Care & Treatment
Your healthcare provider will work with you to determine the best treatment based on the type of arrhythmia you have and the symptoms it is causing. Some arrhythmias don’t need any treatment. Others might be treated with lifestyle changes, changes in medications, or treatment of another medical condition that is causing the arrhythmia. Other times, medications or procedures may be needed to treat the arrhythmia.
A first step in treating atrial fibrillation is to identify and treat other medical conditions that can cause the problem. These can include conditions such as heart disease, high blood pressure, or an overactive thyroid gland.
Even if the atrial fibrillation only happens sometimes and does not cause any symptoms, people with atrial fibrillation are still at risk for complications such as stroke and are often treated with medications. The two main risks of atrial fibrillation are stroke and a heart rate that is too fast to pump blood effectively. Your healthcare provider will assess your risk of stroke to identify the treatment approach that best balances the benefits and risks to you.
The most common medications used to keep the heart from beating too fast in atrial fibrillation are beta-blockers (such as metoprolol and carvedilol) and calcium-channel blockers (such as diltiazem or verapamil).
Medications sometimes called blood thinners are also used to reduce the risk of stroke in people with atrial fibrillation. Warfarin is commonly used, but newer medications (novel anticoagulants, or “NOACs”) are being used more often. Some of these are dabigatran, rivaroxaban, and apixaban. The main advantage of NOACs is that they do not require frequent blood tests for monitoring the level of blood thinning like warfarin does.
The main risk of blood thinners is bleeding, most often from the stomach or bowels, but also in the brain. Bleeding in the brain, or intracranial hemorrhage, is a much more serious complication. A common concern regarding anticoagulation for older patients with atrial fibrillation is the risk of falls that could cause intracranial hemorrhage. However, in most cases, the benefit of preventing a stroke outweighs the risk of falls-related bleeding in the brain.
Although there are anti-arrhythmic medications that can restore the heart’s normal rhythm, they are not usually used to treat atrial fibrillation. This is because large studies of atrial fibrillation found that keeping the heart from beating too fast was just as good as restoring a normal heart rhythm. Anti-arrhythmic medications also have many potentially dangerous side effects, so they are usually only used when the atrial fibrillation causes uncomfortable symptoms despite beating at a normal rate.
Bradycardia (slow heart rhythm)
The first step in treating bradycardia is to identify and treat the cause, which might involve changing your medications. Many people with bradycardia do not need any treatment at all. Treatment may only be needed if the slow heart rate is causing symptoms, such as fainting spells, dizziness, or shortness of breath. Some bradycardia may be caused by blocked electrical signals in the heart. In some cases, these “heart blocks” need to be treated. Some kinds of “heart block” or bradycardia may require implanting a pacemaker to keep your heart beating at a faster rate.
The first step in treating bradycardia is to identify and treat the cause. This might involve changing your medications or adjusting your levels of minerals, such as potassium. If the problem continues, your cardiologist might implant an internal electronic pacemaker that sends electrical signals to your heart, to keep it beating at a faster rate.
Ventricular Arrhythmias and Ventricular Fibrillation
Ventricular arrhythmias often occur as a result of other heart conditions, such as heart failure or damage to the heart from a heart attack. Because these arrhythmias can be life-threatening, treatment involves preventing ventricular arrhythmias with medications and lifestyle changes, including exercise, losing weight, and quitting smoking. Sometimes special devices are used to prevent ventricular arrhythmias in patients who are at risk for them.
In some cases, ventricular arrhythmias can lead to ventricular tachycardia or ventricular fibrillation, which is a life-threatening emergency. In ventricular fibrillation, the heart does not beat properly, and blood stops circulating. This causes loss of consciousness and cardiac arrest.
Immediately stopping the fibrillation is key—you’ve probably seen the procedure on TV shows. Using a defibrillator, emergency personnel place pads or paddles that deliver an electric shock to the chest. This can help “reset” the heart back into a normal rhythm. In the past, this life-saving procedure required trained medical professionals. But these days, automated defibrillators are available in many public places, and can be easily handled by lay people with some training.
If a defibrillator is not available, call 911 and start chest compressions (CPR) immediately. Good chest compressions are critical to keep blood circulating until emergency personnel arrive.
If you have episodes of life-threatening ventricular arrhythmias, or are at high risk for developing ventricular arrhythmias, your healthcare provider may recommend you have a small defibrillator implanted in your chest, like a pacemaker.
Procedures to Treat Arrhythmias
Sometimes arrhythmias cannot be managed with medications or lifestyle changes alone. A number of procedures are performed by cardiologists to treat these arrhythmias.
This is a procedure sometimes used to treat atrial fibrillation or other heart arrhythmias. A cardiologist inserts a catheter into a blood vessel in the thigh, groin, neck, or elbow, and uses X-rays to guide the catheter through the blood vessel and up into your heart. A wire in the catheter sends out heat or freezing cold and destroys the tissue in the heart that is causing the irregular heartbeat. The parts of heart tissue that are destroyed are very small, so this procedure does not stop the heart from being able to do its job.
This is a procedure where an electric current is used to reset the heart's rhythm back to its normal pattern. It is similar to defibrillation, but the “dose” of electricity delivered to the heart is much lower.
Pacemakers can be used to control arrhythmias and their symptoms, most often bradycardia. A pacemaker is a small, flat device inserted just under the skin beneath your collarbone during a minor surgical procedure. Thin wires attached to the pacemaker are threaded through small blood vessels into your heart. The pacemaker contains a computer chip programmed to send electrical signals to your heart to control your heartbeat. The pacemaker's computer chip also records your heartbeat’s rate and rhythm. Your healthcare provider will use these recordings to check and adjust your pacemaker periodically so it works best for your type of arrhythmia. The pacemaker can be adjusted in your provider's office, or sometimes even over the telephone or online. The pacemaker uses a battery that gets replaced about every five to eight years, through minor surgery.
If you have a pacemaker, you will need to be careful about having close or continuous contact with certain electrical devices when they are turned on, such as cell phones, music players (such as iPods), or microwave ovens. These can interfere with the electrical signals your pacemaker is sending to your heart. Some medical procedures are safe if you have a pacemaker, but others, such as MRIs, are not.
Tell your healthcare providers, dentists, and medical technicians that you have a pacemaker.
Also, tell airport security about your pacemaker. You can walk through airport security at your normal pace, but you should not sit too close to airport metal detectors or have a metal detector wand held over the site of your pacemaker.
Your healthcare provider can give you a card that states what kind of pacemaker you have. Carry this card with you at all times. You can also wear a medical ID bracelet or necklace that shows you have a pacemaker. These are helpful in case of a medical emergency.
Implantable Cardiac Defibrillators (ICDs)
An implantable cardioverter defibrillator (ICD) may be recommended if you have had a ventricular arrhythmia, or are at risk for developing this arrhythmia. An ICD looks similar to a pacemaker but is a little larger. An ICD senses an abnormal heart rhythm and delivers an electrical shock to reset the heart to a normal rhythm.