Our arrhythmia specialists are experts at treating common and complex electrical disturbances of the heart. We consider several factors when it comes to treating an arrhythmia. Some arrhythmias respond better to more simple medications, while others require stronger medications. We take your complete health history, including other health problems, into account when we consider which treatment you should have.
We also talk to you about your personal preferences and lifestyle. Some patients prefer to take medications, while others would prefer a minimally invasive procedure or surgery.
In general, many arrhythmias improve with lifestyle changes such as diet, weight loss, stress management and reducing caffeine intake. If you already have high blood pressure, diabetes, heart failure or sleep apnea, then keeping tight control on these conditions could help control the arrhythmia burden. We work with your other medical providers to get a good picture of your health and what we can do to maintain and improve it.
We start with diagnosis and work with you on a treatment plan. Treatment for an arrhythmia (irregular heart beat) may include monitoring, medication, minimally invasive procedures or surgery. We follow a standard treatment path.
Our first priority is to prevent a stroke related to AFib. The blood in the heart can become more viscous/thick when you are in AFib. This can put you at risk for a blood clot to form. Based on your stroke risk, we will recommend a blood thinner such as Warfarin, Eliquis, Pradaxa or Xarelto.
Next, we work to control the heart rate. When experiencing arrhythmia or AFib, your heart rate may be too slow, too fast or just right. If it is too fast, we can start a medication to lower the heart rate, such as a beta blocker or calcium channel blocker.
Then we can offer a way to control your heart's rhythm.
- There are medications we can prescribe which work on pathways in the heart to prevent an irregular heart rhythm from starting.
- For a “quick fix” – we can “shock” a patient’s heart into normal rhythm. This is called a cardioversion, and it is done under anesthesia.
- We also can offer an ablation procedure to most patients. This is a surgical approach to where catheters are inserted into the heart via a large vein in the groin to map areas of electrical abnormality. When we find the abnormalities, we cause a surgical “burn” to the sites to stop the irregular hear beat from initiating at all.
Medications or Medical Management
We use medication to control the heart rate or heart rhythm, or to prevent blood clots.
In the case of atrial fibrillation (AFib or AF), our first priority is to preventing stroke. The blood in the heart can become thicker when someone is in AFib, putting you at risk for blood clot to form. Based on your stroke risk, we will recommend a blood thinner (Warfarin, Eliquis, Pradaxa, Xarelto).
Next, we work to control the heart rate. In AFib, your heart rate may be too slow, too fast or just right. If it is too fast, we can start a medication to lower the heart rate such as a beta blocker or calcium channel blocker. We can also offer a "rhythm control medication." These medications work on pathways in the heart to prevent an irregular heart rhythm from even occurring.
Some arrhythmias, such as occasional early beats — premature atrial contractions (PACs), premature ventricular contractions (PVCs) — do not pose a stroke risk and therefore, you don't need a blood thinner. These early beats, if rare, do not require any treatment. If there are abundant or cause bothersome symptoms, then we can offer several different medication options to decrease the burden of early beats.
Stress and anxiety can cause arrhythmia. In those cases, we will have you work with your primary care provider to treat the underlying problem with counseling, therapy or anti-anxiety medication.
Cardioversion, used to treat AFib or atrial flutter. This brief procedure delivers an electrical shock to the heart to quickly convert an abnormal heart rhythm back to normal. Cardioversion is most often done by delivering an electrical shock via electrodes placed on the chest, but medications can be used, too.
Cardioversion is used in emergencies to correct abnormal rhythms associated with fainting, low blood pressure, chest pain, difficulty breathing or loss of consciousness. It is a good first step to temporarily stabilize the patient and treat any other symptoms, but there is a good chance the irregular heartbeat will recur.
We can perform an ablation to treat conditions such as AFib, atrial flutter, PVCs and supraventricular tachycardia. In an ablation, we go up into the heart with catheters through veins. The doctor maps the location of the early beats and "burns" the area of cells to stop them from firing inappropriately. Using ablation, there is a chance to cure your arrhythmia or AFib permanently.
- Catheter ablation or radiofrequency ablation uses bursts of high energy to destroy the source of irregular heartbeats in heart muscle.
- Cryoballoon ablation, a form of catheter ablation that uses cryo, or freezing, energy.
- Surgical ablation or maze procedures, techniques for reorganizing irregular electrical heart impulses by open-heart or minimally invasive surgery.
Since it is a surgical procedure, there are some risks that come with it, such as stroke, pulmonary vein stenosis, phrenic nerve injury or cardiac perforation. The chances of these occurring is minimal, and your doctor will work with you to see if you are at an elevated risk for any of them. When we consider prescribing ablation, we consider these factors along as well as your overall health.
- Does a patient tolerate anesthesia well?
- Is there sleep apnea that needs to be treated?
- Is any heart failure under good control?
- Left atrial appendage closure (LAAC) devices, such as WATCHMAN FLXTM — A device that is inserted via a minimally invasive procedure and is an alternative to long-term anticoagulation therapy with Warfarin. It prevents migration of blood clots, thus reducing the risk of stroke.
- Implantable defibrillators
- Bi-ventricular devices and cardiac resynchronization therapy (CRT)
- Loop recorders
- Lead extraction, for safely removing damaged, infected or otherwise problematic pacemaker or defibrillator leads.