Types of treatment

Catheter Ablation

Catheter ablation is a procedure that was first used in 1982 and can be used to treat most arrhythmias. The techniques, success rates and risks vary according to the type of arrhythmia. The common arrhythmias treated with catheter ablation are atrial flutter, supraventricular tachycardia and atrial fibrillation.

Atrial Flutter and Supraventricular Tachycardia

Using local anaesthetic and sedation, small tubes are inserted in the veins in the groin and fine wires are passed up to the heart
The abnormal area of the heart is mapped
The procedure then involves delivering a form of energy down the wire to the target area within the heart
Most commonly, the energy used is a heat source, such as radio-frequency energy, which is a type of diathermy
Other types may be used such as cryotherapy, which freezes the area
The area which needs treating is usually fairly small
Success rates are usually around 90% with complications being extremely rare
Most patients are treated as day-cases and can return to normal life within a few days

Atrial Fibrillation (AF)

Ablation for atrial fibrillation is a newer procedure that is rapidly growing with improving success rates
The procedure for AF is complex and usually involves electrical isolation of the four veins leading into the left atrium (one of the top chambers of the heart)
The procedure involves passing a pair of wires through a small hole in between the atria into the left atrium and burning or cauterising the area that appears to be the cause of the problem
It is a very successful procedure and can often provide a permanent cure for many patients
The procedure does carry the potential for risk, which may be serious in approximately 2% of patients
Risks include blood leaks around the heart, stroke, nerve damage and pulmonary vein damage

Pacemakers

A pacemaker monitors the heart's own impulses and, if there is a lack of any impulse, will pace the heart as required and according to the way the physician has programmed it
Pacemakers are commonly implanted to prevent the heart beating too slowly and are often implanted to treat patients with dizziness or blackouts
They can occasionally be used to treat fast heart rhythms
The pacemaker is placed in the chest near the collarbone and electrical leads are passed through veins in the chest to the heart
The leads then pass information from the heart to the pacemaker and if it is beating too slowly, the pacemaker will send out a tiny electrical impulse via the leads to speed up the heartbeat
Approximately 25,000 pacemakers are implanted in the UK every year

Implantable Cardioverter Defibrillator (ICD)

An ICD works in a similar way to a pacemaker for slow rhythms, but can also treat dangerously fast and potentially life threatening arrhythmias with either bursts of rapid pacing or small electrical shocks delivered to correct the abnormal heartbeat
Like the pacemaker, it is placed in the chest near the collarbone and the leads that feed back to the generator, monitor the heart's rhythm to detect and treat any dangerously fast heart rhythms (ventricular tachycardia or ventricular fibrillation)
On the basis of research studies, certain groups of patients have been shown to have prolonged survival with an ICD compared to drug treatment. This includes certain patients who have suffered a heart attack in the past leading to significant damage to the heart muscle function

Cardiac Resynchronisation Therapy (CRT)

CRT therapy treats heart failure that occurs when not all parts of the lower chambers of the heart (the ventricles) contract simultaneously, which leads to the heart not pumping efficiently
CRT involves implanting a special CRT pacemaker or defibrillator that has an extra lead overlaying the left ventricle to stimulate both ventricles and coordinate simultaneous contractions

Cardioversion

Cardioversion is a technique used to restore the normal heart rhythm. It can be used for any abnormal heart rhythm but it is particularly useful in treating the most common form of arrhythmia, atrial fibrillation
There are different types of cardioversion but the most common used is electrical cardioversion which is often referred to as 'DC' or direct-current cardioversion
Cardioversion can also be delivered via a wire passed through a vein to the heart whilst the patient is anaesthetised, although this is rarely needed
Sometimes, an alternative called 'chemical cardioversion' can be administered as medication via injection or by tablets

Drug Therapy

Drug treatment plays an important role in the treatment of arrhythmias and sometimes no other treatment is required
For patients with tachycardia (fast heart rate) drugs such as beta blockers, flecainide or calcium antagonists can be used to slow down the heart rate
Stronger drugs such as amiodarone can be used to prevent recurrences of arrhythmias but may cause side effects