Treatment Options - Cardiac Arrhythmia
What Are Heart Rhythm Disorders?
There are many different types of heart rhythm disorders, each requiring different treatment. Usually, it is not necessary to treat occasional extra heartbeats (so-called extra systole). Rhythm disorders like bradycardia (a heartbeat which is too slow) or tachycardia (a heartbeat which is too fast), however, have to be regulated therapeutically because they may negatively affect the heart´s ability to function and/or damage its health. Furthermore, atrial fibrillation elevates risk of stroke. Tachycardias like ventricular flutter or ventricular fibrillation can be acute life-threatening events. Without defibrillation to restore the heart’s normal rhythm, ventricular fibrillation leads to sudden cardiac death within minutes.
How Are Heart Rhythm Disorders Treated?
The treatment depends on the type of arrhythmia as well as its underlying causes, which may be located within the heart itself or outside of it. Diagnosis and treatment of the cause is a prerequisite for the long-term success of any therapy. In addition, the therapy has to take into account the potential consequences of the heart rhythm disorder. One of these consequences is, for example, an elevated stroke risk in the case of atrial fibrillation. In order to treat a heart rhythm disorder, the physician has to choose the best therapeutic approach for the individual patient. The basic aim of the treatment is to restore the normal heart rhythm, to control the heart rate and to minimize associated risks. The most common heart rhythm disorders are treated as follows:
treatment is to restore the normal heart rhythm and to resolve tachycardia. Several strategies are available for this purpose. Antiarrhythmic medication or electric cardioversion are capable of stopping atrial fibrillation.Atrial fibrillation is not always symptomatic. A single patient may experience both symptomatic and asymptomatic episodes of atrial fibrillation. Asymptomatic atrial fibrillation also needs to be treated, as the occurrence of atrial fibrillation increases the risk of stroke. If the normal heart rhythm cannot be restored, the patient will receive blood thinners in order to prevent stroke. Many elderly patients in particular have chronic atrial fibrillation for which treatment cannot restore the normal heart rhythm. These patients are generally free of complaints, as they have grown used to atrial fibrillation. Regular doses of blood thinners are important to minimize the risk of a stroke for those experiencing chronic atrial fibrillation.
Another form of tachycardia occurs when patients suffer from atrial flutter. This is a fast but rhythmic atrial activity, usually with a pulse of 120 beats per minute. If your doctor detects an atrial flutter, ablation is one form of treatment. The atrial flutter is stopped and the normal heart rhythm is restored. Antiarrhythmic medication can also be used to treat this condition.
Ventricular Tachycardia (Ventricular Flutter/Ventricular Fibrillation)
Ventricular tachycardia is a life-threatening emergency that, if left untreated, could lead to sudden cardiac death. In acute cases life-saving defibrillation to restore the normal heart rhythm must be carried out. An implantable cardioverter defibrillator (ICD) which protects the patient from sudden cardiac death by ventricular fibrillation or flutter can be used as a preventative measure. ICDs monitor the heart rhythm and, in case of a life-threatening arrhythmia, deliver energy to the heart muscle causing the heart to beat in a normal rhythm once more. Antiarrhythmic medication is also used to prevent tachycardia and atrial fibrillation.
If the heart beats too slowly, or there are symptomatic pauses with skipped beats, a pacemaker has to be implanted to ensure it beats as necessary. Pacemakers work as needed, meaning they don't compete with the natural heart rhythm, but only provide therapy if the heart beats too slowly or skips beats.
Chronotropic incompetence is the medical term for a condition in which the heart is unable to adapt its rate to provide adequate blood to meet metabolic demand. Modern rate-adaptive pacemakers with Closed Loop Stimulation technology – exclusively available from BIOTRONIK – are able to adjust the heart rate in response to both physical and mental stress.
Patients suffering from extra systoles should undergo a cardiac examination. In some cases, long-term monitoring of the heart rhythm by an insertable heart monitor is needed to detect the cause of the extrasystoles.
Emergency Response to Life-Threatening Heart Rhythm Disorders
Unconscious patients may be suffering from sudden cardiac arrest. If they have no palpable pulse and/or are suffering respiratory arrest, immediately contact a medical emergency team and initiate cardiopulmonary resuscitation (CPR). Cardiac massage must be administered until the emergency medical team can take care of the patient. If an automated external defibrillator (AED) is available ventricular fibrillation might be stopped by using it. These devices are designed to be used by lay people and are found in many public places. Step-by-step instructions automatically guide the user through how to use the device properly.
Which Devices Are Used in the Treatment of Heart Rhythm Disorders?
There are various devices like heart monitors, different types of pacemakers or implantable defibrillators available to meet the patient’s specific needs. In some cases, an intervention called ablation is necessary to control the arrhythmia. The cardiologist uses electrodes to deliver a safe pulse of radiofrequency energy to destroy diseased areas of heart tissue, helping to restore the heart’s regular rhythm.Implantable cardiac devices to treat heart rhythm disorders include:
- An insertable heart monitor is used for the long-term monitoring of cardiac activity to determine the cause of arrhythmias.
- A pacemaker generates electrical stimuli and serves as a timekeeper for the heart. It is implanted subcutaneously below the collarbone. A thin wire called a lead conducts the electrical stimuli of the pacemaker to the heart.
- An implantable defibrillator is used to give the heart an electric shock in order to stop ventricular fibrillation and to restore normal heartbeats. There are also implantable cardioverter defibrillators (ICDs) that recognize life-threatening arrhythmias autonomously and end these with electrical impulses. They are implanted permanently under the patient’s skin and are the best protection against ventricular fibrillation.
How You Can Prevent Heart Rhythm Disorders
- Stress and agitation may trigger heart rhythm disorders. Avoid both as much as possible. Take a rest several times a day and relax.
- Refrain from drinking too much caffeine or alcohol, and avoid smoking completely. If you want to quit smoking your physician will support you by advising you on appropriate smoking cessation programs.
- Certain medications may trigger rhythm disorders. If you have to take medication discuss the issue with your physician and ask him to change dosage or preparation as necessary.
- Take advantage of all available medical checkups because different diseases like, for example hyperthyroidism, may cause arrhythmia.