Arrhythmia Treatment

Atul Bhatia, MD, a cardiac electrophysiologist, repairs a patient’s heart flutter using a new 3D heart mapping system. Dr. Bhatia also explains the basics and benefits of this new technology.

Aurora's physicians are internationally known for their experience in and treatment of heart arrhythmia patients. After a comprehensive diagnosis we offer the very latest treatment options.

Medication

Medical therapy (i.e. nonsurgical) focuses on using medications to help control or prevent fast arrhythmias, either as a standalone treatment or as part of a broader approach to the cardiac care. Some medicines, called antiarrhythmic drugs, specifically target the function of the heart cells to prevent the specific heart rhythm from occurring. Other medicines are used only to slow rapid heart rhythms, but do not necessarily suppress or prevent them. In general, medicines cannot prevent slow heart rhythms and pacemakers are needed instead.

Patients are prescribed a variety and often a combination of medications to attempt to suppress heart rhythm problems and their associated symptoms. Often these medications have multiple effects such as on heart rate or blood pressure, or directed against a specific heart rhythm problem. It’s important that a patient understands the exact reason why a medication is being used. For instance, a “beta-blocker” drug may be used to slow heart rhythms that are usually too fast. However, the drugs also have beneficial effects in controlling high blood pressure. A patient who is prescribed a “beta-blocker” for the purpose of preventing rapid heart rates should be aware that it is specifically being used for this reason, and does not imply that the patient has hypertension (high blood pressure).

Our doctors will often take advantage of these drugs’ multiple properties to simplify a patient’s medical regimen (i.e. reduce the number of different drugs they take). If a patient is on a drug for high blood pressure and needs a new drug to slow the heart rate, our doctors may often stop the blood pressure drug and use one that has both blood-pressure-controlling and heart-rate-controlling effects, like a “beta-blocker.”

Cardioversion

Cardioversion is the process of extinguishing an abnormal heart rhythm and allowing your own normal rhythm to take over.

Medical Cardioversion: Medicine taken orally or given through an IV can be tried first if the patient is alert and not severely distressed by the symptoms of irregular and fast heartbeats. These medicines directly affect the way the heart cells function to prevent them from maintaining the abnormal heart rhythm, and eventually the rhythm usually stops, allowing the normal heart rhythm (sinus rhythm) to take over.

Electrical Cardioversion/Defibrillation: When medications do not work or the arrhythmia is dangerous, an electrical cardioversion shock is used to restore normal sinus rhythm immediately. The shock can be uncomfortable and the patient is usually sedated during the cardioversion. However, in true emergencies, such as when ventricular fibrillation causes sudden cardiac arrest, the patient usually has already lost consciousness. In this case, sedation is obviously not required. When cardioversion is used to terminate ventricular fibrillation, this is called defibrillation.

Ablation

Electrical impulses travel through the heart to make it pump. If impulses travel along abnormal pathways or circuits, the heart may beat too quickly and erratically. The catheter ablation procedure is a nonsurgical technique that destroys (ablates) abnormal electrical pathways that may be causing an abnormal rhythm. The arrhythmias that can be treated with catheter ablation are:

  • AV nodal reentrant tachycardia
  • Accessory pathway
  • Atrial tachycardia
  • Atrial flutter
  • Atrial fibrillation
  • Inappropriate sinus tachycardia
  • Ventricular tachycardia

Sedation and/or anesthesia will be given throughout the procedure. Catheters (long, flexible wires) are inserted into the veins of your leg and neck (and possibly into the arteries in the leg). These wires are threaded into the heart under X-ray guidance. They will sense electrical signals from different parts of the heart.

Your doctor will try to start your abnormal heart rhythm to find exactly where it comes from. Once this is done, a special catheter can be used to damage (ablate) the tissue that is causing the arrhythmia. In some cases, this results in lifetime cure, in others it significantly reduces the amount of arrhythmia the patient experiences.

Implantable Cardioverter Defibrillator

An implantable cardioverter defibillator (ICD) is a small device implanted under the skin. It’s designed to treat dangerously fast and potentially life-threatening arrhythmias. The ICD can treat these dangerous rhythms by delivering small electrical impulses or by delivering a shock. Often, patients with heart failure and a weak heart need an ICD to prevent sudden cardiac death. Today, all ICDs also have pacemaker capabilities. ICDs, like pacemakers, should be checked regularly after implant. This can be done in the office and on the phone.

Permanent Pacemaker

A pacemaker is a small device placed under the skin (usually near the collarbone). It’s designed to help prevent the heart from beating too slowly (bradycardia). The pacemaker monitors the heartbeat continuously and will speed up the heart rate by sending small electrical signals to the heart. After insertion, the pacemaker should be checked regularly. This can be done in the office or via the telephone. Your physician can arrange remote monitoring (telephone follow-up) of your pacemaker.

In addition, Aurora Health Care was the first health system in Wisconsin to implant an MRI safe pacemaker in a patient. A patient with an MRI compatible pacemaker may safely undergo MRI scans to help detect future health issues.

Cardiac Resynchronization Therapy

Patients who have heart failure and a weak heart often have damage to their electrical conduction system, which results in slower than usual activation of the ventricles (lower chambers of the heart). These delays, commonly known as bundle branch block (BBB), results in an unsynchronized activation of the ventricles making it inefficient and further reducing the strength of the heart contraction, which is already weak. Using pacing to activate the ventricles at the same time, known as cardiac resynchronization, improves the efficiency and strength of the heart contraction, thereby reducing heart failure and associated symptoms. This can even help the heart become stronger in the future.

Often there is an overlap in the type of patient who requires a defibrillator and the type who requires CRT. These capabilities can be combined into a single device (CRT-D). Alternatively, not all patients who need ICDs also require CRT, and some patients receiving a CRT device may not be candidates for ICDs.

New Cardiac Care Technology

Aurora Health Care is continually improving its quality care for heart patients. One of the ways we are progressing in the cardiac field is by staying at the forefront of burgeoning technologies. Our physicians are committed to learning and utilizing these advancements for better patient outcomes.

One of these advancements is CARTO 3 -- a 3D electroanatomical navigation system. It provides our physicians unparalleled views of the electrical activity of the heart through real-time data on 3D, color-coded cardiac maps. It also ensures precise real-time tracking of catheter location, allowing for safe and accurate diagnosis.

Designed to minimize unnecessary radiation exposure and procedure times, this new mapping system improves location accuracy and site-targeting results while maintaining an excellent safety profile.