Tachycardia

Treatment

Mayo Clinic cardiologists collaborate with a team of medical specialists to determine the most accurate diagnosis and the most effective treatment of tachycardia. Mayo Clinic physicians treat thousands of patients each year with tachycardia, with excellent success. Mayo Clinic is an international leader in catheter ablation and implantable devices and uses the most advanced technology to treat tachycardia and other arrhythmias.

The goals of tachycardia treatment at Mayo Clinic include restoring the heart to normal rhythm, regulating the heart rate and preventing blood clots. Tachycardia treatment options may include:

• Nonsurgical procedures (catheter radiofrequency ablation)
• Medical devices — implanted pacemakers, defibrillators
• Surgery
• Medications
• Follow-up care

Nonsurgical Procedures

Catheter Radiofrequency Ablation

The catheter ablation team at Mayo Clinic has experience and expertise in treating all types of arrhythmias, and the team performs thousands of procedures each year. Catheter radiofrequency ablation is a minimally-invasive procedure performed without opening the chest. For tachycardias caused by abnormal heart tissue, catheter radiofrequency ablation uses heat to destroy abnormal tissue.

In this procedure, catheters (thin, flexible tubes) are threaded through the patient's blood vessels to reach the abnormal heart tissue. The cardiologist then uses radiofrequency energy to remove the abnormal tissue. When successful, this procedure restores normal rhythm and eliminates the need for daily medications.

Catheter radiofrequency ablation offers an alternative to medication, which often has side effects. The procedure is done with local anesthesia and mild sedation. Most people resume normal activities after a few days. The type of abnormal rhythm or tachycardia determines whether catheter radiofrequency ablation is an appropriate option.

Read more about catheter radiofrequency ablation.

Types of catheter radiofrequency ablation include:
Pulmonary vein isolation ablation (PVI Ablation or PVA) — Pulmonary vein isolation ablation electrically isolates "hot spots" in the pulmonary veins that trigger atrial fibrillations (a common type of tachycardia). Pulmonary vein isolation eliminates atrial fibrillation in most patients. In addition, medications that did not help patients prior to ablation might now become effective.

AV node ablation with pacemakers — AV node ablation is most commonly performed to treat atrial flutter and atrial fibrillation, types of tachycardia. In AV ablation, a catheter is placed near the atrioventricular (AV) node (the electrical connection between the atria and ventricles). Radiofrequency energy is applied through the catheter to destroy a small area of tissue. The radiofrequency energy applied to the AV node prevents the atria from sending too many electrical impulses to the ventricles. In nearly all patients, this procedure completely blocks the heart's electrical impulses and eliminates atrial fibrillation. Once the AV node is destroyed, doctors then need to implant a pacemaker to establish normal rhythm. These patients need a pacemaker for life. Anticoagulation (blood-thinning) medication is required after the procedure to reduce the chance of developing blood clots.

Ventricular tachycardia ablation — Ventricular tachycardia that resists management with medication is sometimes treated with catheter radiofrequency ablation at Mayo Clinic. Most patients with ventricular tachycardia will still need treatment with medications or a device such as an implantable cardioverter defibrillator after the ablation procedure.

Supraventricular tachycardia ablation — Supraventricular tachycardia can often be treated by catheter ablation. In this procedure, catheters (long, thin tubes) are threaded through the patient's blood vessels to the heart. Radiofrequency energy is applied through the tip of the catheter to destroy (ablate) the small area of the heart that is causing the fast heart rate.

Medical Devices — Pacemakers, Defibrillators

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 a heart rate that is too slow or the heart is not beating, it emits electrical impulses that stimulate the heart to speed up or resume beating. A pacemaker is used most often for patients if medications to prevent tachycardia or control the heart rate result in excessively slow heartbeats; also, the device is used after AV node ablation.

Implantable Cardioverter Defibrillator (ICD)

Ventricular tachycardias can be treated with a medical device called an implantable cardioverter defibrillator (ICD.) ICDs also are small devices that are implanted under the skin below the collarbone. The ICD continuously monitors the heart's rhythm. If the heart rate becomes too slow, the ICD paces the heart to prevent pauses. If the heart develops an abnormal rhythm, the ICD delivers bursts of electrical energy to restore normal rhythm. Clinical studies have shown ICDs to be effective with nearly all patients in stopping life-threatening ventricular tachycardias.

Surgical Procedures

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 tachycardia.

Due to its complexity, only a few medical centers in the United States perform the surgical maze procedure. Heart surgeons at Mayo Clinic have years of experience with the maze procedure. Maze procedures can generally treat atrial fibrillation, a type of tachycardia.

Patients treated with the maze procedure include those with rare forms of heart arrhythmias, acquired heart disease and congenital heart disease. Of the Mayo Clinic patients who have had the maze procedure for atrial fibrillation (the most common type of tachycardia), nearly all patients have had no atrial fibrillation at discharge from the hospital. Even those who do not respond well to surgery may have more success with drug therapy after the procedure.

Read more about maze procedure surgery.

Medications

Medications may be combined with other treatments for tachycardia. Options include:

• Drugs to slow the heart rate — Choosing an effective medication or combination of medications requires an accurate diagnosis of the rhythm disorder. The medications are usually taken daily for life.
• Medications to restore normal rhythm. These are also usually taken for life.
• Drugs to prevent blood clots.

Many patients with tachycardias and heart disease are at especially high risk of stroke. Blood-thinning medications (anticoagulants) such as warfarin or aspirin may be prescribed.

Follow-up Care

Many patients have benefited from Mayo Clinic's cardiac rehabilitation program while recovering from heart surgery or following implantation of medical heart devices. 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 following heart surgery, including monitoring and adjusting medical devices as necessary.