Irregular Heart Rhythm (Arrhythmia) Treatment

What is irregular heart rhythm treatment?

Irregular heart rhythm treatment aims to treat heart arrhythmias, a condition where the heart beats:

• Too slowly (below 50 beats per minute)
• Too quickly (above 100 beats per minute)
• At an irregular pace

There are several kinds of arrhythmias. Of these conditions, atrial fibrillation (also called AF or AFib) is the most common type of arrhythmia; it tends to affects those aged 60 years and older.

Depending on your age, overall heart health, and any underlying causes of arrhythmia, your treatment may include one or more of the following:

Lifestyle changes

Lifestyle changes can improve overall heart health and manage other underlying conditions such as high blood pressure and heart disease.

These lifestyle changes include:

• Exercising regularly.
• Eating heart-healthy foods.
• Avoiding nicotine, alcohol, caffeine, dietary and herbal supplements.
• Managing your blood pressure and blood sugar.
• Maintaining a healthy weight, which also helps to manage symptoms of atrial fibrillation and improve the results of catheter ablation.
• Managing stress and sleep disorders.

Medication

To restore normal heart rhythm and prevent a relapse of arrhythmias, anti-arrhythmic medication may be given to:

• Slow the transmission of impulses
• Suppress abnormal firing of pacemaker tissue

Other medications such as blood thinners, calcium channel blockers, beta blockers or anticoagulants may also be prescribed to lower blood pressure and reduce the risk of blood clots and stroke.

Cardioversion

Cardioversion converts an abnormally fast heart rate to a normal rhythm. There are 2 forms of cardioversion:

1. Chemical cardioversion, which uses medication.
2. Electric cardioversion, which uses electrical shocks sent through electrodes to the heart. This takes less time than chemical cardioversion.

Additional procedures are often needed to maintain a normal heart rhythm.

Catheter ablation

Catheter ablation is a non-surgical procedure that ablates (removes) the affected area of the heart.

It is the most common type of irregular heart rhythm treatment for atrial fibrillation. It is also an option for ventricular fibrillation and for those at risk of sudden cardiac arrest.

Catheter ablation is recommended when the arrhythmia cannot be controlled by medicine or cardioversion.

Pacemaker implantation

If your arrhythmia is serious, you may need a permanent cardiac pacemaker. A pacemaker works by continuously monitoring the heart rhythm. If there is an abnormal heart rate, the pacemaker will emit an electrical charge to reset the heart to a normal rhythm.

A pacemaker may be recommended for those who have had or are at risk for cardiac arrest.

Cardioverter-defibrillator (ICD) implantation

If your arrhythmia is serious, you may need an implantable cardioverter defibrillator (ICD). An ICD is a small battery-powered device.

This device is smaller than a deck of cards and contains a small computer that monitors the heart rate and delivers small electrical shocks when needed to regulate any electrical problems

An ICD is able to perform cardioversion, defibrillation and pacing of the heart.

Using an ICD does not reverse heart disease, but can reduce the risk of cardiac arrest. ICD is the preferred treatment for patients at risk for sudden cardiac death due to:

• Ventricular fibrillation, where the heart's electrical impulses are rapid and chaotic. This causes the lower chamber of the heart to quiver ineffectively instead of pumping blood to the body.
• Ventricular tachycardia, a condition where the heart rate is fast and abnormal. This does not allow the lower chamber of the heart to fill and contract efficiently, making it difficult to pump enough blood to the body.

Surgical ablation

Surgical ablation, also known as a maze procedure, is a major surgery done under general anaesthesia. Surgery is usually done only when all other treatments have not been successful.

During the surgery:

• Small incisions, radiowaves, freezing, or ultrasound energy are used to create scar tissue in the heart muscle.
• This scar tissue does not conduct electrical activity so the abnormal electrical signals causing the arrhythmia are blocked.
• The scar tissue directs electric signals through a controlled path of scar tissue (the maze) to the lower heart chambers (ventricles).

A maze procedure may be done through small cuts in the chest or as open-heart surgery.

If you are already doing heart surgery (e.g. coronary artery bypass or valve repair or replacement), your surgeon may recommend surgical ablation as a concurrent procedure.

Why do you need irregular heart rhythm treatment?

The goal of irregular heart rhythm treatment is to:

• Restore normal heart rhythm where possible
• Reduce the risk for serious complications and heart disease
• Restore quality of life

Your doctor may advise irregular heart rhythm treatment if your:

• Symptoms are severe
• Arrhythmias are highly irregular
• Arrhythmia is caused by a weak or damaged heart
• Condition increases the risk for dangerous complications such as stroke and heart failure

Catheter ablation and atrial fibrillation

Studies indicate that catheter ablation for atrial fibrillation successfully improves the condition at a rate of 95 - 98%, even after medication is stopped.

Clinical studies have also demonstrated that catheter ablation:

• Is more effective at restoring and maintaining a normal heart rhythm compared to medication. This reduces the need for life-long treatment and the side effects linked with medication.
• Can improve heart function.

What are the risks and complications of irregular heart rhythm treatment?

Depending on the treatment, side effects of arrhythmia treatment can include:

• Diarrhoea
• Nausea or vomiting
• Hypotension
• Heart failure
• Tremors
• Headache
• Depression
• Seizures

When choosing the most suitable treatment option for your condition, you and your doctor must consider the potential benefits and associated risks.

How do you prepare for irregular heart rhythm treatment?

Before recommending irregular heart rhythm treatment, your doctor will review your medical history, order tests and explain the risks and benefits of your treatment.

Once your treatment has been decided, your doctor will advise you on how to prepare.

If you are undergoing a medical procedure, you need to fast before it.

Note: If you are taking any medication or herbal supplements, you should inform your doctor. You may need to adjust or stop taking some medication before the procedure (e.g. aspirin, blood thinners).

If you already have an implanted heart device, such as a pacemaker or implantable cardioverter-defibrillator, talk to your doctor to see if you need to take any additional precautions.

What can you expect in irregular heart rhythm treatment?

The most common procedure for irregular heart rhythm treatment caused by atrial fibrillation is catheter ablation.

Estimated duration

Catheter ablation takes about 3 – 6 hours. Complicated procedures may take slightly longer.

Before the procedure

During a catheter ablation for atrial fibrillation, your doctor will insert an intravenous line into your forearm or hand, and you'll be given a sedative to help you relax.

During the procedure

After the sedative takes effect, your doctor will:

• Numb a small area near the insertion area, usually a vein on the groin, neck or shoulder.
• Insert a needle into the vein and place a tube (sheath) through the needle.
• Carefully thread a thin catheter with electrodes through the sheath and guide it to several places within the heart.
• Identify the exact site in the heart that is causing the irregular heartbeats through a 3D mapping system.
• Remove the damaged part through heating (radiofrequency ablation) or freezing (cryoablation).

You may feel some minor discomfort during the procedure. If you experience any type of pain or shortness of breath, let your doctor know.

Care and recovery after irregular heart rhythm treatment

After your treatment, your irregular heart rhythm may recur especially if you:

• Are older
• Have other heart conditions
• Have high blood pressure
• Have a history of difficult-to-treat atrial fibrillation

About 3 months after your procedure, you will likely have a follow-up appointment with your doctor.

If your atrial fibrillation does come back, you may be able to control it with medication now. Some people may need another ablation procedure. If you continue to have heart rhythm problems, your doctor may recommend a permanent pacemaker.