Cardiac Arrhythmia Treatments & Cardiac Electrophysiology

Treatment for arrhythmia depends upon the type of arrhythmia, its severity and other aspects of the patient's health. Initial treatment may include lifestyle changes, medications to prevent and control arrhythmias, or anticoagulants or blood thinners to reduce the risk of blood clots or stroke. Treatment may also involve a procedure such as cardiac resynchronization therapy, implantable defibrillator, cardiac ablation, pacemaker insertion, or cardiac surgery.

Devices

Cardiac Resynchronization Therapy (CRT)

Cardiac Resynchronization Therapy, also known as biventricular pacing, implants an electronic device that delivers small electrical impulses to the heart muscle, through wires called leads, to get the left and right ventricles pumping together. Only when the lower chambers of the heart (ventricles) beat in synch can they contract with enough force to push blood throughout the body. CRT is typically used to treat arrhythmias related to congestive heart failure.

Implantable Cardioverter-Defibrillator (ICD)

An implantable ICD is a pager-sized electronic device inserted into your chest like a pacemaker to constantly monitor your heart rhythm. When it detects a very fast or very chaotic heartbeat, the ICD can deliver a shock to the heart muscle to return it to a normal rhythm. The ideal candidate for an ICD is anyone who has had or is at a high risk of having ventricular tachycardia, fibrillation or sudden cardiac arrest. A person who has coronary heart disease and an arrhythmia is at especially high risk for sudden cardiac death, and can benefit from an ICD.

Lead Extractions

Pacemakers and ICDs employ special wires, called leads, to deliver energy from the implant to the heart muscle. If the leads are not working properly, they may need to be removed. Lead extraction may be required due to a lead malfunction, infection, or a build up of scar tissue around the lead site that reduces implant efficacy.

Pacemaker

A pacemaker is a silver-dollar sized electronic device inserted into your chest to deliver small electrical impulses to the heart muscle through wires called leads. The purpose of the pacemaker is to keep your heart beating normally.

Pacemakers are most often implanted to treat bradycardia (slow heart rhythm), but also are used to control atrial fibrillation, heart failure and syncope (extreme fainting).

A pacemaker procedure typically takes place in the EP Lab of a hospital. The pacemaker usually lasts five to seven years, and is then changed in a relatively minor procedure.

Cardioversion

Cardioversion is a procedure in which an electrical current is given to the heart to restore its normal rhythm. It can be done as an elective or emergency procedure, and typically treats atrial fibrillation or atrial flutter. Emergency cardioversion typically treats atrial tachycardia or ventricular tachycardia.

Cardiac Ablation

In an arrhythmia, a portion of the heart ‘short circuits,’ and upsets the heart’s normal rhythm. Cardiac ablation is a catheter procedure that simply creates scar tissue in the portion of the heart that is short circuiting, thus restoring a normal heart rhythm. Cardiac ablation is typically used in the treatment of atrial fibrillation, atrial flutter, atrial tachycardia or other supra ventricular arrhythmias. It is sometimes used in the treatment of ventricular tachycardia, ventricular fibrillation or premature ventricular contractions.

Ablation is a non-surgical procedure and is performed in a hospital with the patient under general anesthesia.

The type of arrhythmia a person has determines the specific type of ablation used. Types of cardiac arrhythmias in which ablation procedures are used include:

Atrioventricular nodal (AVN) ablation – treats conditions such as atrial fibrillation and supraventricular tachycardia. The ablation focuses on the AV node, a specialized tissue which is part of the heart’s electrical system. This is performed in conjunction with the implantation of a pacemaker.

Epicardial Ablation – minimally-invasive ablation procedure that employs small incisions below the ribs to treat regions on the outside of the heart. While not suitable for all patients, when indicated it can help reduce procedure and recovery times.

Inappropriate Sinus Tachycardia (IST) Ablation – Inappropriate Sinus Tachycardia (IST) is an abnormally high heart rate caused by the sinus node, which is the heart’s primary pacemaker tissue. IST is often difficult to treat but catheter ablation, sometimes combined with pacemaker implants, has shown promising results.

Premature Ventricular Contraction (PVC) Ablation – premature ventricular complexes (PVC) result from extraneous beats from the lower chambers of the heart, the ventricles, and are generally easy to detect. While PVCs are not always dangerous, they can pose a more serious threat to patients with heart disease. If PVCs cannot be controlled using medication, a PVC ablation can selectively remove the heart tissue causing the arrhythmia.

Supraventricular Tachycardia (SVT) Ablation – Supraventricular tachycardias (SVT), so called because they originate in the heart’s upper chambers, are among the most common arrhythmias. SVT, which causes a rapid or “racing” heartbeat, can be treated using ablation therapy which targets and eliminates the heart cells causing the irregular heartbeat.

Ventricular Tachycardia (VT) / Ventricular Fibrillation (VF) Ablation – Ventricular tachycardia (VT) is a fast heart rhythm in one of the heart’s ventricles. VT is sometimes a precursor to ventricular fibrillation (VF), a very serious condition in which the heart experiences uncontrolled contractions that can lead to sudden cardiac death.

Cardiac Electrophysiology

Cardiac Electrophysiology is a field of medicine specializing in diagnosing and treating conditions of the heart involving its electrical pathways. Cardiac electrophysiologists are cardiologists (physicians) with specialized training in this area. They diagnose and treat conditions such as cardiac arrhythmias (irregular heartbeats).

Some current statistics:

In AF, single procedure success rate is ~ 75% in paroxysmal and 68% in non-paroxysmal AF cases.