Treatment and Prevention
In some cases, arrhythmias are due to bad habits like drinking too much alcohol. Breaking the habit can cure the problem. Reducing stress, avoiding caffeine, improving your diet, and increasing the amount of exercise you do in a week can also reduce the frequency of experiencing arrhythmias. You should talk to your doctor first before beginning such changes. In other people, the arrhythmias are a symptom of heart disease, and they won't go away unless this underlying problem is addressed. Fortunately, many people can benefit from modern medical interventions, especially in the area of surgery and the insertion of special electrical devices.
There are several medications that can slow down a rapid heartbeat (known as "rate control"). Beta-blockers (e.g., atenolol*, metoprolol) are medications that are very useful for rate control in people with a variety of heart conditions. Calcium channel blockers (e.g., diltiazem, verapamil) may also be used for rate control. Often, these medications can be used for more than one purpose (i.e., heart rate control, high blood pressure, heart protection after a heart attack). Another medication, digoxin, is derived from a substance called digitalis that has been used for arrhythmias for over 200 years.
Other medications called antiarrhythmics can convert an abnormal rhythm back to normal, and prevent it from recurring (known as "rhythm control"). Examples of antiarrhythmics include amiodarone, propafenone, and sotalol. Patients with atrial fibrillation (AF) are usually given the anticoagulant warfarin, which thins the blood to keep blood clots from forming and causing strokes. Recent research has shown that rate control and adequate anticoagulation are very important (perhaps even more important than rhythm control) to people with certain kinds of arrhythmias (e.g., AF).
In some cases, AF is converted back to a normal rhythm by a treatment called cardioversion, in which a doctor gives the patient a sedative followed by a small electrical shock that "resets" the normal pacemaker in the heart.
Many arrhythmias can be cured outright with radiofrequency ablation. The same tubes used in EPS (see "Making the Diagnosis") are inserted into the heart to send radio waves directly onto electrical pathways carrying inappropriate signals. These waves ablate (destroy) the abnormal tissue, preventing it from triggering an abnormal heart rhythm.
Artificial pacemakers can take over the job of generating the electrical signals. Once limited to treating slow heart rates, the latest pacemakers can control fast heart rates, too. They can run up to 15 years on one battery. Some save power by switching off when the heartbeat is normal. Most units are placed under the skin, requiring only minor surgery.
Defibrillators are devices that restart arrested hearts with jolts of electricity to the chest. Defibrillators are effective at stopping ventricular fibrillation, but since ventricular fibrillation can be fatal in less than 4 minutes, they must be used early. Most defibrillators are external devices, but now there are automatic implantable cardiovertors/defibrillators (AICD). These devices can be as small as pacemakers. They can detect a dangerous fibrillation and jolt the heart back to normal before any harm is done. As one doctor puts it, "it's like having an emergency room implanted in your chest."
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Glenn Gandelman, MD, MPH, FACC Assistant Clinical Professor of Medicine at New York Medical College, and in private practice specializing in cardiovascular disease in Greenwich, CT. Review provided by VeriMed Healthcare Network.