Arrhythmia

Treatment

Mayo Clinic cardiologists and cardiac surgeons have highly specialized expertise and experience in the most advanced treatments for all types of heart arrhythmias. Treatment depends on what is causing the arrhythmia. Treatment at Mayo Clinic may include surgery. nonsurgical procedures, and medications. Mayo Clinic is an international leader in catheter ablation, a procedure to treat arrhythmias. Mayo surgeons also have expertise and experience in advanced surgeries such as the maze procedure.

Surgical Procedures

When other treatments are ineffective, surgery can remove or destroy heart tissue that is causing arrhythmia. Surgery also may be required to treat underlying disease, such as coronary artery blockage.

Open-Heart Maze Procedure

For surgical maze procedures, surgeons create multiple cuts in the muscle of the atria and then stitch them together. These incision lines interfere with stray electrical pathways and circuits. The lines reduce the size of atrial tissue sections needed to maintain atrial fibrillation. Due to the procedure's complexity, Mayo is one of only a few medical centers in the United States that perform the procedure. Read more about the maze procedure.

Minimally Invasive Surgery

Surgeons at Mayo Clinic can perform minimally invasive heart surgery for atrial fibrillation, a type of arrhythmia. Cardiac surgeons access the heart through small incisions in the right and left chest walls. By accessing the heart from the side of the chest, surgeons avoid having to split the breastbone (sternotomy). Avoiding sternotomy reduces pain and recovery time for most patients, enabling them to resume normal daily activities sooner. Minimally invasive surgery also leaves smaller, less-noticeable scars than open heart surgery, has a lower risk of infection, and may involve less blood loss.

Pacemaker

A pacemaker is a medical device that helps regulate the heartbeat. The device, smaller than a matchbox, is placed under the skin near the collarbone. A wire extends from the device to the heart. If a pacemaker detects an abnormally slow heart rate (bradycardia) or no heartbeat, it emits electrical impulses that stimulate the heart to speed up or resume beating.

A pacemaker is often implanted if medications to prevent arrhythmia or control the heart rate result in an excessively slow rate, and following AV node ablation.

Internal Cardioverter Defibrillator (ICD)

For arrhythmias in which the heart beats too rapidly (tachycardia) or quivers (fibrillates) instead of contracting strongly, an internal cardioverter defibrillator (ICD) can be surgically implanted. The ICD sends electronic signals to the heart whenever the heart rate reaches a specified limit or goes very high. These signals shock the heart into beating more slowly and pumping more effectively. This device is typically not used to treat atrial fibrillation.

Nonsurgical Procedures

Catheter Radiofrequency Ablation

For arrhythmias caused by abnormal heart tissue, catheter radiofrequency ablation (heat) can be used to destroy abnormal tissue. Catheters (thin, flexible tubes) are threaded through the patient's blood vessels to reach the abnormal heart tissue. The cardiologist then uses a small cutter or radiofrequency energy to remove the abnormal tissue. The procedure does not require open chest surgery. Read more about catheter ablation.

Cardioversion

To correct atrial fibrillation — reset the heart to its regular rhythm (sinus rhythm) — physicians often perform a procedure called cardioversion, either with drugs or electrically.

Cardioversion with drugs

Medications (anti-arrhythmics) are used to stop the heart's quivering and restore normal sinus rhythm. The medications effectively maintain sinus rhythm for at least one year in 50 percent to 65 percent of people. However, they can cause side effects such as nausea and fatigue, as well as some long-term risks. In rare cases, the medications may adversely affect heart rhythm.

Electrical cardioversion

While under light anesthesia, a patient receives an electrical shock through paddles or patches on the chest. The shock stops the heart's electrical activity for a split second. When the heart's electrical activity resumes, the rhythm may be normal.

Cardioversion is not always effective. It may successfully restore regular heart rhythm in more than 95 percent of patients, but more than half of patients eventually go back into arrhythmia. In many instances, anti-arrhythmic medications are needed indefinitely.

Follow-up Care

Many patients who have had heart surgery or implanted medical heart devices have benefited from Mayo Clinic's cardiac rehabilitation program. The program starts with a walking schedule for the first six to eight weeks after surgery and progresses to more vigorous, supervised physical training.

Mayo Clinic also provides long-term monitoring of patients after they have had heart surgery, including monitoring and any adjustments to medical devices.

Medications

Many medications are available to treat irregular or fast heart rates. Medications are given to prevent arrhythmias and slow the heart rate. In most cases, the drugs have to be taken for the rest of the patient's life.