Existing Nonpharmacological Treatments for Arrhythmia

Conventional treatment modalities include surgery, insertion of medical devices, nonsurgical interventions and pharmacological treatment including medications. Surgical interventions include open-heart maze procedure, ventricular aneurysm surgery and coronary bypass surgery. Medical devices include placement of pacemakers and internal cardioverter defibrillator also known as an ICD. Nonsurgical intervention includes catheter radiofrequency ablation, cardioversion sometimes accompanied with drugs and electrical cardioversion. Pharmacological treatment includes administering antiarrhthymic medications, some of which are listed on this website and will be further discussed in a future post.

Surgery is often only recommended when other options listed above have failed. There are several surgery options available depending on the type of arrhythmia and other complicating factors. The maze procedure is used to treat atril fibrillation. The surgeon directs the heart's electrical activity in the proper order once the cuts have healed. It is called the maze procedure because the electrical impulse can only choose one correct "maze" to travel through. The second surgery, ventricular aneurysm surgery that removes the thinning of the ventricular wall that can be damaged after a heart attack. After a heart attack, the ventricle can become thin, weak and incapable of fully pumping. The third surgical option is a coronary bypass surgery and is usually used for those with serious coronary artery disease. The surgery involves rerouting the blood flow around the clogged artery.

Medical devices such as a pacemaker and ICDs are very common treatments for patients with an irregular heartbeat. For those with bradycardia (slow heartbeat), implantable pacemakers controls the heart's electrical stimulus when the heart's natural pacemaker (sinoatrial node) does not work as it should. The pacemaker can sense that the heart is not beating at the proper time and sends an electrical impulse to make the heart beat. The actual device of the pacemaker consists of a battery to provide power, leads to send the impulse and an electrode to sense each beat of the heart and delivers the electrical impulse when necessary. There are different types of pacemakers dependent on the heart rhythm and therefore vary in the number of leads they contain (one, two or three) and where they are placed (upper or lower chamber). The implantation procedure includes using local anesthesia and receive an additional IV medication for the patient to relax. An ICD or implantable cardioverter defibrillator is a device that acts as a pacemaker for slow heat rate but can also treat fast rhythms. It treats a fast rhythm by delivering the appropriate electrical therapy necessary, whether it be rapid-pacing, low-energy or high-energy shock. Most implantations are done using local anesthesia and possibly a sedative.

The nonsurgical options for treating arrhythmias include radio-frequency ablation and cardioversion. During the radio-frequency ablation, a catheter is placed next to the abnormal pathway and destroys the abnormal tissue. The catheter is inserted into a vein or artery and is commonly used for atrial flutter, supraventricular tachycardias, ventricular tachycardias and atrial fibrillation. The abnormal tissue is destroyed via heat ablation; once the tissue is eliminated, the rapid heart rhythm will be blocked and the rhythm should not occur. This procedure is done under sedation and uses local anesthesia, and may take anywhere from three to seven hours but the recovery time is short. Patients normally return to usual activities within seven days of the procedure. The second option for nonsurgical procedure to treat arrhythmia (particularly atrial flutter and atrial fibrillation) is cardioversion. During this procedure, the patient will be sedated, electrode patches will be placed on the patient's back and chest which are attached to a heart monitor. An electrical impulse will be delivered to the patient's heart through the two large patches to help it return to a normal rhythm. If necessary, multiple impulses will be given to return the heart to a normal rhythm. After the procedure, the patient will only remain in the hospital for a few hours. The only discomfort comes from skin burns on the chest and back where the patches were placed.

As mentioned above, these are just a few of the existing nonpharmacological treatments for irregular heartbeats. Any comments, questions or suggestions are welcome! Coming soon will be the existing pharmacological treatments!! Don't forget to check out www.rateadrug.com to rate drugs that have positively or negatively affected your journey with arrhythmia.

~Alicia