Arrhythmia, Biventricular Pacemaker

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How are arrhythmias treated?

Arrhythmia treatment depends on the type and severity of the arrhythmia. In some cases of arrhythmia, no treatment is necessary. Treatment options include: medications, lifestyle changes, invasive therapies, electrical devices or surgery. In some cases, no treatment will be necessary.

Medications

A variety of drugs are available to treat arrhythmias. Because everyone is different, it may take trials of several medications and doses to find the one that works best for you. Several types of drugs are used:

antiarrhythmic drugs – drugs used to convert the arrhythmia to sinus rhythm or to prevent an arrhythmia
heart-rate control drugs – drugs used to control the heart-rate
anticoagulant or antiplatelet therapy – drugs, such as warfarin (a "blood-thinner") or aspirin, which reduce the risk of clots forming or strokes

Check the drug search to find out more about your arrhythmia medications.

It is important to know:

the names of your medications
what they are for
how often and at what times to take them

Lifestyle changes

Arrhythmias may be related to certain lifestyle factors. Here are some ways to change these arrhythmia risk factors:

If you smoke, stop.
Limit your intake of alcohol.
Limit or stop using caffeine. Some people are sensitive to caffeine and may notice more symptoms when using caffeinated products (such as tea, coffee, colas and some over-the-counter medications).
Avoid ingestion of stimulants. Beware of stimulants used in cough and cold medications and herbal or nutritional suppplements. Some such medications contain ingredients that promote irregular heart rhythms. Read the label and ask your doctor or pharmacist what medication would be best for you.

Electrical cardioversion

In patients with persistent arrhythmias (such as atrial fibrillation), a normal rhythm may not be achieved with drug therapy alone. After administration of a short-acting anesthesia, an electrical shock is delivered to your chest wall that synchronizes the heart and allows the normal rhythm to restart.

Permanent pacemaker

A device that sends small electrical impulses to the heart muscle to maintain a normal heart rate. The pacemaker has a pulse generator (which houses a batter and a tiny computer) and leads (wires) that send impulses from the pulse generator to the heart muscle, as well as sense the heart's electrical activity. Pacemakers are mostly used to prevent the heart from beating too slowly. Newer pacemakers have many sophisticated features that are designed to help with the management of arrhythmias, optimize heart-rate-related functions and improve synchronization.

Implantable cardioverter-defibrillator (ICD)

A sophisticated device used primarily to treat ventricular tachycardia and ventricular fibrillation, two life-threatening heart rhythms. The ICD constantly monitors the heart rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle to cause the heart to beat in a normal rhythm again. There are several ways the ICD can be used to restore normal heart rhythm:

Anti-tachycardia pacing (ATP) – when the heart beats too fast, a series of small electrical impulses may be delivered to the heart muscle to restore a normal heart rate and rhythm.
Cardioversion – a low energy shock may be delivered at the same time as the heart beat to restore normal heart rhythm.
Defibrillation – When the heart is beating dangerously fast or irregularly, a higher energy shock may be delivered to the heart muscle to restore a normal rhythm.

Anti-bradycardia pacing – many ICD’s provide back-up pacing to prevent too slow of a heart rhythm.

Catheter ablation

During an ablation, high-frequency electrical energy is delivered through a catheter to a small area of tissue inside of the heart that causes the abnormal heart rhythm. This energy "disconnects" the pathway of the abnormal rhythm. Ablation is used to treat most PSVTs, atrial flutter, and some atrial and ventricular tachycardias. It can also be used to disconnect the electrical pathway between the atria and the ventricles, which may be useful in people with atrial fibrillation. Ablation may be combined with other procedures to achieve optimal treatment.

Pulmonary vein isolation

In patients with frequesnt, paroxysmal or persistant atrial fibrillation, isolation of the pulmonary veins is a procedure that uses special catheters to render bands of vein tissue, thought to cause atrial fibrillation, dysfunctional. The goal is to isolate, rather than ablate, the foci responsible for triggering atrial fibrillation through a circumferential conduction block.

Heart surgery

Heart surgery may be needed to correct heart disease that may be causing the arrhythmia (see valve surgery or coronary artery bypass surgery).

The Maze and modified Maze procedures are two surgeries used to correct atrial fibrillation not controlled with medications or non-surgical treatment methods. Click here for more information about surgical treatment of atrial fibrillation.

Click here to find a Cleveland Clinic Heart Center Cardiologist who treats abnormal heart rhythms

Click here to learn more about management of arrhythmias


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	This information is provided for education purposes only and is not intended to replace the medical advice of your doctor or health care provider. While we strive to keep our website current, medical practices sometimes change quickly. Please consult your health care provider for advice about a specific medical condition or contact the Cleveland Clinic if you would like an appointment.