Treatments and drugs

By Mayo Clinic Staff

If you have an arrhythmia, treatment may or may not be necessary. Usually it's required only if the arrhythmia is causing significant symptoms or if it's putting you at risk of a more serious arrhythmia or arrhythmia complication.

Treating slow heartbeats

If slow heartbeats (bradycardias) don't have a cause that can be corrected — such as low thyroid hormone levels or a drug side effect &dmash; doctors often treat them with a pacemaker because there aren't any medications that can reliably speed up your heart. A pacemaker is a small device that's usually implanted near your collarbone. One or more electrode-tipped wires run from the pacemaker through your blood vessels to your inner heart. If your heart rate is too slow or if it stops, the pacemaker sends out electrical impulses that stimulate your heart to beat at a steady, proper rate.

Treating fast heartbeats

For fast heartbeats (tachycardias), treatments may include one or more of the following:

  • Vagal maneuvers. You may be able to stop an arrhythmia that begins above the lower half of your heart (supraventricular tachycardia, or SVT) by using particular maneuvers that include holding your breath and straining, dunking your face in ice water, or coughing. These maneuvers affect the nervous system that controls your heartbeat (vagus nerves), often causing your heart rate to slow.
  • Medications. Many types of tachycardias respond well to anti-arrhythmic medications. Though they don't cure the problem, they can reduce episodes of tachycardia or slow down the heart when an episode occurs. Some medications can slow down your heart so much that you may need a pacemaker. It's very important to take any anti-arrhythmic medication exactly as directed by your doctor in order to minimize complications.

    If you have atrial fibrillation, your doctor will likely prescribe blood-thinning medication — such as warfarin (Coumadin) or dabigatran (Pradaxa) or rivaroxaban (Xarelto) — to help keep dangerous clots from forming. These drugs can cause excessive bleeding. Dabigatran isn't recommended for the treatment of atrial fibrillation in anyone who has mechanical heart valves.

  • Cardioversion. If you have a tachycardia that starts in the top half of your heart (atria), including atrial fibrillation, your doctor may use cardioversion, which is an electrical shock used to reset your heart to its regular rhythm. Usually this is done externally in a monitored setting, and you're given medication to relax you during the procedure, so there's no pain involved. Emergency cardioversion (defibrillation) is also used for ventricular tachycardia and fibrillation.
  • Ablation therapy. In this procedure, one or more catheters are threaded through your blood vessels to your inner heart. They're positioned on areas of your heart that your doctor believes are the sources of your arrhythmia. Electrodes at the catheter tips are heated with radiofrequency energy. Another method involves cooling the tips of the catheters, which freezes the problem tissue. Either method destroys (ablates) a small spot of heart tissue and creates an electrical block along the pathway that's causing your arrhythmia. Usually this stops your arrhythmia.

Implantable devices

Treatment for heart arrhythmias also may involve use of an implantable device:

  • Pacemaker. A pacemaker is an implantable device that helps regulate slow heartbeats (bradycardia). A small device is placed under the skin near the collarbone in a minor surgical procedure. An insulated wire extends from the device to the heart, where it's permanently anchored.
  • If a pacemaker detects a heart rate that's too slow or no heartbeat at all, it emits electrical impulses that stimulate your heart to speed up or begin beating again. Most pacemakers have a sensing device that turns them off when your heartbeat is above a certain level. It turns back on when your heartbeat is too slow.

  • Implantable cardioverter-defibrillator (ICD). Your doctor may recommend this device if you're at high risk of developing a dangerously fast or irregular heartbeat in the lower half of your heart (ventricular tachycardia or ventricle fibrillation).
  • An ICD is a battery-powered unit that's implanted near the left collarbone. One or more electrode-tipped wires from the ICD run through veins to the heart. The ICD continuously monitors your heart rhythm. If it detects a rhythm that's too slow, it paces the heart as a pacemaker would. If it detects VT or VF, it sends out low- or high-energy shocks to reset the heart to a normal rhythm.

Surgical treatments

In some cases, surgery may be the recommended treatment for heart arrhythmias:

  • Maze procedure. This involves making a series of surgical incisions in the upper half of your heart (atria). These heal into carefully placed scars in the atria that form boundaries that force electrical impulses in your heart to travel properly to cause the heart to beat efficiently. The procedure is effective, but because it requires surgery, it's usually reserved for people who don't respond to other treatments or for those who are having heart surgery for other reasons. The surgeon may use a an instrument for applying extreme cold to tissue (cryoprobe) or a hand-held radiofrequency probe, rather than a scalpel, to create the scars.
  • Coronary bypass surgery. If you have severe coronary artery disease in addition to frequent ventricular tachycardia, your doctor may recommend coronary bypass surgery. This may improve the blood supply to your heart and reduce the frequency of your ventricular tachycardia.
Feb. 27, 2013