Treatments

Arrhythmias

Arrhythmia Treatments

At the University of Maryland Maryland Heart Center we offer a wide range of treatment options for arrhythmias. The treatments depend on the type of arrhythmia, the symptoms that the patient experiences, and the risk of the arrhythmia to the patient's prognosis. These treatments may include alterations in life-style, medications, a catheter-based procedure to alter the electric properties of the heart (an ablation), a surgical treatment, or implantation of a pacemaker or defibrillator.

Some mild arrhythmias require no treatment. Other arrhythmias can be treated with medicines, or potentially cured with an ablation. If another health problem is causing the arrhythmia, treatment is aimed at taking care of that problem. In more serious cases, other treatments are available.

We are also conducting research on new and experimental treatment methods that may prove to be more effective than current options.

Non-Surgical/Interventional Treatments

  • Medications: We use a wide variety of medicines, including those that control heart rate and rhythm disturbances (anti-arrhythmia drugs). 
  • Ablation: This procedure uses energy to eliminate the tissue in the heart that is causing the arrhythmia. The abnormal electrical tissue is identified during an electrophysiology study -- a procedure that uses a catheter and a device for mapping the electrical pathways of the heart. In special cases, the heart can be reconstructed in 3 dimensions to allow for precise positioning of the catheters. Many arrhytmias can be eliminated using this treatment (see list below).

After receiving medicine to help relax, a catheter is inserted into a vein and guided to the patient's heart. Using high-frequency radio waves, or severe cold, doctors can destroy (ablate) the tissue causing the arrhythmia.

Arrhythmias Amenable to Catheter Ablation:

  • Ventricular tachycardia

  • AV nodal reentry

  • Wolff-Parkinson-White Syndrome

  • Atrial flutter

  • Atrial fibrillation

  • Paroxysmal supraventricular tachycardia

  • Atrial tachycardia

  • Inappropriate sinus tachycardia

  • Sinus node reentry

Implantation of Permanent Pacemaker or Internal Cardioverter Defibrillator: A permanent pacemaker is inserted to provide a reliable heartbeat when the heart's own rhythm is too slow. An internal cardioverter/defibrillator is inserted in patients who are at risk for life-threatening ventricular arrhythmias.

The procedure for implanting either pacemakers or defibrillators is very similar. It takes about two to three hours from start to finish.

First, a small incision is made in the chest below the clavicle and to access one of the larger veins, in the upper part of the body. Then, one or more wires are advanced into the heart. Once they are placed in appropriate places in the heart, they are connected to a generator and a pocket is made under the skin and the generator is placed there.

For either procedure (pacemaker or defibrillator implantation), the patient stays overnight in the hospital and can go home the next day. The patient can go back to full unrestricted activity within a month, and can resume full activity within a couple of days.

We also implant special pacemakers and defibrillators that are designed to help people who have congestive heart failure. These devices have a special wire that can pace the left ventricle which can improve cardiac function.

At the University of Maryland Heart Center, we follow defibrillators and pacemakers long term, and have extensive experience with these devices. Between pacemaker and defibrillator implantations, we perform between 250 and 300 procedures a year. We also take care of pacemaker and defibrillator complications that occur, even if you've had them implanted at another hospital.

As part of our commitment and desire to develop better treatments for our patients, our physicians are consistently conducting research. We have years of experience with defibrillator research, design and implantations, and are well known nationally for our defibrillation research.


Advanced Pacing Devices for Heart Failure: We are now treating patients who have significant heart failure with special pacemakers and defibrillators. We implant defibrillators and pacemakers that have the ability to pace the heart in special ways to help alleviate the heart failure symptoms (Bi-ventricular pacing).

Cardioversion for Atrial Fibrillation and Atrial Flutter: Cardioversion is the procedure of applying electrical shock to the chest to change an abnormal heartbeat into a normal one.

Surgical Treatment Options (the CryoMaze Procedure)

Currently, treatment of atrial fibrillation is aimed at preventing strokes and improving symptoms. The fast heart rates can be controlled with either medication or placement of a pacemaker after modification of the conduction system in the heart. In many patients, atrial fibrillation can be cured by electrically modifying specific areas of the heart with a catheter.

In rare cases where these therapies don't work and there are debilitating symptoms, the heart can be modified by a surgical procedure during which certain areas are frozen. This surgery, called the CryoMaze procedure, can restore a regular coordinated heartbeat, and can restore coordinated pumping from the upper chambers of the heart. Click here for more information about the CryoMaze procedure.

This page was last updated: August 26, 2014

         
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