks and complications.

Pacemakers

A pacemaker is a small device that sends electrical pulses to help your heart beat at a normal rate and rhythm. Pacemakers can also be used to help your heart chambers beat together in sync so your heart can pump blood more efficiently to your body. You may need a temporary (short-term) or permanent (long-term) pacemaker.

Treating the cause of your arrhythmia

Your doctor may talk to you about steps to manage the cause of your arrhythmia, such as a problem with your electrolyte levels, high blood pressure, heart disease, sleep apnea, or thyroid disease. Your doctor may use supplements to treat low levels of magnesium or potassium.

Vagal maneuvers

Vagal maneuvers are relaxation techniques that may help slow your heart rate.

Techniques your healthcare team may guide you through include:

  • Coughing or gagging
  • Holding your breath and bearing down, which is called the Valsalva maneuver
  • Lying down
  • Placing a towel dipped in ice-cold water over your face
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