Treatments & Devices
The underlying cause of an arrhythmia provides the basis for selecting the best treatment. Treatments fall into several main categories along a continuum from the least to most invasive. In general, the least invasive treatment that effectively controls the arrhythmia is the treatment of choice. Options include lifestyle changes, medication, devices, ablation procedures, and surgery, including the implantation of pacemakers and defibrillators.
Catheter Ablation for Atrial Fibrillation
Since other heart disorders increase the risk of developing arrhythmias, lifestyle changes often are recommended. In addition, improving health can lesson the symptoms of arrhythmias and other heart disorders as well as prove beneficial to overall patient health.
Medications can control abnormal heart rhythms or treat related conditions such as high blood pressure, coronary artery disease, heart failure and heart attack. Drugs also may be administered to reduce the risk of blood clots in patients with certain types of arrhythmias.
Learn more about medications that treat heart rhythm disorders.
Cardioversion is a brief procedure where an electrical shock is delivered to the heart to convert an abnormal heart rhythm back to a normal rhythm.
Catheter ablation is a procedure where one or more flexible, thin tubes (catheters) are guided via x-ray into the blood vessels and directed to the heart muscle. A burst of radiofrequency energy destroys very small areas of tissue that give rise to abnormal electrical signals.
Catheter Ablation for Atrial Fibrillation
The Arrhythmia Institute at The Valley Hospital participated in a live webcast of a catheter ablation, a new treatment for atrial fibrillation.
Catheter ablation of atrial fibrillation has been a focus of the Arrhythmia Institute for well over a decade. With the largest experience in the New York Metropolitan region, the physicians of the Arrhythmia Institute are considered experts in the interventional treatment of atrial fibrillation using catheter and ablation techniques. Each year, hundreds of patients undergo ablation by the Institute’s physicians and are treated comprehensively before, during and after the procedure. Approximately 95% of patients ultimately respond to the procedure, with the vast majority experiencing loss of all arrhythmic symptoms and the need for medical therapy. The Institute’s experience records only a very small complication rate, and serious complications no more than 1% of the time. Most patients undergo only a single procedure. The Institute has access to a variety of highly sophisticated interventional devices and energy delivery systems including radiofrequency, cryo, and laser energy; electroanatomic mapping systems; intracardiac ultrasound; remote magnetic navigation (Stereotaxis); cardiac CT scanning; and a variety of other sophisticated tools. Many of these tools have direct benefit to the patient, including reduced radiation exposure as well as enhanced procedural success.
Physicians of the Arrhythmia Institute are internationally recognized for their expertise in the ablation of atrial fibrillation. Dr. Steinberg is an editor of one of the premier medical textbooks on the technique of ablation in atrial fibrillation. Drs. Steinberg, Arshad and Sichrovsky have authored a chapter on atrial fibrillation in a recently published cardiology textbook. Drs. Steinberg and Mittal, as well as the entire membership of the Institute, are frequently asked to teach other physicians how to perform complex procedures like ablation of atrial fibrillation, and indeed are often the course directors of national programs. Members of the Institute have published numerous articles in the most prestigious cardiology and arrhythmia journals on their experiences with atrial fibrillation and ablation, and are regularly invited to write editorials, participate in or lead clinical trials, or contribute to medical education conferences. In the future, these clinical trials may definitively determine the value of ablation for patients with atrial fibrillation.
Catheter Ablation for Ventricular Tachycardia. The electrophysiology team at the The Valley Hospital is skilled in endocardial and epicardial approaches to catheter ablation of ventricular tachycardia
Although surgery is sometimes used to treat abnormal heart rhythms, it is more commonly elected to treat other cardiac problems, such as coronary artery disease and heart failure. Correcting these conditions may reduce the likelihood of arrhythmias.
The first step in treating any arrhythmia is determining the underlying cause of the problem. Then, patients and clinicians can discuss treatment options factoring in the circumstances of each individual case. The following are some of the considerations when determining appropriate treatment:
- The nature and severity of the heart rhythm disorder and its symptoms
- Underlying diseases and other conditions that contribute to the disorder or affect the patient's health or quality of life
- The patient's age, overall health and personal and family medical history
- Medications and other therapies that the patient may be using for other conditions
By delivering a controlled electric shock to the heart, defibrillators or cardioverters “shock” the heart back into a normal heart rhythm. Sometimes the devices are external, such as in an emergency situation. Often, the electronics are implanted in the patient’s chest.
- Implanted Cardioverter Defibrillators (ICDs). ICDs are 99 percent effective in stopping life-threatening arrhythmias and are the most successful therapy to treat ventricular fibrillation, the major cause of sudden cardiac death. ICDs continuously monitor the heart rhythm, automatically function as pacemakers for heart rates that are too slow, and deliver life-saving shocks if a dangerously fast heart rhythm is detected.
- Pacemakers. Devices that “pace” the heart rate when it is too slow (bradycardia) can take over for the heart’s natural pacemaker, the sinoatrial node, when it is functioning improperly. Pacemakers monitor and regulate the rhythm of the heart and transmit electrical impulses to stimulate the heart if it is beating too slowly.
- Cardiac Resynchronization Therapy (CRT) for Congestive Heart Failure Devices for Heart Failure The U.S. Food and Drug Administration (FDA) recently approved a special type of pacemaker for certain patients with heart failure. In Cardiac Resynchronization Therapy, an implanted device paces both the left and right ventricles (lower chambers) of the heart simultaneously. This resynchronizes muscle contractions and improves the efficiency of the weakened heart.
The Arrhythmia Institute of The Valley Hospital has become the first center in New York City to have the Spectranetics Laser Sheath” with the CVX-300 Excimer Laser for the removal of chronic pacemaker and defibrillator leads. This laser catheter, which obliterates the scar tissue binding these leads, represents a significant advance in lead removal technology making extraction procedures safer and easier to perform. This technology has become available to the Arrhythmia Institute through its participation in the Pacing Lead Explant with Excimer Sheath (PLEXES) Trial.
Cardiac Lead Removal
Over the past decade, there has been dramatic growth in the number of patients being implanted with a permanent pacemaker or cardioverter-defibrillator (ICD). Perceptions of lead reliability, performance, complications and approaches to management have also evolved dramatically since the inception of these devices.
A cardiac lead is a flexible wire, coated with insulation that connects a pacemaker or implantable cardioverter defibrillator (ICD) to the interior of the heart. Removal of the lead may be necessary under certain circumstances. Cardiac Lead Removal is often referred to as lead extraction.
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Source: © Heart Rhythm Society